Learn the art of observation.
“The whole art of medicine is in observation… but to educate the eye to see, the ear to hear and the finger to feel takes time, and to make a beginning, to start a man on the right path, is all that you can do.”
– Wiliam Osler
One of my favourite books as a medical student was Michael Zatouroff’s Physical Signs in General Medicine, a book brimming …
The art of medicine is in observation
One of the most difficult family decisions can be whether to move an aging parent(s) out of their own home and into assisted living or even a nursing home. I’ve seen families face this dilemma numerous times. (After my psychiatry residency, I completed a geriatric psychiatry fellowship and also spent the first few years in practice consulting at nursing homes.)
Nobody wants to face this situation.
In fact, I’ve seen repeated instances …
Technology can help your aging parents
An excerpt from Doctor Guilt?
by Everett Winslow Lovrien, MD
This is the story of a boy who had hemophilia, a bleeding disorder that resulted in pain, disability and death before adulthood. A new medicine was developed which brought an end to suffering and increased longevity in persons with hemophilia. The effect of the new medicine was like magic. It was a remarkable revolutionary advancement …
A drug to treat hemophilia was polluted with hepatitis viruses and HIV
You are now out of the Gray Zone, and you are now a member of an exclusive club.
But membership to this club comes at a steep price. Membership is not offered, it is not dependent on your income, title nor your social status. Membership is granted simply by surviving or living with a grave or potentially fatal illness or injury and realizing just how fragile life is and how quickly …
Surviving a potentially fatal injury and the fragility of life
I had been running late on another busy summer day. The type of day where you gain one step and lose two. Meetings and paperwork had filled up another summer morning. Baseball games, swimming practices, and soccer scrimmages had filled up another summer afternoon. And for this particular summer evening, I was scheduled to work an odd emergency room shift from eight p.m. to four a.m.
While driving to work, I …
A sweet and tender moment between a mother and daughter
by Keith Humphreys, PhD
When my friend Paul Costello left the Carter Administration, he wrote a funny New York Times article suggesting a special course for departing staffers:
There ought to be an “outward bound” course for White House employees facing exile. Must we face this cruel and unusual punishment cold turkey?
Maybe people were tougher back then – I personally would have collapsed five minutes into the first day of the …
How working in the White House breaks down your body
Something happened to the public perception of health and medicine in the 1970s. People began to adopt — and financial interests and the media began to profit from – “healthy lifestyles.”
This was not without consequences.
• Americans became increasingly preoccupied with diet, exercise, and health habits.
• There was a big uptick in the use of alternative “medicine” and stress reduction practices – acupuncture, chiropractic, herbalism, naturopathy, nutritional therapies, yoga, massage, biofeedback.
• …
How a tyranny of health is bad for both patients and physicians
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 70-year-old man with a history of a systolic murmur presents for further assessment of exertional dyspnea. He has had dyspnea his entire life, but has noted a recent deterioration in his exercise capacity. He has no other medical conditions and is on …
MKSAP: A 70-year-old man with a history of a systolic murmur presents with exertional dyspnea
by Brian McMichael, MD
The NEJM recently published an interesting case in the ongoing series: “ A Request for Retrieval of Oocytes from a 36-year old Woman with Anoxic Brain Injury.” Usually these cases are diagnostic dilemmas. This one focused on an ethical dilemma at end-of-life.
The Case
A 36-year-old woman, in overall good health taking oral contraceptive pills (OCPs), was on a prolonged international flight, and …
Searching for solace while balancing the care of patient
What does your breast type say about your cancer risk? Quite a bit, actually.
Whether you have large, small or lumpy breasts, self-awareness is very important. Getting to know how your breasts look and feel can help you recognize possible red flags.
Large vs. small breasts
When it comes to cancer risk, size really doesn’t matter. But, size can affect your mammogram and clinical breast exam.
For example, women with large breasts may need …
Breast cancer and understanding your breast type
An excerpt from CyberSafe: Protecting and Empowering Digital Kids in the World of Texting, Gaming and Social Media.
by Gwenn Schurgin O’Keeffe, MD, FAAP
Screen Time and Childhood
Have you ever tried to go “screen-less”? I often tell the story of taking my girls to New York City on an April vacation, looking forward to Turnoff Week. This is a semiannual event that encourages families to flip off the screens …
Protecting kids in the world of social media, a Cybersafe excerpt
by Kristina Fiore
They’re still there. Rows upon rows of number- and color-tagged manila charts, packed in so closely together that Fiore sometimes sticks to Fiori, or hides behind it.
None of my physicians has yet converted to electronic health records. I dream of the day when my PCP can pull up my chart on her iPad, accessing all of the important information (allergies, family history) before …
Challenges facing patients adopting personal health records
by Joanna Fief
About two years ago in the wee hours of the morning, I found myself in a local emergency room with severe stomach pain, incessant vomiting and dehydration. It wasn’t pretty, and I was desperate for something – anything – to ease my pain and stop my vomiting.
Gratefully, within minutes of receiving an IV with medications for pain and nausea, my symptoms subsided. After a couple of blood tests …
Tips for questioning costs in today’s health care system
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The rise of the e-Patient movement has the potential to change the practice of medicine, in my opinion, for the better. e-Patients demand to be taken seriously, to be “equipped, enabled, empowered, engaged, equals, and emancipated.”
My recent post on KevinMD.com suggested the need for e-Doctors as well, in response to the growth of the e-Patient movement.
So how do you become an e-Doctor? I believe you, and I, need to be equally …
October is breast cancer awareness month. There are pink ribbons and wristbands to wear, pink products to buy, and pink races to run — all to improve awareness about screening and raise money for a cure. And rightly so, because breast cancer affects 250,000 American women every year.
Fewer people know that October is also intimate partner violence awareness month. Purple is the color representing the more than 1.3 million women …
Intimate partner violence an epidemic of grave proportion
One of the most common complaints that I hear from people attempting to lose weight is, “I don’t know how to deal with my triggers.” Most of us have had the experience of eating just one bite of something and suddenly wanting to devour the entire thing. Sometimes we do, even though we know we won’t be happy with ourselves when we finish.
I am familiar with the experience of insisting …
Deal with your triggers when trying to lose weight
by Dennis Grace
The last time I visited my physician for an epidural injection, as the doctor’s assistant was situating me under the fluoroscope, the doctor was feverishly dictating notes on his previous patient’s procedure. No doubt your physician has a similar work schedule: when not dashing off notes from one patient or burrowing through medical research to diagnose another, he’s performing delicate medical procedures …
Trust your doctor but review your medical bills
NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.
If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”
Very telling.
The thrust of the article …
Watchful waiting is underutilized for most men with prostate cancer
[Editor’s note: Please visit part 1 of Dr. Harpham’s take on OpenNotes.]
“Our” Chart
Does the opportunity for patients to read their medical charts help or hurt patients’ ability to become Healthy Survivors?
Open notes can facilitate Healthy Survivorship for some patients.
Unfortunately, other patients may learn something about their condition that makes it more difficult to get good care or live as fully as possible. Or they may experience feelings that threaten the physician-patient bond. …
How open medical charts help Healthy Survivorship
One of my docs was telling us about a patient’s experience at another practice. Apparently, the parent was at her wits end with her crying baby. She called the on call doctor to ask for advice and the doctor told the patient, “your baby has colic’s; turn on the vacuum and stop calling.”
It turned out the baby had some gastric condition (not colic) and needed treatment. The patient ended up …
Why doctors have poor customer service
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