“Wow, cool case,” was the response from the residents in continuity clinic on Monday morning as I told them about a patient I had seen over the weekend at our main campus urgent care. Ironically, or maybe more tellingly, I thought the same thing; “that was a cool case.”
The “cool case” was a senior in high school who was eagerly looking forward to her college career but woke up with …
The patients behind the cool cases
When President Trump slurred his words during a news conference this week, some Trump watchers speculated that he was having a stroke. I watched the clip and, as a physician who specializes in brain function and disability, I don’t think a stroke was behind the slurred words. But having evaluated the chief executive’s remarkable behavior through my …
Should President Trump be tested for degenerative brain disease?
Concussions and football have come up before, and the news so far has been discouraging. We want kids to stay active, and football is one of the most popular boys’ sports out there. But we know that some prominent professional athletes have had serious, cumulative brain damage from years of football – sometimes brain damage that has destroyed their lives. What about high school football, or football …
Youth football and concussions: some good news?
Humans evolved with the constant force of the earth’s gravity. This is relevant to several of our organs, but the brain’s anatomy makes it especially important. The brain floats in spinal fluid encased inside the closed box of the skull. Gravity would be expected to affect the details of that. Indeed, studies of people who spent prolonged periods of time in bed in a head down position indicate this abnormal …
What happens to our brains in space?
The presidential symposium at this year’s Annual Meeting of the Child Neurology Society of America in early October in Kansas City raised many eyebrows. The first presentation of this symposium focused on burnout rates among neurologists around the country.
Many of my colleagues felt that this was an inappropriate choice, especially with so many trainees and young child neurologists in the audience. Typically, the presidential symposium at a conference of such …
How burnout is plaguing doctors and harming patients
Recently, I was challenged by the mother of a trauma patient. She had read about traumatic spleen injuries online and was concerned about the risk a hematoma presented and wanted the ultrasound to look at the hematoma. I found myself floundering around trying to explain how this study was unnecessary. In frustration, I turned to my nurse practitioner and said, “Heather, can you translate for me?”
This is a common problem. …
Maybe the reason patients don’t understand us is because we don’t speak in plain English
Part of a series.
Cognitive decline is a normal process of aging; Alzheimer’s is a disease.
Cognitive decline due to aging can be slowed but not halted with appropriate lifestyle approaches. The “big four” are equally important to slow cognitive decline: Don’t smoke. Reduce stress. Exercise often. And eat a quality diet in moderation.
Good sleep and brain stimulation need to be added for maintaining good cognition. Some form of …
Want to slow cognitive decline? Here’s how.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is seen for follow-up evaluation of Parkinson disease, which was diagnosed 10 years ago. Although his symptoms initially were well controlled with medications, he has experienced increasing fluctuations in motor symptoms, specifically tremor at rest and slowness, within the past 3 years. Medications are carbidopa-levodopa, entacapone, and amantadine. He …
MKSAP: 68-year-old man with Parkinson disease
Two months into my pediatric residency, while working on an overnight call, I encountered my first medical mistake. We, fortunately, had had a very good night, and all patients had remained stable. It was an hour before sign-out to the morning team, that I received a page. I quickly held my pager and dialed the 4-digit number, only to find a busy dial tone. I was a little surprised and …
A safe space is needed to talk about medical errors
I am not a doctor. (Yet.) I am a novice third-year medical student, somewhat able to perform and document a physical exam on a sleeping child, to dial the correct number to call a consult and to make wild guesses about chest X-rays (“I see a consolidation?”). I write about medicine not from a position of experience, but of malleability. I want to become like the best doctors I see.
Towards …
I vow not to call my patients “difficult.” Here’s why.
For American conservatives, Britain’s NHS is an antiquated Orwellian dystopia. For Brits, even those who don’t love the NHS, American conservatives are better suited to spaghetti westerns, such as Fistful of Dollars, than reality.
The twain are unlikely to meet after the recent press surrounding Charlie Gard, the infant, now deceased, with a rare, fatal mitochondrial disorder in which mitochondrial DNA is depleted — mitochondrial depletion disorder (MDD). In this condition, …
Did doctors know best in the Charlie Gard case?
Part of a series.
Can we slow the aging process? The answer is a definite yes. It’s not easy and requires some real diligence, but aging can be slowed.
When thinking about a car we all know “old parts were out.” It is equally true for the human body. But less appreciated is the fact that we can either slow or speed up the process, just as good preventive …
Can we slow the aging process?
A study published in JAMA looking at the brains of former football players donated to a brain bank, a highly selective sample, found signs of chronic traumatic encephalopathy (CTE) — a degenerative neurological disease — in nearly all deceased players examined.
The mainstream media converged towards numerical consensus.
Are CTE headlines overblown? A radiologist investigates.
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Patient psychology is increasingly recognized as an important contributor to health outcomes. What patients believe about their health and their providers can significantly affect their initiative and their adherence.
It is important to recognize that factors that appear to be unrelated to medical care can influence feelings about that care, as well as outcomes. The reason this occurs is that the brain is not designed to parse out each element of …
3 unconscious things you might be doing that affect your patients
For many, American football is a beautiful game that is simple to enjoy but complex to master. Choreographed with a mixture of artistry and brutality, it features the occasional “big hit” or bone-jarring tackle, forcing a fumble and turning the tide of the game.
But with this part of football comes justified concern about the long-term health effects of engaging in this type of activity over time, concerns that abound in …
Concussions and CTE are more complicated than even the experts know
I had the pleasure of traveling to Rochester, Minnesota for a wedding this summer. Minnesota is home to more people from Somalia than any other state. My home of Columbus, Ohio is also a hub for people from Somalia. As a pediatric resident, I take care of Somali-American children and work with Somali American healthcare providers every day.
It was surreal, then, to set foot in a state recovering from a …
Minnesota and measles: Andrew Wakefield targets refugees
Charlie Gard was a one-year-old boy who had a rare genetic disease leaving him blind, comatose, and unable to breathe on his own. This metabolic disorder can be fatal and has no known cure.
Charlie’s parents wanted him treated with experimental drugs in the hope that a miracle would happen. As reported in the press, the British medical and legal community considered this care futile and blocked …
Planning for the end of life: What baby Charlie can teach us
When I was a medical student, trying to forge my path on the clinical wards as a third year, there was a lot to turn me off the idea of a career in medicine entirely — sleep deprivation, early mornings, late nights, standing for hours on rounds, subsisting on diets of hospital graham crackers and off-brand peanut butter. However, what frosted me the most was constantly playing 6 degrees of …
Stop the abuse of hierarchy with these 5 tips
Dear Sen. McCain,
I was saddened to hear that you received a diagnosis of glioblastoma. I also live with this particularly aggressive type of brain cancer. On the surface, you and I are very different. I am a 35-year-old dad with three sons aged 5 and under. I have a beard and listen to indie rock. I hold …
Dear Sen. McCain: 9 ways to live with glioblastoma
Senator John McCain recently had surgery to “remove a blood clot above his left eye” according to a CNN report. CNN, fortunately, didn’t have a chance to wade into their familiar territory of fake news because they had a practicing neurosurgeon, and CNN Chief Medical Correspondent, Dr. Sanjay Gupta on hand to discuss Senator McCain’s surgery.
Despite the cheery description, “minimally invasive craniotomy,” this was brain surgery, opening the skull …
Does Senator McCain’s blood clot explain his recent behavior?
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