Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 19-year-old man is hospitalized with a 6-day history of lightheadedness and nightly fevers. He also reports sore throat, headache, joint and muscle aches, and a dry cough. He recalls a blotchy rash on his trunk and arms, which has resolved. He returned home 12 days ago from a ...

Read more...

Being a cardiologist, the most frequent question coming my way for the last few years is “Doc what do you think about the “keto” [ketogenic] diet.” All foods contain both micronutrients and macronutrients that are essential for the body to function optimally. The human body requires macronutrients in large amounts, which include carbohydrates, proteins, and fats. These nutrients provide energy for your body in the form of calories. Micronutrients are nutrients ...

Read more...

I have just finished another round of that dreaded process that we call “the interview process.” Without fail, this process has haunted me almost cyclically every 3 to 4 years in the last 11 years of my life. First, there were medical school interviews, residency program interviews, and then lastly, fellowship interviews. You would think that after so many rounds of applying, it would get easier. You would think after I ...

Read more...

Between 2011 and 2015 there were over 21,000 children killed by guns. This recent study in Pediatrics, the journal of the American Academy of Pediatrics, further analyzes the question; it compares pediatric firearm fatality rates among the various states and then tests for correlation between children killed and the degree of strictness or not of the state’s gun laws. There are extensive data on whole populations showing that stricter ...

Read more...

An excerpt from Career & Life Planning Guidebook for Medical Residents: The Best Part of Your Journey Is about to Begin. Life is a journey. Where is this journey of life taking you? Do you know? If I asked you where you will be in seven years, could you tell ...

Read more...

It’s Monday, I recall as I step into work; “Preparing for battle,” I say with a smirk. Surviving all weekend with a sick kid in tow, the parents’ relief as they waited to show you their child with fever, diarrhea and sneezing, the one who is too hot, too cold or is freezing, the one who forgot that a helmet is needed, the one who is eating too much, they conceded. The one who still haunts you when ...

Read more...

We can learn a lot about ourselves by looking at, and thinking about, perceptual illusions and our biases. Look at the image above. The classic, Muller-Lyer illusion. We know that the two lines are the same size. But no matter how much we intuitively "know" this to be true, we see the top line as bigger. We can't unsee it — even if we ...

Read more...

Burnout in medicine has reached epidemic proportions. A recent systematic analysis found that the prevalence of burnout was as high as 80.5%. All medical specialties are affected, although prevalence rates of burnout vary widely between specialties. Classically, burnout is defined as a triad of emotional exhaustion, depersonalization, and inefficacy. Recently, moral distress or moral injury has also been recognized as a potential component of
Read more...

I have been treating diverticulitis for 30 years the same way. When I suspect that a patient has this diagnosis, I prescribe antibiotics. This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through. It is an easy task to miss the diagnosis. Every physician has done this. The diagnosis can be ...

Read more...

In the history of medical care, medical records served one purpose and two masters: to record diagnosis and treatment for physicians to refer to and for patients to use to transfer care when they desired. The medical record was a simple 3 x 5 or ledger card in the 1950s. The patient paid directly for care at the time of service. Usually, the physician had a nurse and a spouse ...

Read more...

I'm a healthy 48-year old, ASA physical class I anesthesiologist. At least I was healthy until an unintentional 20-pound weight loss over the summer, accompanied by an unquenchable thirst, insatiable appetite, blurry vision, and the bathroom frequency of an elderly prostatic. My lab workup would reveal a fasting blood sugar of 310 mg/dL, an A1C >14, positive urine ketones, low C-peptide, and glutamic acid decarboxylase antibody (GAD-65) level that was off ...

Read more...

When patients started showing up in doctors' offices and emergency departments with coughs, shortness of breath, chest pain, nausea, vomiting, abdominal pain, diarrhea, fever, chills and weight loss, physicians' first instincts were that the cause of these symptoms were common illnesses such as pneumonia or flu. But treatments that are usually highly effective for these diseases weren't helping patients as expected. Many became seriously ill quite quickly and required care ...

Read more...

After third-year medicine, I was required to withdraw for handing in an assignment late. It was a paragraph of self-reflection; I couldn't believe I was being kicked out for something so seemingly inconsequential. My dealings with the faculty became increasingly hostile and negative. I realized that my fellow students had to band together. Otherwise, there will be no change. I have to say that at my medical school, they have been ...

Read more...

Doctors need to be true to themselves, but at the same time, they must be chameleons. A doctor fills certain roles in the lives and stories of patients. It is a two-way relationship that looks different to each person we serve throughout every workday and even in the most casual interactions we have. Some patients need us to take charge for a while because they’re exhausted; others need us to listen quietly ...

Read more...

The doctor shortage across the United States is coming and has the potential to be painful to millions of Americans. According to the Association of American Medical Colleges, by 2023, the country may experience a deficit of up to nearly 122,000 physicians. With more and more Americans getting access to health care because of policies like the Affordable Care Act and Medicaid expansion, and with the aging population, medical schools ...

Read more...

Start at the origin. Over two, up four. Down three, right six. Left five, up one. Keep connecting the dots. Everything will take shape. I liked graphs. Plotting coordinates — whether it be for a parabola or ellipse — was always calming for me: numbers told you exactly where you needed to be. But my numbers scared me. My 8-year-old feet would hesitantly step on the scale at the doctor’s office. I ...

Read more...

I’m a member of the ACR (American College of Radiology). One of their recent online postings is entitled: Choosing Wisely. Number three (of ten things physicians and patients should question) is: "Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam." In only 2 percent of cases, will it make a difference in management. Thirteen years ago, I was working on the queue of cases that ...

Read more...

I walk out my front door today to do my obligatory walk around the block with my pups. Two police cars with blue lights flashing, lead a caravan of over 100 motorcyclists to a funeral for one of their fallen brothers. They revved up their motors in the procession, I guess, as a sign of love, of brotherhood, of kindred spirits in the motorcycle world. I choked up. I was ready to ...

Read more...

The family doctor used to be almost the only source of medical information patients had access to. Now, few people need us to bring them the latest news. It’s there for everyone to see. There’s even too much of it. Today, our role is to help make sense of it all. In order to do that, we must possess and project authority, but we have no reason to put ourselves on ...

Read more...

My 83-year-old patient had outlived peoples' expectations on several occasions. Faced with a critical illness three years ago, she underwent emergency surgery and spent several months in the hospital with a series of complications, including septic shock, renal failure, and hospital-acquired pneumonia. I'd seen her in the office for a new visit soon after she was discharged. It took nearly 20 minutes to go through her history before walking into the ...

Read more...

Most Popular

Join 150,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.