Cardiologists, other physicians, and patients writing on KevinMD about heart disease: statins and the cholesterol guidelines argued since 2013, blood pressure thresholds, stroke and the clock, cardiac arrest and what CPR can and cannot do, stents and atrial fibrillation, heart failure drugs that go unprescribed, prevention from salt to calcium scores, and a specialty that became procedural because procedures were paid. One maintained record draws on this archive: Heart disease: what physicians say, in their own words.
I missed a drug interaction warning the other day when I prescribed a sulfa antibiotic to Barton, a COPD patient who is also taking dofetilide, an uncommon antiarrhythmic.
The pharmacy called me to question the prescription, and I quickly changed it to a cephalosporin.
The big red warning had popped up on my computer screen, but I x-ed it away with my right thumb on the trackball without reading the warning. Quite …
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Alarm fatigue is problem. Here’s a pragmatic solution.
In Houston, all of my colleague’s offices are closed, and there is limited access to the Texas Medical Center due to Hurricane Harvey. As a virtual medical doctor, there was only one thought on my mind this entire weekend, “How can I help?”
As a Floridian, I have certainly faced my share of natural disasters beginning with Hurricane Andrew, a category 5 hurricane in 1992. Living through Hurricane Andrew gave me …
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5 ways virtual doctors can help during a natural disaster
I was browsing the latest issue of the Journal of the American Medical Association, as I often do, and an article by one Andy Slavitt, MBA, and Gail Wilensky, PhD, titled “Reforming Medicaid,” caught my eye. From 2015 to 2017, Mr. Slavitt served as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). In that role, he oversaw the government’s awful Meaningful Use EHR program, and helped …
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Administrators who don’t see patients often make the most important decisions
“F*ck!”
I pried my eyes open and had the realization of exactly what time it was. I was going to be late — again. I jumped out of bed as fast as my stiff and weary body would allow, threw scrubs on I was mostly sure were clean, ran a brush through my hair so I didn’t look totally disheveled when I had to look like professional in a few minutes …
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A surgeon makes a mistake, and couldn’t stop crying
We sat in the office of the intensive care unit under fluorescent lights, both staring at computer screens covered in vital signs and labs. It was the summer of my second year of residency, and I spent it entirely in the intensive care unit. There were two of us on call at night. Half the nights we would spend shooting the shit about life, and the other half we spent …
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Physicians put up walls. But they feel everything.
“He is the best physician who is the most ingenious inspirer of hope.”
– Samuel Taylor Coleridge
I was a third-year medical student on a Sunday morning when the reality of what I had chosen as my life career truly hit me in the gut. At that moment, I realized how intimate the practice of medicine was and that I would have to bring not only my brain and skills to work …
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Doctors: Don’t emotionally detach
This is the patient’s eight admission over the course of two weeks. The patient is a heroin abuser and has bacteremia and endocarditis. Their heart valve is failing and they are in and out of congestive heart failure. Every day, dozens of medical professionals converge on the patient to give treatment and advice. And every day after hearing that advice, the patient leaves the hospital against medical advice and goes …
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7 ways to combat compassion fatigue
Today, I hugged a stranger.
And I didn’t know his name.
We had just operated on a young man, probably in his late teens. He sustained multiple gunshot wounds to the chest and abdomen, and was in critical condition. When he lost pulses in the trauma bay, we cut his chest open and spread his ribs. His lifeless body laid there as we held his heart in the palm of our …
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Today, I hugged a stranger
A patient of mine recently came to see me in a follow-up appointment after an emergency department visit. He had been working out at the gym, on a hot day, after he had skipped breakfast, and after his usual routine he felt extremely lightheaded. Everyone told him he looked “white as a sheet”, and a physician who was at the gym told him he must go to the emergency department.
In …
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How to game medical coding isn’t why I became a doctor
“Can you hear it?” she asked with a smile. The thin, pleasant lady seemed as struck by her murmur as I was. She was calm, perhaps amused by the clumsy second-year medical student listening to her heart.
“Yes, yes I can,” I replied, barely concealing my excitement. We had just learned about the heart sounds in class. This was my first time hearing anything abnormal on a patient, though it was …
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Sometimes high-tech care can be high value
I feel privileged to be practicing medicine. Many people consider doctor careers and imagine how great it may be. Is it the right thing for you? Yes there are days of frustration, exhaustion, and utter defeat, but at the end of the day I home and know that I helped at least one person if not two from the 16 I meet.
The fact that I alleviated one individual’s anxiety or …
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10 reasons why being a doctor is a privilege
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old woman is evaluated for a 3-week history of substernal chest pain. The pain is dull, nonradiating, and unrelated to activities. Sometimes the pain is worse after eating spicy foods and can be occasionally triggered by emotional stress. She has not had shortness of breath or weakness. She is moderately active, …
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MKSAP: 60-year-old woman with substernal chest pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old pregnant woman is evaluated for a cardiac murmur identified on examination by her obstetrician. She is asymptomatic. She is in her 24th week of pregnancy. Medical history is unremarkable, and there is no family history of heart disease. She takes prenatal vitamins and no other medications.
On physical examination, she is …
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MKSAP: 28-year-old pregnant woman with a cardiac murmur
“Annie, Annie, are you OK?”
Many of us learned to resuscitate a person who has collapsed using Annie, the mannequin based on a death mask of a young woman who had drowned in the Seine in Paris in the 19th century. Bystander cardiopulmonary resuscitation (CPR) has become increasingly accepted and expected as the years have passed, and we have even begun to make affordable machines to deliver a life-saving shock (defibrillation) …
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Bystander CPR makes a difference
As we enter into the hospital each day, our goal is giving patients the best care we can provide. We get a list of patients that we will take care of each day, and as we get that list, we start thinking about what we should monitor in terms of their physical exam, lab results, and vital signs to ensure that their hospital course runs smoothly for the day. However, …
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Being superhuman in the most human circumstance
When you go to the internet or phone book today, there are hundreds of physicians listed in most urban areas. In the next two decades, you can expect more difficulty finding a physician in your hometown — a major physician shortage is looming.
In the last year, I have noted many mid-career physicians are leaving the practice of medicine. While the growth of mid-level hospital administrators has ballooned at nearly 3,000 …
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Note to Congress: It’s your fault there’s a physician shortage
Decisions regarding medical care are often not very straightforward due to the uncertainties, risks, and limited options involved. But, above and beyond the actual choices to be considered, the process of how the choices are made has become a red-hot topic. And the value of the patient — as opposed to the doctor — as the driver of medical decision is, quite curiously, just beginning to be recognized in a …
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Shared medical decision making is a not a new concept
Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their personal role in the genesis of this problem. Our words matter. They can reverse the good we do with our medications and procedures.
If you are a heart …
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Watch what you say to patients
