Pulmonologists and physicians writing on KevinMD about the lungs: asthma and inhaler technique, COPD, sleep and insomnia, tobacco harm reduction, ventilator care after discharge, lung cancer, and the pandemic as it was lived on the respiratory wards. Board-review cases make up part of this archive. One maintained record draws on this archive: COVID-19: what physicians wrote as it happened.
I argue with my father a lot. He works as an intensivist at a community hospital in Indianapolis while I am about to graduate from a highly academic internal medicine program in Chicago. Needless to say, we have very different perspectives.
He sometimes expresses views similar to those written in an article, “When I Was a Resident: How Duty Hour Rules Are Creating a Lost Generation of Physicians.” I started residency the …
Read more…
Duty-hour regulations do not define me as a doctor
It is noteworthy how certain vital and effective generic drugs for common diseases have become exorbitantly expensive. We are use to new pharmaceutical brands costing a small fortune. But generics, one of which goes back to use in Egyptian times? Really? Allopurinol and asthma inhalers that are cheap but effective medications have become unaffordable to those that need it the most: Simply stated, those that can’t breathe and those that …
Read more…
Why patients cannot afford to have asthma or gout
I’m back at it again, talking about my continued love/hate relationship with EMRs. From my conversations with doctors at different hospitals in our region, it seems that most docs appear to be falling into the “hate” column. Meanwhile, I’m still chugging along with the EHR that’s been installed in my office. And while it works just fine for the needs of a 3 physician single-specialty outpatient practice, it’s hardly the …
Read more…
The population health benefits of EMR implementation done right
I first met Carol* (name and identifying details have been changed) when she came to my clinic after a severe asthma attack had sent her to the intensive care unit. After a few days, she had been extubated and had acquired a new diagnosis: asthma. When she saw me in clinic, she felt better than she had when she had come to the hospital, but she continued to complain of …
Read more…
Will bronchial thermoplasty for asthma be more widely used?
If you are among the thousands of doctors who make their living as intensive care physicians, there is no normal work day with predefined hours or routine. Interruptions are the norm. Your day starts early in the morning, meeting with the ICU nursing staff and respiratory therapists long before morning rounds. Difficult clinical issues are reviewed as you and your team apply critical thinking on the challenging problems of the …
Read more…
An ICU physician’s work is never done
Clinical medical research — finding out which treatments help and which ones don’t (or even make the situation worse) — is tough research to do. In the laboratory a scientist can control conditions so that only one thing is different between the control and the experimental groups. This isolates the effect of the particular thing and one can see if there is any difference in outcomes depending upon what is …
Read more…
A case where a meta-analysis can help
A few years ago when I went skydiving for the first time, I learned about the backup parachute. This is a second chute, just in case the first one failed. While no one wants to think about the primary parachute failing, it was comforting to know we were prepared … just in case. That’s kind of how I see end of life care planning, while we don’t want to think …
Read more…
4 things everyone should know about end of life planning
I just didn’t like the looks of him.
It was the way he was breathing. I counted for a full minute: 24 breaths. (The ER would later document 40.) No accessory muscle use. Not even much coughing. He didn’t look overly anxious or uncomfortable, though he said he couldn’t breathe. No fever. No wheezing or other abnormal lung sounds on exam. No leg swelling or tenderness. Pulse ox 95% on room air (97% in …
Read more…
The sixth sense of an experienced clinician
A middle-aged obese female with a past medical history of diabetes and congestive heart failure is in cardiac arrest after several hours of immobility on an airplane. What is the cause of her condition?
If this were a USMLE exam, my thoughts would race to Virchow’s triad: stasis, endothelial injury, hypercoagulability. But this wasn’t an exam. This was a few rows behind me on an airplane.
I sat only …
Read more…
An embolus in one but trauma in many at 30,000 feet
‘Tis the season to be coughing …
It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season. For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world.
Or just ask a primary care clinic what its waiting room sounds like these days. A chorus of coughs, high, low, dry, …
Read more…
Treating post-viral coughs: This too shall pass
It’s time again for bronchiolitis, which usually comes in winter through spring. In some ways this problem is similar to asthma, but in other important ways it is very different. With winter upon us it’s time to reacquaint ourselves with this common entity. There is a reliable seasonal arrival of the virus we call RSV, the chief cause of bronchiolitis. The letters stand for respiratory syncytial virus, a description of what …
Read more…
Bronchiolitis and RSV: What you need to know
Besides the importance of physician happiness when using an EHR, using design principles that maximize user intuition and presentation of relevant information, there is one aspect of health care information systems that should never be overlooked: patient safety.
Scot Silverstein, MD, blogging at Health Care Renewal as InformaticsMD, frequently brings to light issues surrounding health care IT implementations that compromise patient safety. Reading his posts should be sobering and concerning to both medical …
Read more…
How EHR design can affect patient safety
I grew up most of my life avoiding doctors and hospital visits. I never fancied getting shots or blood draws as a child, and without health insurance; I didn’t have much of a choice. This lack of access is what drew me to volunteer at the county hospital I was born at. Every Wednesday morning, I would report to the pediatric asthma allergy clinic at San Francisco General Hospital. Most …
Read more…
An important lesson in personalized patient care
When he was five, my son Daniel went through a rough patch with his asthma. Both he and his sister Allison had been diagnosed the year before, when we were living in Colorado. I never knew if it was the fault of the pollution that too often smeared our view of the mountains, or my then-husband’s two-pack-daily cigarette habit. Or was it the unspoken shriek of anxiety?
After I divorced my …
Read more…
Could we exhale, my children and I?
Asthma is a common problem in children — nearly 10% now have it — and the number is increasing. Researchers are not sure of the reasons for this steady increase, but decreased air quality, lower activity levels among children, and an increase childhood obesity have all been implicated. Whatever the cause, it means that millions of American children take medicine for asthma. A significant number of these children end up in …
Read more…
Asthma in children: A complete primer
Well, I’ve done it again. It seems that everytime I try to make the early registration deadline for a conference, something seems to come up. One of the kids gets sick, a transmission breaks, I have a crazy week at work … you know, life.
Unlike the past few years however, I’m very excited to say that I will be making it to the American College of Chest Physician’s annual scientific …
Read more…
Using Twitter to stay updated in scientific meetings
