Earnest Tipp was very overdue for his blood pressure follow-up. Almost a year and a half overdue, as a matter of fact. The last few times I had refilled his medications, I had added “needs follow-up” to the signum on his scripts.
The other day I finally saw him in my schedule. I thought about him all morning. A tall, muscular 90-year …
Stay away from doctors: From a patient who listens
As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies.
As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is …
The day that I truly became a cardiology fellow
After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient’s estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline’s new risk calculator had not been validated in …
Are cardiac risk calculators accurate?
The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins.
One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication …
We are overprescribing statin medications for high cholesterol. Here’s why.
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Before undergoing surgery, you should carefully discuss your medications with your surgeon and physician anesthesiologist. You may fare better during the operation and the early recovery phase if you continue required medications, but you might need to avoid some medications that could interfere with your anesthesia. Three …
Having surgery? Here’s how to manage your medications.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman comes for a preconception evaluation. She has a history of hypertension that is well controlled with lisinopril. Medical history is otherwise unremarkable.
On physical examination, blood pressure is 134/86 mm Hg in both upper extremities; other vital signs are normal. Results of the cardiovascular examination are unremarkable. There is no …
MKSAP: 25-year-old woman comes for a preconception evaluation
I can recall, though it seems quite long ago, my first basic life support (BLS) course as a first-year medical student. The instructor dutifully demonstrated on a mannequin to eager young medical students what to do if someone is found unresponsive. Shaking the unmoving mannequin she said loudly, “Sir, are you OK?” Then hearing no response she showed us how to …
Should ACLS certification be mandatory?
An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation …
Why does treating heart attacks cost so much money?
Standing in front of my patient’s home, I reach out to ring the bell. On the other side of the door live a man and his wife, who have been waiting patiently for my arrival. I hesitate for a moment before pressing the button.
As I wait uneasily for the door to open, I think to myself that this is the first time I make a house call on my patient …
The last house call: Turning off the defibrillator
“He’d feel okay about not replacing the pacemaker’s battery when it ran down, he said. But turning it off, he said, would be ‘too active.’ Later he would tell me that it would have been “like putting a pillow over your father’s head.”
These are the words of Katy Butler in her book Knocking on Heaven’s Door – The Path to a Better Way of Death in which she writes about her …
Deactivating a pacemaker: Is it euthanasia?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 21-year-old man is evaluated during a medical examination for health insurance. The patient is a weight lifter. He has no medical problems and takes no medications or illicit drugs.
On physical examination, blood pressure is 128/73 mm Hg, pulse rate is 56/min, and respiration rate is 16/min; BMI is 30. Increased skeletal …
MKSAP: 21-year-old man with a heart murmur
“Daddy, I think we have a flat tire.”
I just rolled out of the garage with my 4th grade daughter. It was Tuesday morning. Usual daily routine. Drop her off at school then go to work. A little different today as I was to lead an important meeting.
How could she possibly know what a flat tire sounds like? Now? Right now? She’s …
Chest pain and what we can learn from changing flat tires
Knowing what to do when faced with a sick patient is relatively straightforward. We learned a lot of it in medical school, picked more up by experience, and usually have the opportunity to look things up quickly on the Internet. Even when faced with a brand new situation, we can usually fall back on our general knowledge of science and medicine.
But in today’s practice of medicine, that’s not enough. Physicians, …
Welcome to the world of metamedicine
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman is assessed for a 6-month history of progressive exertional leg discomfort, described as a “heaviness” involving both calves. The symptoms are relieved within 5 to 10 minutes of rest. She has noted the same limiting heaviness with bicycling. Medical history is significant for hypertension, type 2 diabetes mellitus, and …
MKSAP: 68-year-old woman with exertional leg discomfort
A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia.
This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined …
Why are doctors still prescribing Zetia?
Taking call is the worst thing about being a doctor. There, I said it. But wait! What about medical malpractice lawsuits? What about dealing with patients’ suffering or dying either from their illness, or far worse, relating to decisions you made or procedures your performed? Certainly these are far worse events than being on call.
Granted. However, these awful events are part of …
Should doctors be paid overtime for taking call?
“I don’t like taking medicines.”
All physicians hear some form of this opinion very frequently. Even more frequently, patients don’t state this view outright but rely on it to completely subvert their doctor’s plans.
When I was new to practice such an utterance would shock and confuse me.
“I don’t want to take any medicines,” a patient would declare.
“That’s fine,” I would reassure my interlocutor. “It’s a free country. No one is going …
The problem with an anti-medication bias
When I first learned to take care of patients in the hospital, as a third-year medical student, we used a mnemonic to help us remember what to order when a patient was first admitted. Patients would come in to the hospital from a doctor’s office or from the emergency room and the nurses needed a set of orders to know what to do for the patient. The mnemonic we used …
A requiem for handwritten admitting orders
Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn’t help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by …
The health care industrial complex is stronger than ever
It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications.
“It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer.
There are …
How do we fix the high blood pressure problem?
Get free updates delivered free to your inbox.
