IMG_0785 Sitting in a rickety jeep rumbling through treacherous mountainous terrain, on winding unpaved roads full of blind curves and teetering on the edge of cliffs recently ravaged by an earthquake, I began to question my decision to go along on this trip.  We were about 3 hours outside Kathmandu, Nepal heading to a small village along the banks of the Melamchi ...

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shutterstock_255233311 As a multi-racial and ethnically ambiguous American, 90 percent of the time I walk into a patient's room or show up to help run a clinic I'm asked if I'm a nurse or a translator. Most of my patients simply do not perceive someone who looks like me to be a doctor. This may be because the majority of doctors at ...

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shutterstock_277040312 american society of anesthesiologists A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Summer is immortalized in popular culture for good reasons -- no other season can match it for the variety of fun and exciting activities it brings. Unfortunately, that variety of activities and the large volume of ...

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shutterstock_210047401 In 1735, Benjamin Franklin wrote, “An ounce of prevention is worth a pound of cure.” Now 280 years later, this basic concept of human health has been refined and applied throughout medicine. Recently, the emphasis on prevention has been amplified by the passage of the Affordable Care Act that prioritizes such services. Radiology remains uniquely poised for this change with its ...

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shutterstock_166402376 We are data druggies. We spend our days like desperate junkies crawling the carpet, sifting through the shaggy strands of patient histories with shaky fingers in search of facts. Every word our patients utter we feed to the never-ending demands of the electronic chart. We find a fact and we enter it. The database grows. Someone somewhere adds another question we are supposed to ...

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shutterstock_277885379 Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision making in the ICU, in a large survey published in JAMA Internal Medicine. About 1,300 staff at 13 academic hospitals in Canada rated barriers to end-of-life goals of care on a 1 to 7 scale. Doctors and nurses considered the largest barriers to end-of-life decision ...

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shutterstock_125105294 The feminization of health care is fundamentally changing care delivery in the United States and it is doing so in ways that will accelerate the pursuit of improved quality and affordability. Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” -- traits such as heroism, independence, and competition. Yet it ...

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shutterstock_139593809 At 3 a.m. last Saturday, I was feverishly devouring medical journal articles on subarachnoid hemorrhages (which I now know are a type of stroke caused by bleeding into the space surrounding the brain), trying to determine just how much I needed to be panicking about the health of a loved one. With every text message update from the rural hospital he ...

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shutterstock_144659519 “Your wife has gestational diabetes.” My heart stopped when my wife’s physician called to tell me this. “I want you to tell her because it’ll be easier to give it some time and let it sink in. Tell her to call me if she has any questions.” But I had questions -- about a million. Let me give some background information. I’m ...

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shutterstock_114519565 How is it that, in this day and age, a talented teenager treated for lymphoma emerges cured but with a life-threatening eating disorder? How is it that, in our nation’s capital, a boy dying at home from neuroblastoma experiences excruciating pain in his final moments? How is that, when we develop new drugs to treat children with cancer, we do not, at ...

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We must be “brave, brave, brave,” as we exhaust and challenge ourselves to reconcile the disparities that exist in our country. These words, delivered by keynote speaker Bryan Stevenson at the 2013 Teaching and Leadership Development Summit, inspire me as I continue on my mission to help break down barriers that give rise to health challenges in our nation. Towards this end, I strongly believe we need to build a ...

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shutterstock_90934610 I recall a talk on imaging biomarkers for Alzheimer’s disease (AD). “Take this with a pinch of salt. I have a financial conflict of interest (COI) in the success of these markers,” the speaker warned. I glanced at the audience -- MDs and PhDs with a cumulative IQ higher than the French intake of wine. I looked for pinches. I searched ...

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Well, decision time was here and it looked as if Bill would choose surgery, and why not, with the doctors liberally throwing around the word "cure.'" The various tests Bill endured, breathing tests, echocardiogram and MRI of the brain, were all within tolerable ranges, we were told.  The oncologist noted some marks in the brain that suggested mini-strokes, but Bill didn't hear this or it didn't register with him, or ...

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Terminator-Salvation_0 In the past, physicians were responsible for both the business and practice of medicine.  While administrative personnel played an important and complementary role in practice and hospital management, physicians were the cornerstone.  In comparison, today the leadership structure in medicine is now an entirely foreign landscape.  Administrators dominate medical practices today and, according to the New York Times, their ...

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A hospital can be full of discomfort. My patients tell me that the food is unappetizing. The beds hurt their backs. The noise echoing through the hallways at night makes it impossible to sleep. And for those patients near the end of life, the treatments being offered may no longer be of benefit, causing more pain than good. The answer to discomfort for those who are very ill is comfort care, ...

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The_Anatomy_Lesson

Your First Patient: The opportunity to dissect a human body is a once in a lifetime opportunity.  The cadaver that you will use for dissection was donated by a person who wished to make a contribution to your education as a physician.  It is not possible to put into words the emotions experienced by that individual as he or she made ...

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shutterstock_249289327 Fifteen months ago, the Federal Drug Enforcement Agency, or DEA for short, began an investigation in four states: Alabama, Arkansas, Louisiana, and Mississippi.  The DEA was looking for illegal drug trafficking, as they do.  But they were looking for prescription drug dealers, not Columbian drug cartels.  And they found them.  They are doctors. Forty-eight people were arrested, seven of them doctors.  DEA ...

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shutterstock_95651341 There can be little doubt that these days that political correctness has run rampant. Terms like "racist," "sexist," or "homophobic" are thrown around so frequently and early now that one has to wonder what is actually being accomplished. If you were to ask a physician what PC label they most fear, it would be "disruptive." Let's face it. We are no longer ...

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"Only one rule in medical ethics need concern you -- that action on your part which best conserves the interests of your patient." - Dr. Martin H. Fischer, German-American Physician and Author "A physician shall, while caring for a patient, regard responsibility to the patient as paramount." - Principles of Medical Ethics, American Medical Association "I pledge to pursue the practice of surgery with honesty and to place the welfare and the rights of ...

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shutterstock_143533171 I take a deep breath as I get ready to go see Mrs. H. I can predict after sign-out from the ER doc where this is likely to go. Mrs. H. is an 87-year-old woman who comes to the emergency room with weakness. She stumbled and fell to the floor but could not get up to reach the phone to call ...

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