Although my father did not discover penicillin, he helped do the research showing its effectiveness in curing infective endocarditis. As an internist, he then became enamored with the role antibiotics could play in treating infections. Growing up, my siblings and I can attest to his unbridled enthusiasm, as every time we contracted a cold, we would get a shot of the wonder mold in our butts. The fact that colds …
The unscientific lure of antibiotics
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old man is evaluated for a 2-month history of progressive lower-extremity edema, weight loss, and fatigue. Medical history is significant for recreational use of inhaled cocaine; he denies injection drug use. He has no other known medical issues and takes no medications.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure …
MKSAP: 28-year-old man with lower-extremity edema
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 35-year-old woman is evaluated for intermittent fever, sweats, fatigue, and dull midchest pain of 2 weeks’ duration. Medical history is significant for liver transplantation 6 months ago for primary biliary cirrhosis; she was seronegative for cytomegalovirus and Epstein-Barr virus, and her donor was positive for both. Results of pretransplant testing for tuberculosis …
MKSAP: 35-year-old woman is evaluated for intermittent fever
A recent article and accompanying commentary in the journal Pediatrics describe what we currently know about children who have died from influenza over the past decade or more. The Centers for Disease Control (CDC) has collected information about this since the 2003-2004 influenza season. In that first report, there were 153 deaths. Since then there have been at least 100 influenza deaths annually among children. Several characteristics have not changed. …
Influenza in children: reducing the death rate
While I was reading an issue of New England Journal of Medicine, I came across an interesting perspective article. Usually, I skip these articles and focus on clinical studies, images in medicine and review articles that usually have higher yield information that I can apply to help care for my patients. However, Dr. Jerry Avorn’s article, “The Psychology of Clinical Decision Making- Implications for Medication Use,” …
How behavioral finance can be used in medicine
Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside of the hospital or less than 48 hours after hospital admission. CAP is classified into typical and atypical subtypes, differentiated by their presentation and causative pathogens. This illustration focuses on the classic features of typical CAP.
The most common cause of typical CAP is Streptococcus pneumoniae. It is an encapsulated, gram-positive, …
Learn typical community acquired pneumonia with a Medcomic
I first experienced the impact of drug shortages in the U.S. in my first month of my residency training in emergency medicine. The most common drug used to sedate patients for intubation, etomidate, was on national shortage. I learned to use the second most common drug, Propofol, until it went on shortage too. We use it as the first line medication for sedation for painful procedures like re-aligning broken bones, …
The problem of drug shortages in the emergency department
A recent sports injury required me to have surgery. As a cardiothoracic surgeon, my experience as “the patient” reminded me of lessons-learned years ago on finding one’s purpose. You should never underestimate your capacity as a health care professional to dramatically impact the lives of your patients.
As a pre-med in college, I interviewed at Johns Hopkins Medical School under an early decision program. I was beyond excited. After my interview, …
How to find purpose in the age of burnout
For millennia, blood-letting was the standard of care for many diseases; today it is a joke, evoked only to mock our predecessors. But it is time to dismount our high horse and realize that there is at least one infection that we still primitively try to drain from the body, not from the bloodstream, but from the colon. This is our friend Clostridium difficile.
According to the CDC, there are about …
It’s time to treat C. diff diarrhea
There is peanut butter on the doorknob.
Coffee cup in one hand, I stumble after my 17 month-old who is chattering away Mogwai-style, and quickly wipe my other greasy hand on my pajama pants. I ensure that she is not about to ingest any number of the choking hazards my 4 year old has left splayed on our floor.
It is 6:45 am on a Saturday morning, and in about an hour I will rush off …
A typical day in this physician’s household
You’ve probably already seen the news: A 6 year old boy in Florida has died of rabies. He had handled a sick bat (some reports said he was trying to rescue the critter), and that was enough contact to transmit the virus. Once symptoms begin, rabies in almost always fatal — so the only way to prevent this from happening again is to avoid contact, and get rabies …
Your questions about rabies: answered
Talk of the widespread and dangerous flu circulating this year has the public on edge and hungry for quality information about how to protect themselves.
ABC’s Good Morning America isn’t helping with this segment featuring chief medical correspondent Jennifer Ashton, MD, titled “3 complementary natural remedies for the flu.”
It’s a mess of conflicting messages about herbal approaches to managing flu symptoms. And it positions Ashton — an ABC …
Complementary remedies for the flu: How Good Morning America failed
So you heard the flu shot is 10 percent effective.
With so many sources of information available, the primary care provider’s role increasingly becomes that of educator. It is important to me that the parents of my patients make informed decisions, so when I have a parent decline the influenza vaccine, I make an effort to ask why. The number one response I hear has been “What’s the point? The flu …
So the flu shot is only 10 percent effective. Here are 5 reasons to still get it.
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It started slowly. My former resident and present colleague, Terry Shaneyfelt first authored “Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature.”
This paper alerted us to the problem. But guideline fever continued to rage. Almost every specialty and subspecialty society decided that they needed to join the guideline movement. They needed to tell us the right way to practice medicine.
While …
A physician’s descent into guideline fatigue syndrome
Clostridium difficile is a gram-positive anaerobic bacillus which secretes toxins (A and B) that cause diarrhea and pseudomembranous colitis. C. difficile is the most common infectious cause of nosocomial diarrhea. Transmission of C. difficile can occur from contact with contaminated humans and fomites. The organism contains endospores that can survive the acidity of the stomach and reach the large intestine.
C. difficile colonizes the intestinal tract after the normal …
Learn about Clostridium difficile infection with a Medcomic
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated in follow-up after HIV testing. He states he has sex with other men and usually uses condoms. He had a negative HIV test result 1 year ago. He feels well today but reports having a flulike illness last week with mild fever, headache, myalgias, and fatigue; these symptoms have resolved. …
MKSAP: 25-year-old man is evaluated in follow-up after HIV testing
Until very recently, the pantheons of the world’s religions swelled with gods and divine beings to ward off calamities. And none loomed so large as smallpox. From the inky beginnings of civilization, the disfiguring disease slowly spread over the entire Eurasian continent and North Africa. In the last millennium, smallpox alone has caused 10 percent of all human deaths, including half a billion in the 20th century.
In China, the goddess …
Is smallpox set for a comeback?
Just under half of health care workers do not get their annual flu vaccine. Some of these workers contract the flu and unknowingly transfer it to their sick hospitalized patients, and in some cases, because of them passing the flu along, those patients die. We know the most important reason for health care workers to get vaccinated against influenza is that it is the most effective way of preventing influenza …
Medical workers: Vaccinate yourselves first
When a patient is diagnosed with a chronic disease, like diabetes or hypertension, physicians don’t merely suggest medications to lower blood sugar or blood pressure – they insist that patients take medications to protect their health. However, the recommendation to get an annual influenza (flu) shot to prevent flu is often not as emphatic. Research has shown that patients are much more likely to get a flu shot when it …
Make a difference by being a vaccine insister
Days are getting shorter and evenings are getting cooler in temperate regions in the Northern hemisphere. This also means that the flu season will be around the corner soon. Most people group influenza (flu) and cold together and refer to the “cold and flu season” as the time of the year when we expect to come down with a “flu bug” and consider it “normal” or customary. Some are even …
This is the deadly virus you need to look out for
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