I learned a new word recently: transdiagnostic, which refers to something that is applicable across a spectrum of conditions. It seems that this is becoming an increasingly popular concept in treating anxiety disorders. No wonder. As I researched this word,…
I learned a new word recently: transdiagnostic, which refers to something that is applicable across a spectrum of conditions. It seems that this is becoming an increasingly popular concept in treating anxiety disorders.
No wonder. As I researched this word, I read this:
As of 2013, there are twelve anxiety-disorder diagnoses and over twenty-five subtypes and categories of these disorders, with specific treatments for about half of them. Research has …
Last year, a cardiologist at my institution presented the story of a patient he had cared for and correctly diagnosed with a not uncommon condition after several other physicians had failed to do so. The patient was a 72-year-old man…
Last year, a cardiologist at my institution presented the story of a patient he had cared for and correctly diagnosed with a not uncommon condition after several other physicians had failed to do so. The patient was a 72-year-old man with near syncope after exercise for several months, with no other symptoms or clues to the diagnosis. The cardiologist asked him to discuss each episode in detail, and the man …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated during a follow-up visit for systemic lupus erythematosus. She was diagnosed 3 months ago after presenting with pericarditis and…
A 30-year-old woman is evaluated during a follow-up visit for systemic lupus erythematosus. She was diagnosed 3 months ago after presenting with pericarditis and arthritis. She was initially treated with prednisone, 40 mg/d, with improvement of her presenting symptoms. The prednisone has been tapered over 3 months to her current dose of 10 mg/d with …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 82-year-old woman is evaluated for a 2-week history of left-sided headaches with pain on chewing, accompanied by achiness in the shoulders and hips.…
An 82-year-old woman is evaluated for a 2-week history of left-sided headaches with pain on chewing, accompanied by achiness in the shoulders and hips. She has no other pertinent personal or family history. She takes no medications.
On physical examination, temperature is 38.1 °C (100.6 °F), blood pressure is 132/86 mm Hg, pulse …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated for a 2-day history of right anterior knee pain and swelling. The pain began suddenly and has increased in…
A 48-year-old man is evaluated for a 2-day history of right anterior knee pain and swelling. The pain began suddenly and has increased in intensity. He currently rates his pain as an 8 on a 10-point scale. He has no knee instability and reports no fever or chills. He has no history …
As a surgical resident nearing my final year of training, I loved to operate. Whenever I was on call in the trauma unit at our large urban teaching hospital in Washington, DC, I'd yearn for my pager to go off.…
As a surgical resident nearing my final year of training, I loved to operate. Whenever I was on call in the trauma unit at our large urban teaching hospital in Washington, DC, I’d yearn for my pager to go off.
I was always tired, too — but for a surgical resident, fatigue is a given. Sleep and eat when you can, get your work done and operate like a madwoman: That …
I love my doctors. I have an undiagnosable autoimmune disease. It's mostly manageable, my lab work is perfect, and I rarely get sick. I get allergy shots and take blood pressure medication. I always have at least low level, mostly…
I love my doctors.
I have an undiagnosable autoimmune disease. It’s mostly manageable, my lab work is perfect, and I rarely get sick. I get allergy shots and take blood pressure medication. I always have at least low level, mostly familiar, physical symptoms. Occasionally a new one appears. Sometimes it is scary.
I could have sued any or all of my doctors over the last decade-plus. I could be “livin’ large.” They …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has…
A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has an 8-year history of diffuse …
Mark Letterman’s rheumatoid arthritis had been progressing unrelentingly despite popping dozens of pills each week -- eight methotrexate pills on Mondays alone. Letterman felt like he was 63 going on 93. If rheumatoid arthritis progresses unchecked, it is as debilitating…
Mark Letterman’s rheumatoid arthritis had been progressing unrelentingly despite popping dozens of pills each week — eight methotrexate pills on Mondays alone. Letterman felt like he was 63 going on 93.
If rheumatoid arthritis progresses unchecked, it is as debilitating of a disease as can be imagined. Don’t think garden variety arthritis that only interferes with activities like, um, gardening. Think: finger and wrist joints so inflamed it feels like your …
As I sit in the exam room waiting for my first patient of the afternoon, the phone rings. It rings four more times before I realize that Amanda Ringwald, our eighty-year-old receptionist, hasn't come back from taking a rare lunch…
As I sit in the exam room waiting for my first patient of the afternoon, the phone rings. It rings four more times before I realize that Amanda Ringwald, our eighty-year-old receptionist, hasn’t come back from taking a rare lunch break.
I pick up the phone and say, “VA Hospital. Marianna Crane.” Oops, I’m not back at the VA anymore. “Senior Clinic,” I quickly add.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties…
A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties falling asleep and gets 10 hours of uninterrupted but nonrestorative sleep each night. He has seen several physicians over the past year. Evaluation has included a complete blood …
Having a chronic disease can be frustrating, especially when the patient seems to know more than the doctor. Unfortunately, this situation may be familiar to the millions of Americans suffering from a rare disease. In June, I had the unique…
Having a chronic disease can be frustrating, especially when the patient seems to know more than the doctor. Unfortunately, this situation may be familiar to the millions of Americans suffering from a rare disease. In June, I had the unique experience of attending a convention for patients and health care providers to learn about one such rare disease category, vasculitis.
Vasculitides (plural of vasculitis) are a family of autoimmune diseases characterized …
I had my first outpatient surgical procedure when I was still in high school and needed a plantar wart removed from the sole of my foot. As the doctor injected the area with a local anesthetic, he explained he did…
I had my first outpatient surgical procedure when I was still in high school and needed a plantar wart removed from the sole of my foot. As the doctor injected the area with a local anesthetic, he explained he did these procedures all the time, and I wouldn’t feel a thing. After a short wait, he began to dig out the deeply embedded wart with a hooked scalpel.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity…
A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including the ankles …
It was Albert Einstein’s “biggest blunder.” Using his general theory of relativity, Einstein devised a formula that predicted the universe was expanding. This was an unfathomable idea, though. How could the universe expand with all the gravitational forces pulling the…
It was Albert Einstein’s “biggest blunder.”
Using his general theory of relativity, Einstein devised a formula that predicted the universe was expanding. This was an unfathomable idea, though. How could the universe expand with all the gravitational forces pulling the heavenly bodies together.
In Einstein’s time, the universe was thought to be stationary. A universe that was anything but stagnant was an inconceivable idea since celestial matter would spin out of control, …
On my last day of internal medicine residency, as I finished my senior grand rounds presentation, I “came out” to my colleagues and confessed the deep dark secret I had been hiding since medical school: I have fibromyalgia. A few…
On my last day of internal medicine residency, as I finished my senior grand rounds presentation, I “came out” to my colleagues and confessed the deep dark secret I had been hiding since medical school: I have fibromyalgia.
A few jaws literally dropped, and there was an awkward silence, then polite applause. Afterwards several of my colleagues came up to talk with me privately and were offended and/or curious as to …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his…
A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing stairs due …
Back in my first year of blogging, I wrote a post, titled "A Day Without a Diagnosis," about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went…
Back in my first year of blogging, I wrote a post, titled “A Day Without a Diagnosis,” about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school.
That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring.
Jeffrey Lurie is the owner of my beloved Philadelphia Eagles. He pays the players. He picks the coaches. But I think we would agree that his checkbook should not allow him to be the one who calls the offensive plays.…
Jeffrey Lurie is the owner of my beloved Philadelphia Eagles. He pays the players. He picks the coaches. But I think we would agree that his checkbook should not allow him to be the one who calls the offensive plays. The coach should do that.
So why is it different in health care?
I have a patient who was diagnosed with polymyositis. Polymyositis is an autoimmune disease that causes inflammation of muscles …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated in the emergency department for acute swelling, severe pain, and warmth of the right knee that woke him from…
A 72-year-old man is evaluated in the emergency department for acute swelling, severe pain, and warmth of the right knee that woke him from sleep. He does not recall any inciting injury to the knee. Three months ago, he had an acutely swollen great toe that improved within 3 days, for which he did not …
