How could a patient die from anesthesia for a colonoscopy?

Physician
February 4, 2021

Every death related to anesthesia is a tragedy; even more so when a minor procedure such as a colonoscopy leads to a completely unexpected death. Everyone knows that open heart surgery carries a mortality risk, but few of us walk into the hospital for a colonoscopy thinking that death is a plausible outcome.

We know so few facts at this point about what happened on January 21 at Beaumont Royal Oak …

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How could a patient die from anesthesia for a colonoscopy?

The healing power of art [PODCAST]

Podcast
June 16, 2020
YouTube video

“Each morning before the doctors came in for rounds; I’d paint feverishly whatever abstraction came to mind and what evolved from my situation. When I completed my pieces, I felt like I had not only gotten out my frustrations and worry, but also found a place of joy and gratitude. I would put each canvas outside my hospital room, and soon …

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The healing power of art [PODCAST]

3 enemas? For a man without a colon?

Conditions
June 5, 2020

“Three Fleet enemas?” I ask the nurse. She isn’t much interested in a conversation with me about anything. She is busy.

“This man, so far as I understand it, does not have a colon.”

It looks to me like they want to reconnect his colon,” she says as if I hadn’t said what I just said.

“I am not a doctor,” I remind her, “but I don’t see how that is possible. Too …

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3 enemas? For a man without a colon?

The opportunity cost of the liver organ shortage in the United States

Conditions
April 12, 2020

The first five liver transplant recipients were all dead within 23 days. The year was 1963, the surgeon was Dr. Thomas Starzl, and the operations were actually deemed a success for their surgical complexity. Since then, liver transplant (LT) has evolved from an experimental, often fatal procedure to the standard of care for end-stage liver disease (ESLD). Compared to the 0% 30-day survival rate of LT in 1963, the most …

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The opportunity cost of the liver organ shortage in the United States

When a mnemonic becomes dangerous

Conditions
April 9, 2020

Fat.

One tiny word. One voluptuous, full-figured concept.

Several weeks ago, amidst a conversation regarding the risk factors for cholelithiasis (i.e., gallstones) during a chief concern small group session for preclinical students, my preceptor ushered in an aurally convenient yet unsettling mnemonic utilizing alliteration that has apparently been in the works among medical education for a while now, known as “the 4 Fs”: female, fertile, forty, and … fat.

Yes, you read that …

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When a mnemonic becomes dangerous

The art of diagnosis is like a riddle

Physician
February 26, 2020

“I have a riddle,” Paul says, as the dining room falls silent.

“You’re at the bottom of the stairs. And on the wall, there are three light switches labeled one, two, and three. There’s a room upstairs with three lamps, labeled X, Y, and Z.

You can turn on and off as many switches as you want while you’re downstairs, but you can only go upstairs once. And once you’re upstairs, you …

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The art of diagnosis is like a riddle

MKSAP: 32-year-old woman with loose stools, bloating, and weight loss

Conditions
February 8, 2020

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old woman is evaluated for a 6-month history of loose stools, bloating, and a 3.2-kg (7-lb) weight loss. Her medical history is otherwise unremarkable. Her brother has type 1 diabetes mellitus, and her mother has autoimmune thyroid disease. She reports no other symptoms and takes no …

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MKSAP: 32-year-old woman with loose stools, bloating, and weight loss

The intern who knows everything

Conditions
January 3, 2020

What seems like a tidal wave of pages washes over you. Drowning in a torrential sea of order clarification, bowel regimens, and vital sign deviations — you struggle to stay afloat. Medical school did not prepare you for this. Patients and nurses are calling you, “doctor,” you wish to return to that minimal responsibility role as a medical student.

Welcome to your first on-call weekend.

These first few days, weeks, and months …

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The intern who knows everything

Debunking the myth that life gets easier once you finish medical training

Physician
November 11, 2019

Residents and fellows around the country have bought into the “medical training myth.” The myth states: “Life will get so much better when I finish residency/fellowship.”

Sadly, too many house staff buy into this false belief and experience tremendous letdown when they graduate.

Residents often see their attending stroll into the team room with a cup of coffee at 8 a.m., ready to round. Meanwhile, they think, “I’ve been …

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Debunking the myth that life gets easier once you finish medical training

Why diverticulitis can be an elusive diagnosis

Conditions
November 7, 2019

I have been treating diverticulitis for 30 years the same way. When I suspect that a patient has this diagnosis, I prescribe antibiotics. This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through.

It is an easy task to miss the diagnosis. Every physician has done this.

The diagnosis can be …

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Why diverticulitis can be an elusive diagnosis

Patients are used to seeing physicians who are not their doctors

Physician
October 27, 2019

Nowadays, patients are used to seeing physicians who are not their doctors. Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician. A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that: Your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely.

The medical universe …

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Patients are used to seeing physicians who are not their doctors

What role does the science of complexity play in medicine?

Conditions
August 27, 2019

The science of complexity lays a conceptual foundation for understanding “complex adaptive systems.” What all complex adaptive systems have in common is that they are all bound by the same set of physical laws. Their “behavior,” i.e., growth, maintenance, and death, can all be described using the same set of mathematical relationships. These systems (animals, plants, ecosystems, etc.) are the most productive and functionally effective systems known to man.

Unfortunately, our …

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What role does the science of complexity play in medicine?

Why doctors make bad patients

Physician
August 8, 2019

I’m a doctor. And, like most medical professionals, I’m a bad patient.

Two years after my last appointment, I got a CTJ, “Come to Jesus” from my doctor.

I called his office for a form. I needed proof that I don’t have tertiary syphilis. For my Thai visa.

Why tertiary syphilis, as opposed to HIV, cholera, lepers or bubonic plague? I don’t know. That’s the power of bureaucracies. They don’t have to make sense. …

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Why doctors make bad patients

MKSAP: 63-year-old woman after right hemicolectomy for colon cancer

Conditions
June 15, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 63-year-old woman is evaluated at a follow-up appointment after undergoing right hemicolectomy for colon cancer 1 year earlier. Her paternal grandfather had colon cancer diagnosed at age 75 years. She reports that she has been feeling well and takes no medication.

All physical examination findings, including vital signs, are …

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MKSAP: 63-year-old woman after right hemicolectomy for colon cancer

MKSAP: 48-year-old woman with elevated liver chemistry tests

Conditions
June 1, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 48-year-old woman is evaluated at a follow-up appointment for elevated liver chemistry tests over the preceding 6 months. She reports no symptoms. She has type 2 diabetes mellitus and hypertension. Her family history is unremarkable. She drinks two glasses of wine one or two times per month. Her …

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MKSAP: 48-year-old woman with elevated liver chemistry tests

Don’t forget this common trigger of cyclic vomiting syndrome

Conditions
May 21, 2019

There is a condition known as cyclic vomiting syndrome which causes people to develop episodes or “attacks” of frequent vomiting lasting for a few days at a time without an apparent cause. Sufferers of cyclic vomiting are totally fine between episodes … it’s kind of like a migraine of the upper gastrointestinal tract! Just like treating migraine headaches, treatment of cyclic vomiting syndrome is aimed at identifying and removing triggers, and using …

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Don’t forget this common trigger of cyclic vomiting syndrome

Private equity in gastroenterology: Is it the future?

Policy
May 18, 2019

An excerpt from Private Equity in Gastroenterology: Navigating the Next Wave.

A long time ago, gastroenterologists ran solo or small group practices. Despite the myriad challenges of running a medical business, doctors enjoyed the independence that private practices offered.

But over the years, everything got too complicated. From insurance reimbursements to …

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Private equity in gastroenterology: Is it the future?

Every doctor needs to monitor their online reviews

Physician
April 25, 2019

We’ve had several articles from various sources over the years on grooming your social media. Most of them advise paying attention to your physician ratings, but not acting on anything specifically. “Don’t engage” is the mantra. Let’s take a fresh look at this.

Like probably everyone in medicine, I have my share of physician rating site reviews. Most are good, some are bad, but all of them I pay attention to. …

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Every doctor needs to monitor their online reviews

MKSAP: 39-year-old woman with fatigue, intermittent rectal bleeding, and abdominal pain

Conditions
April 20, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or …

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MKSAP: 39-year-old woman with fatigue, intermittent rectal bleeding, and abdominal pain

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