After I left my position as a staffer for the U.S. Preventive Services Task Force in November 2010, it was three years before I was tapped for another guideline post, this time at the American Academy of Family Physicians. Recently I joined the AAFP's Commission on Health of the Public and Science, which formulates guidance for family physicians on a variety of topics, including clinical preventive services. My appointment coincided ...

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After decades of bravely keeping them at bay, health care is beginning to be overwhelmed by “fast, cheap, and out of control” new technologies, from BYOD (“bring your own device”) tablets in the operating room, to apps and dongles that turn your smart phone into a Star Trek tricorder, to 3-D printed skulls. (No, not a souvenir of the Grateful Dead, a Harley decoration or a pastry for the Mexican Dia de ...

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Cardiovascular disease still remains the number one cause of death in women.  Heart attacks account for 24% and strokes 7% of all deaths.  Among minority women, these numbers are even higher.  The challenge remains that doctors traditionally have not identified women at high risk of stroke.  Internists and cardiologists do not routinely think of stroke prevention in women, and neurologists have been busy treating stroke victims and have had no ...

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“I don’t like taking medicines.” All physicians hear some form of this opinion very frequently. Even more frequently, patients don’t state this view outright but rely on it to completely subvert their doctor’s plans. When I was new to practice such an utterance would shock and confuse me. “I don’t want to take any medicines,” a patient would declare. “That’s fine,” I would reassure my interlocutor. “It’s a free country. No one is going ...

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When I first learned to take care of patients in the hospital, as a third-year medical student, we used a mnemonic to help us remember what to order when a patient was first admitted. Patients would come in to the hospital from a doctor's office or from the emergency room and the nurses needed a set of orders to know what to do for the patient. The mnemonic we used ...

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I recently got back from a brief trip to Florida. I went down there to celebrate my mother’s 85th birthday. As you might expect, her social circle has shrunk in recent years, but she did get a number of cards and calls from friends and family members. The cards were on display in her kitchen, and a few calls came in while I was there. One in particular pointed out some ...

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The health care industrial complex is stronger than ever Walking to the 2014 Heart Rhythm Society (HRS) Scientific Sessions recently, I couldn't help but marvel how beautiful San Francisco was. The weather was perfect, the streets bustling, the quaint shops and eateries doing brisk business in a very hip metropolitan city with a distinctive West Coast vibe. As I walked up to the Moscone Conference Center, I was struck by ...

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It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications. “It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer. There are ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 63-year-old man is evaluated for pleuritic left-sided anterior chest pain, which has persisted intermittently for 1 week. The pain lasts for hours at a time and is not provoked by exertion or relieved by rest but is worse when supine. He reports transient relief with acetaminophen and codeine and occasionally when ...

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“Can you hear it?” she asked with a smile. The thin, pleasant lady seemed as struck by her murmur as I was. She was calm, perhaps amused by the clumsy second-year medical student listening to her heart. “Yes, yes I can,” I replied, barely concealing my excitement. We had just learned about the heart sounds in class. This was my first time hearing anything abnormal on a patient, though it was ...

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