Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. ...

Read more...

In the spirit of World Breastfeeding Week, I want to highlight all we can about breastfeeding; why it’s great for you and your baby, some ways to make it easier, and how to manage common challenges. But one challenge that often gets ignored in the offices of doctors and lactation consultants is the issue revolving around the ethics of breastfeeding. That is, addressing uncomfortable questions like these:

STAT_LogoDear 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 ...

Read more...

As the kids say, it’s complicated. Practicing physicians are seeing an ever increasing list of protocols and pathways coming their way. These arrive in several forms -- order sets for medications, guidelines in how to proceed for various conditions, when to do this, when to do that, and when not to do either one. They generally are the product of various committees trying to synthesize what these days we call ...

Read more...

I began medical school, like many of my peers, with some experience working with patients. I worked as a volunteer EMT with Cornell University EMS for four years during my undergraduate years; shadowed a cardiologist and an anesthesiologist through Cornell’s Urban Summer program at NYP Hospital–Cornell and worked with patients during Global Medical Brigade trips to rural Honduras. All of this sparked my interest in medicine, but to claim I ...

Read more...

There are two schools of thought about how to extubate patients at the conclusion of general anesthesia: Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patient’s head bleats, “Open your eyes!  Take a deep breath!” Or: Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence ...

Read more...

In Sweden, back when I trained, three blood tests were the “routine labs” done at most doctor visits: hemoglobin, white blood cell count, and erythrocyte sedimentation rate. I’m trying to remember, but I don’t think everyone waited an hour to see the doctor, so they must have used a modified rapid sedimentation rate. The “sed rate,” or “sänkan” as we call it, was invented by Robin Fåhraeus, a relative of one ...

Read more...

Over the past decade, I have thought often about the benefits and the problems of clinical guidelines. The first concept that attracted my attention was reading about conflicting guidelines.  Given the same data, different guideline committees would have significantly different recommendations.  At the least, this problem raises questions about guideline validity.  It makes clear that committee perspective could influence recommendations.  Guideline recommendations sometimes are clear and demonstrably evidence based, but too ...

Read more...

A woman recently requested a medication evaluation at the suggestion of her psychotherapist.  The caller told me her diagnosis was borderline personality disorder. She hoped medication might ease her anxiety.  She also admitted that two other psychiatrists refused to see her because she was too “high risk.”  I asked if she was suicidal.  Yes, thoughts crossed her mind. However, she never acted on them, and was not suicidal currently.  I ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 34-year-old man is evaluated for episodic palpitations of 8 months' duration. The palpitations last 5 to 10 minutes and then resolve spontaneously. They are usually associated with sweating and anxiety. Medical history is significant for thyroidectomy for medullary thyroid carcinoma diagnosed at 12 years of age. His father ...

Read more...

Most Popular