A guest column by the American College of Physicians, exclusive to KevinMD.com.
A couple of months ago I received a Facebook invitation to “like” a page. That was not unusual, and usually the pages are on silly or obscure topics, but this page was different. The name of the page was New Kidney for Stu.
A doctor turns to social media for organ donation
If you want to understand what ails the U.S. health care system, look no farther than the dialysis industry. A recent New York Times article, “UnitedHealthcare Sues Dialysis Chain Over Billing,” provides a pre-made case study.
In brief, a chain of dialysis clinics, American Renal Associates, pushed poor people out of government coverage and into private insurance with UnitedHealthcare so that the clinics could bill $4,000 per treatment rather than $200. A …
The dialysis industry is a microcosm of what ails the health care system
Around 30 years ago, LRZ taught me a most important lesson. LRZ, one of my most fondly remembered patients, was a classic blue collar guy. He had a wonderful, gregarious personality. He had significant systolic dysfunction, yet still worked hard for the city. Amongst other things he did, he shoveled the salt into trucks on snow and ice days. He functioned well most days.
One day he came to see me. …
The importance of listening to the patient before we develop our plans
The most valuable assignment I received in fellowship was to write a few textbook chapters. I wrote on sodium, calcium, potassium, phosphorus, and magnesium for three different chapters. I had already developed deep knowledge of electrolytes writing “The Fluid and Electrolyte Companion,” but writing these chapters forced me to look beyond how things work and dive into how we know how things …
The NIH meets Kickstarter: DreamRCT is back for 2015
Yesterday my friend Sophie asked me to accompany her to a Miami hospital intensive care unit to see her older brother, Guillermo. He’d been admitted the previous night with seizures and cardiac arrhythmia.
Joined by my husband, we made our way to the ICU. When she saw Guillermo lying immobile, swollen and unresponsive, with a breathing tube in his mouth and other tubes snaking into his chest from IV poles, Sophie …
Finding compassion for the choice a patient made
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 53-year-old woman is evaluated for a 3-month history of swelling of the face, hands, and feet. She has untreated hepatitis C virus infection. She takes lithium for bipolar disorder. She has no additional symptoms.
On physical examination, temperature is normal, blood pressure is 134/93 mm Hg, pulse rate is 71/min, and respiration …
MKSAP: 53-year-old woman with swelling of the face, hands, and feet
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old man is evaluated as a new patient. He was diagnosed with type 2 diabetes mellitus during a health insurance evaluation 6 months ago. At that time, metformin was initiated. Medical history is otherwise unremarkable.
On physical examination, blood pressure is 145/94 mm Hg; other vital signs are normal. BMI is 29. …
MKSAP: 60-year-old man with type 2 diabetes mellitus
One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients.
I began to understand this paradox clearly when I listened to my friend’s anguish.
She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town …
Medicare’s perverse incentive to keep patients on dialysis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 48-year-old man is evaluated during a follow-up visit for urinary frequency. He reports no hesitancy, urgency, dysuria, or change in urine color. He has not experienced fevers, chills, sweats, nausea, vomiting, diarrhea, or other gastrointestinal symptoms. He feels thirsty very often; drinking water and using lemon drops seem to help. He …
MKSAP: 48-year-old man with urinary frequency
We tell ourselves many things about our health each day, every day, all day long. The vast majority are unintentional, uninspired and blunt. A particularly sinful dessert brings admonishment, “You should not have eaten that.” Panting after two flights of stairs call for an exasperated, “I am out of shape!” Receiving a diagnosis prompts mental overdrive of “What if I don’t survive this?” thoughts.
Learning my diagnosis of chronic kidney disease …
5 messages you should say about your health
I wish I could share the photo of my 4mm boomerang shaped kidney stone. I labored for 2 months, back in early 2009 to pass it, the second stone in 5 years.
During my ordeal with these stones, I had the following health care encounters, tests, medicines, lab and imaging tests.
The high cost of kidney stones
Given all the complaining I and my colleagues do about the problems with the EMR, I figured I’d take the opportunity to tell you about something good that came from having my practice online.
A patient came to see me last week for a check up and requested a prescription for birth control pills. She’d used them in the past without problems. I wrote the script and sent her on her …
One example where the EMR can really make a difference in outcomes
The field of nephrology is in a workforce crisis. We as a subspecialty have witnessed a steady decline in the number of applicants perusing nephrology fellowship over the last several years. In fact, fewer than 100 US medical school applicants participated in the 2014 nephrology fellowship match. This is a sobering statistic as 403 nephrology slots were available in this year’s …
NephMadness 2014: Let’s reinvigorate nephrology
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old woman is evaluated during a routine follow-up visit. She was recently diagnosed with type 2 diabetes mellitus and hyperlipidemia. She feels well. Medications are metformin, atorvastatin, and aspirin.
Physical examination findings and vital signs are normal. BMI is 27.
Laboratory studies reveal a serum creatinine level of 0.9 mg/dL (79.6 µmol/L), an …
MKSAP: 59-year-old woman with type 2 diabetes mellitus and hyperlipidemia
I have been doing admitting shifts at a large hospital, as hospitalist. It is flu season, so volumes are large. Even people without the flu are sick. It often happens that way. And they are so very sick!
The thing about the very sick patients I see is that they are generally what might be called medical “train wrecks.” They are very sick because they have had interventions over the years …
The wisdom of Dr. Bernard Lown and sick patients with chronic diseases
This post is a question, an invitation and a challenge. How can we bring technologies we take for granted back home to those in the developing world? Many before me have spoken with outrage about the reality of two worlds: one of abundance, and the other where people live like they have in centuries past.
The situation is more complicated since even poor people may have some technologies like cellphones now, but vital lifesaving technologies …
Bringing health care technology to the developing world
Much has been made about the steady decrease in the number of U.S. medical school graduates choosing to pursue nephrology as a career. Even among nephrologists, both those in private practice as well as academia, there has been substantial hand-wringing on this issue.
My more pessimistic colleagues see a subspecialty in decline, which they attribute to a myriad of factors. These include the encroachment on our “turf” by other sub-specialists (intensivists …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old woman is evaluated for a 2-month history of fatigue, anorexia, and a 6-kg (13.2-lb) weight loss. She was treated with chemotherapy for ovarian cancer 6 months ago. She also has hypertension managed with hydrochlorothiazide.
On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is 132/75 mm Hg without postural …
MKSAP: 74-year-old woman with fatigue, anorexia, and weight loss
The very idea of living individuals selling body parts prompts revulsion in some people, while others may ask whether the price is right.
A recent nbcnews.com article reported on an organ-transplant study conducted by Canadian researchers. It began with this finding: “Paying living kidney donors $10,000 to give up their organs would save money over the current system based solely on altruism—even if it only boosts donations by a conservative 5 percent.”
Actually, the …
The ethics of paying living kidney donors
Yesterday, I went with my friend to meet his new nephrologist and receive an unwanted diagnosis. I went with my friend because I have a unique skill set at meeting new doctors and healthcare providers and dealing with unfamiliar health situations. I know this routine.
I know after awhile any diagnosis at all, no matter how awful or serious, becomes a rhythm. I’ve done this as a patient and I’ve done it …
How to meet your doctor and receive your diagnosis in a better way
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