We are assembling too many panels of people in the name of health these days. Too many.
They usually seem like a good idea. I’ve been supportive before. I assumed we needed them. More of them.
I might have been wrong.
There was a day when I believed my food would be toxic, my medicine harmful, and my safety gone without them. But, I’ve come to believe I was mistaken.
I was wrong because …
Health care has far too many medical panels
A recent publication in a fine peer-reviewed medical journal of the SPRINT study proved that lowering our blood pressure to the old target of 120/80 or less led to fewer heart attacks, strokes, and kidney failure. There was no question on what to do with younger people but to lower their blood pressure more aggressively to these levels. Debates arose in the medical community about the ability to lower it …
Blood pressure in the elderly: How low is too low?
The time has come. The time has come for patients to know how dangerous the state of health care has become and to finally do something about it. I’m ticked off. So ticked off that I’m writing this in between office patients, and I really try very hard to prevent my patients from waiting. Apparently insurance companies feel practicing medicine is as easy as checking off boxes, like hanging chads …
It’s time for doctors to tell insurance companies how they really feel
Most primary care physicians (PCPs) who admit patients to a hospital are family practitioners or internists. Since medicine becomes more complex each day, PCPs must remain up-to-date on the latest treatment related to drugs, surgery, procedures, risks, complications, and costs. This might require your PCP to be a quarterback bringing together a team of consulting specialists to guide you through your hospital stay.
The economics of hospitalization are changing, and since …
If you are admitted to the hospital, will a specialist see you?
I’m pulling on my last elbow’s displaced wrist when a nurse pops in, and tells us a critical patient is two minutes away.
“Mind staying?” my colleague asks.
“Sure.”
Paramedics are hunched over the patient as she is wheeled quickly into the resuscitation bay. At the top of the bed, a mask is secured over her mouth and oxygen is pumped with loosely gloved hands. It isn’t helping — her skin is grey — like …
Paramedics saved this woman’s life. They are the true heroes.
Since beginning my medical education, I had been on one side of the curtain; the side where the doctors confer and discuss before telling the patient his or her fate, going from room to room giving updates and prognoses. I interacted with patients for the purpose of getting their histories and physical examinations, collecting all the data so that I could present the case to my attending. I was engrossed …
I will make a concerted effort every day to do my job with love
I very distinctly remember March 16, 2015. I was the chief surgical resident on call for trauma at my busy urban training program. Like any other springtime trauma call I was steadily busy, running back and forth from penetrating and blunt trauma victims in the trauma bay to inpatients, OR cases, and attending rounds. The characteristically hectic flow of the day was interrupted when I got a call from my …
Here are the lessons I learned from caring for my ailing father
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 58-year-old man is evaluated during a routine appointment and asks for advice on cardiac risk assessment. He does not have any current cardiac symptoms, exercises 4 days per week, and has never smoked. He has no chronic health issues and takes no medications. He has no known drug allergies. Results of the physical examination …
MKSAP: 58-year-old man asks for advice on cardiac risk assessment
Aggressive control of blood pressure has saved millions of lives and has prevented millions of people from experiencing heart attacks, strokes, and kidney failure, among other things. Admittedly, controlling blood pressure is not the sexy part of medical care, but when primary care doctors like me help people get their blood pressure under control, we do just as much good as any of our colleagues who practice as cardiovascular surgeons. …
Aggressive blood pressure control: Too much of a good thing?
Monday morning. As I click through the usual beginning of the week barrage, I open an email from my ER chief. My heart drops into my stomach, where it begins to race. He’s forwarded a letter of concern from a specialist from a different hospital. It’s about a patient that I failed to help, and failed to diagnose, so she had to seek help elsewhere. As I read the details, I remember the case. I pick …
Respect your nurse. Your life may depend on it.
This post is purposely controversial. I write it because I believe that mounting evidence suggests that we should encourage “out of the box” thinking about this issue. This post is hypothesis challenging. I may be right, or I may be wrong. I hope we get some debate on my speculations.
The latest blow to the cholesterol hypothesis: “Dashing Hopes, Study Shows a Cholesterol Drug Had No Effect on Heart …
Should cardiologists evaluate their obsession with LDLs and HDLs?
Of life’s two certainties, death, and cataracts, it seems statins defer one and prompt the other, although not necessarily in the same person. If you blindly love life, you may be blinded by your love for life.
In the HOPE-3 trial, ethnically diverse people without cardiovascular disease were randomized to 10 mg of rosuvastatin daily and placebo. The treatment group had fewer primary events: death from myocardial infarction (MI), non-fatal …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 49-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his risk for cardiovascular disease. Medical history is notable for hypertension. He is a nonsmoker, and he works as an executive at a highly successful company. Family history is noncontributory. His only medication is hydrochlorothiazide.
On physical examination, the patient …
MKSAP: 49-year-old man is evaluated during a routine examination
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Every fall, medical schools welcome nearly 20,000 college graduates. They arrive anticipating endless hours of lectures, too much coffee, and infinite facts to memorize. There is one thing they do not expect, however. I know. Forty-nine years ago, I was one of them.
The first day I walked onto the wards was in spring of 1967. I was in St. Louis, doing my second year of medical school. Previously my presence …
A routine heart exam. An unexpected problem.
I was spending time with friends and family over the holiday when I started to experience various vague symptoms without an obvious etiology. Having been treated for high blood pressure about ten years prior before successfully overcoming the issue with exercise, I immediately recognized the return of the condition. (As an aside, it should be stated that elevated blood pressure typically produces no symptoms at all.)
Stopping by my local pharmacy, …
A doctor who forgot the basics they teach you in medical school
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 42-year-old woman is evaluated for episodes of palpitations that last several seconds in duration. They occur once or twice a month and are accompanied by lightheadedness and mild dyspnea. She has not experienced loss of consciousness. The episodes are not precipitated by any particular activity, including exercise. She takes no medications.
On physical examination, the …
MKSAP: 42-year-old woman with palpitations
February is American Heart Month, and the Go Red For Women campaign reminds us to bring awareness to cardiovascular disease in women all month long. Today in the U.S., nearly 44 million women are living with heart disease. Even though heart disease is quite prevalent in women, only 1 in 5 women are aware that they are at risk for developing a cardiovascular problem in their lifetime.
Cardiovascular disease is the #1 …
4 questions every woman should ask about heart disease
With the Supreme Court in the balance, every aspect of the unexpected demise of U.S. Supreme Court Justice Antonin Scalia has received intense scrutiny, from the cause of his recent death to the politically charged choice of his successor. An autopsy was not performed on the 79-year-old jurist, who was found dead in his room in a West Texas hunting resort, and that too has become a lightning rod for …
Justice Scalia: Why didn’t they perform an autopsy?
I was a bit nervous as I had never done this before. I wasn’t even sure what I was going to do once I saw him. The only certainty in my mind at that time was that this was not the Norman Rockwell image of the physician-patient encounter that I proudly displayed in my office. He was my age, 40 years old, living on Nantucket with his wife and two …
How my cardiology practice changed with a click
When I started my first internship, back in Sweden in 1979, I worked under a fifty-something cardiologist who spoke slowly with a southern drawl — yes, there is a southern drawl there, too, slightly reminiscent of Danish, spoken not far from where my supervisor grew up.
He epitomized the old school of cardiology, before it became a procedural specialty. He diagnosed heart murmurs by auscultation with his stethoscope, and he even …
Will cardiologists become slow and methodical internists again?
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