Have you ever Googled yourself or your practice? Did you know that you have an ever growing online reputation? Whether you know it or not, doctors have an online presence. When you type your name in a search engine you may be surprised by what you find. Everything you do professionally creates a digital footprint. If you are involved in social media then you are contributing to your online reputation. …
There was important news recently on statin drugs. As one of the world’s most effective and commonly used medications, statins provide great writing topics. Lots of people have high cholesterol–including cyclists. Lots of people are interested in avoiding our mostly deadly disease.
I’d like to tell you about a recently-published landmark study in the Lancet that should quell safety concerns over statin drugs.
The punch line after I tell you the study’s …
Let’s close the chapter on statin safety
“So the patient has been temporarily paralyzed by the drugs, and you’re the one keeping them alive by squeezing air into their lungs, but … no pressure”.
Gulp.
I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from …
The honor of patient responsibility
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated for a 3-month history of perineal and suprapubic pain. He has experienced urinary frequency and dysuria for 4 to 6 weeks. The patient reports fatigue, insomnia, and low mood for the past 6 months. He has hypertension. Current medications are hydrochlorothiazide …
MKSAP: 52-year-old man with perineal and suprapubic pain
In about 1985, as I remember it, my training hospital underwent a pivotal change. In Cape Town, at the southern tip of Africa, Groote Schuur Hospital was world famous for being the place where in 1967 an arrogant, brash and brilliant surgeon by the name of Christiaan Barnard stunned the world by performing the world’s first heart transplant. Nearly twenty years later, Groote Schuur (Dutch for “Big Barn”) still retained …
The day our hospital lost its heart
Although as a medical student rheumatology was always associated with an air of mystery and complexity to me – factors which might have aroused a younger me had they been associated with a member of the opposite sex – the specialty didn’t catch my eye at all as an undergraduate. To a medical student cruising for medical action in the 1980′s, rheumatology wouldn’t have got as far as a first …
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Since the passing of Michael Jackson and the recent trial of his physician, Dr. Conrad Murray, I have been frequently asked by patients whether they will receive the drug that killed the singer. As have many of my anesthesiologist colleagues, I have taken this opportunity …
Explaining Propofol to patients after Michael Jackson and Conrad Murray
In this day and age, with excellent rehabilitation care available for nearly every injury or illness—no matter how serious—it’s hard to believe that there are millions of people who leave the acute medical system far worse off than they entered it, and aren’t routinely offered rehab. I’m talking about cancer survivors– a group of individuals known for their tremendous advocacy abilities. It’s no surprise that these folks are really starting …
Cancer rehab dramatically improves cancer care
My wife has two world-class oncologists who help her manage her stage 4 lung cancer. Both are excellent clinicians. Yet their skills differ in one very important way. Her radiation oncologist physically touches her a lot (in a good way of course!). There are the touches on her arm, a hand on the shoulder, hugs, and of course a thorough hands-on physician exam. Her medical oncologist not so much.
We all …
The therapeutic value of touch in medicine
1. Mobile health technology will increase patient engagement. Most patients do not take the responsibility they should for their own health. They are likely preoccupied with all the stresses of everyday life and might therefore take the ‘I feel good, so I must be’ approach. They possibly mutter these words after wiping their faces, hurriedly walking out of McDonald’s for lunch. Or is it because of mistrust of their physician …
5 reasons why physicians will love mobile health
At the University Hospital in Madison Wisconsin in 1938, a patient was dying from a very painful bone cancer which had produced fractures. The young interns knew that more morphine injections were needed but they feared they might be blamed for giving a lethal dose. So a tacit agreement was reached. Every hour or so,one of them would come into the patient’s room and give a shot of morphine. This …
We are seeing more terminal patients being referred to hospice
The glittering commercialism and noisy cheer of the holiday season can be stressful for any of us. But for the parent who’s lost a child during the past year, facing the first Thanksgiving and Christmas with an empty place at the table can make already unbearable grief so much worse.
No one in modern America expects a child to die. Children only die in nineteenth century novels and third-world countries, or …
“Traveling makes one modest – you see what a tiny place you occupy in the world. ”
-Gustave Flaubert
We have come to Kenya, expecting to work outside of our “comfort zones.”
Our patient has arrived from miles away, riding on the back of her husband’s bicycle. She has an enlarging, bleeding mass growing off of the side of her neck. There are no pathologists available, so we are uncertain what kind of tumor …
In Kenya, operating in our comfort zone
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Radiation therapy has advanced dramatically in the past few decades and the rate of change is increasing rapidly. Innovations as a result of engineering and computer advances along with conceptual advances are making a dramatic difference.
Some of the new technologies include improved computer assisted treatment planning (smarter and faster and has more capability like auto-contouring, smart segmentation and improved algorithms) , continuous imaging guidance (fluoroscopic, stereoscopic, and cone beam CT), …
Major advances in radiation therapy for cancer treatment
The American public seems to consider cancer and cardiovascular disease in diametrically opposing ways. Cancer evokes the threat of relentless, painful suffering and whatever medical science can do to delay the judgement day is appreciated. Therapeutic regimens may involve disfiguring operations, prolonged toxic irradiation and chemotherapeutic agents that may be beneficial if they do not kill you first.
Response to treatment of limited incidence and duration are accepted and deemed beneficial. …
Considering cancer and heart disease in opposing ways
No matter how quickly you tried to switch the television channel lately, you probably couldn’t escape the trial of Dr. Conrad Murray or avoid hearing about propofol, an anesthesia drug that can be fatally easy to use.
What you may not have heard is that the American people just dodged a serious threat to their anesthesia care, and most don’t know how near a miss it was.
The Centers for Medicare and …
Unsupervised anesthesia care by a nurse anesthetist is a threat to patient safety
Until recently, there was a financial difference between performing a “consultation” and a “new patient visit” for office visits (Medicare stopped paying for consultations at a higher rate than new patient visits in 2010).
In specialists’ offices, patients often got billed for the more expensive “consults” when in fact the visit was not a consultation at all. Let’s just use this understanding as the brief background for what I’m about to say.
I …
Billing an established patient visit as a consultation
Cheryl and Susan arrived at the hospital at 6:30 AM. As was their routine, they stopped for their Starbuck’s latte and shared family stories as they walked toward the ICU. The two were well known pranksters but were widely respected for being top notch ICU nurses. The whole crew there was like a family. They went to baseball games, picnics, and vacations together. Today was like most other days. They …
Gallows humor is only a temporary release from a traumatic situation
I’ve had irritable bowel syndrome for 20 years, and I’m angry. About the pain, and the suffering, and the limited diet, and the huge impact that it has had on my life. But mostly, I’m angry at my doctors. No, they didn’t misdiagnose me. No, they didn’t harm me. No, they didn’t treat me like dirt. But they still made me angry.
Before we go any further, let’s get one thing straight: I know …
Why patients with irritable bowel syndrome are angry at their doctors
I am a writer as well as a doctor. My heroes are Keats, Chekhov, Williams, Coulehan, Coles, and other physician writers. And those greats of medicine too, known and unknown, who have spent their lives caring for people.
My writing is short. Really short. If it isn’t poetry, it scans like poetry. And one act plays. As in The Ride, my latest collection. Someone said if you can’t write poetry, you …
Lives focused through the lens of medicine will burn your eyes
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