A guest column by the American College of Physicians, exclusive to KevinMD.com.
In the run-up to the Academy Awards this year, like many people I made a concerted effort to see most of the top-nominated pictures. Of particular interest was Bohemian Rhapsody, the biographical film about the lead singer of the rock band Queen, Freddie …
How medicine rose up to the challenge of the AIDS epidemic
As I sit in the conference room awaiting one of my first interviews for residency, the angst among all the applicants was palpable. We all make awkward eye contact and conversation with each other as our interviewers pull us out of the room one by one to speak with us. Amongst the awkwardness and anxiety, my attention was directed at the applicant next to me when I heard the dreaded …
It’s time to wave goodbye to the handshake
In my clinical practice, I have encountered patient aggression typically with narcotic medications, in particular with the refusal of a refill due to evidence of concerning behavior, like a positive drug screen for drugs not prescribed. Aggressive behavior can include yelling, threatening physical violence or intimidation. I have had less trouble with narcotic-related aggression nowadays especially with media coverage of the dangers of narcotic abuse and especially since a lot …
Inappropriate antibiotics are the new drugs of abuse
Measles outbreaks across the United States have been identified with Texas being the 11th state so far to report an outbreak. The Philippines with over 2 million unvaccinated children has declared an outbreak of measles after nearly 2,000 cases and 26 deaths since January alone. In Madagascar, more than 50,000 people have been infected by the disease since October — more than the total number of …
Measles outbreaks: Getting to the root of the problem
If you think that you might have the flu, don’t head to the emergency room at the first sign of fever.
Emergency departments were created to handle emergencies – heart attacks, strokes, severe trauma, and other life-threatening emergencies. No matter how awful it feels, the flu typically doesn’t fall into this category – unless you are in a high-risk category for complications. This includes children younger than 2, adults over 65, …
For most, the flu is a misery, not an emergency
Part 3 of a series.
Patients with advanced cancer are particularly vulnerable to infection due to a compromised immune system. Moreover, the typical symptoms of serious infection, such as fever and chills, may be absent in cancer patients. If not identified and treated early, infection can lead to sepsis, a life-threatening reaction of the immune system that causes organ failure, shock, and death, as …
Why did it take over a week for doctors to initiate treatment?
“Cha-ching!” goes urgent care. For your rhinovirus, adenovirus, or seasonal allergies you get a strep screen, flu swab, CBC, and chest X-ray. You get a steroid shot, Rocephin, and Z-Pak. A week later, you present for medical care again, because your virus is no better, and you want a stronger antibiotic.
In the meantime, your body’s normal healthy bacterial flora has been altered and will take six weeks to six months …
The antibiotics arms race must end
Jim Henson, creator of the Muppets and Sesame Street, died at the age of 53. His diagnosis was toxic shock syndrome/streptococcus pneumonia — a deadly bacterial infection.
We were on vacation when we heard the news: The genius who opened the imaginations and hearts of our children … maybe you too … was gone. We were devastated and saddened that the magic Muppet man had died.
One year later, our ICU admitted …
Many Americans hold beliefs about the flu vaccine that are at odds with the best available scientific evidence. For example, a recent study found that more than two-fifths, or 43 percent, of Americans believe that the seasonal flu vaccine can give us the flu. Scientific research strongly suggests that this is not true. Because most modern flu shots do not contain a live virus, the shot itself simply cannot get …
Countering misinformation about flu vaccine: Why it’s so hard
It was another simmering-hot Texas day, and the AC was faltering in the family-practice clinic where I worked as a family nurse practitioner. Most of our clients were poor and spoke only Spanish.
My nurse, Eliza, approached, wide-eyed.
“There’s a new patient — a woman named Maraby. She seems really angry,” she murmured. “She’s the color of Dijon mustard, and she’s wearing a long, heavy wool cape. She looks like she’s nine …
A change in a patient changed us all
“Get rest and drink plenty of fluids,” might not sound like adequately aggressive medical advice. If you’ve dragged yourself out of bed to visit an urgent care or your doctor’s office, you will probably feel somewhat cheated by an admonition to head right back to bed and stay there until you feel better.
Most likely, you’ll want a prescription for an antibiotic. You might even demand it.
Don’t. Antibiotics are not the …
When the best prescription is no prescription
Imagine this scenario. Your two-year-old son has had a runny nose for a day or two and an occasional cough, but seemed no worse to you that everyone else in his preschool class. Two hours after you put him to bed you hear him coughing, only this cough is like none you have ever heard from him before. It sounds like a barking seal at the circus — a brassy, …
Everything you ever wanted to know about croup
I don’t mean to pick on McDonald’s. Insert any other large retail business where customer satisfaction massively trumps every other consideration of the relationship between employee and customer.
Telemedicine companies have exploded the past few years. I suspect a lot of my readers have already seen this, but just in case not, a recent study in JAMA Internal Medicine measured the correlation between customers with a cold who called …
Physicians are trapped between patient satisfaction and unnecessary prescribing
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I am bad at taking vacations — really bad.
It’s not that I don’t take days off or even travel on days off. It’s my near inability to actually unplug and not bring work with me. Despite recovering from a level of burnout a few years ago that left me considering quitting medicine altogether, I still struggle with this.
There is a never-ending to-do list related to work — both the items …
Be a master at your craft by taking time each day to truly rest
A true allergic reaction is one of the most terrifying events in medicine. A child or adult who is highly allergic to bee stings or peanuts, for instance, can die within minutes without a life-saving epinephrine injection.
But one of the most commonly reported allergies — to penicillin — often isn’t a true allergy at all. The urgent question that faces physicians every day in emergency rooms and operating rooms is …
Why it’s important to determine who’s truly penicillin-allergic
During my urgent care shifts, I see 20 to 30 people with viral upper respiratory infections. They are all feeling miserable, and they just want to feel better. They want an impressive-sounding diagnosis to justify their suffering to themselves, their spouses, and their bosses. They want a prescription medication which will immediately cure their illness, so they can get back to their lives. Their faces fall when they receive their …
Prescribing unnecessary antibiotics is the path of least resistance
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated for a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps, bloating, intermittent nausea, and mild anorexia that has resulted in the loss of 2.3 kg (5.0 lb). She has had no fever or blood in the stool. She works …
MKSAP: 30-year-old woman is evaluated for a 2-month history of diarrhea
Influenza is the leading cause of vaccine-preventable deaths in the United States. Influenza also tops the list of the burden of disease and disability-adjusted life years (DALYs) according to a Eurosurveillance article.
The flu is more likely to cause severe illness and harm pregnant women as compared to women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women (including …
Flu vaccination in pregnant women reduces risk of hospitalization
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 34-year-old man is evaluated for several slow-growing lesions on his penis. He first noticed the wart-like growths 3 years ago, and they have progressively enlarged. He was treated with topical cryotherapy six times and topical imiquimod over the past year without improvement; the lesions have continued to enlarge. Medical history is significant …
MKSAP: 34-year-old man with slow-growing lesions
Here are a few thoughts about the latest chapter in the never-ending debate about antibiotics vs. surgery for the treatment of uncomplicated appendicitis.
You will recall the randomized controlled trial from Finland published in 2015 that found a 27% rate of failure of antibiotics within the first year.
Now that the patients have now been followed for five years, 100 (39%) of the 246 patients treated with antibiotics have experienced persistent …
Antibiotics vs. surgery for appendicitis: What one surgeon thinks
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