A 30-year old male patient was recently admitted to my service via the emergency department. He came in complaining of abdominal pain and dark tarry stools. He mentioned a recent fall resulting in knee pain for which he had been taking 400 mg ibuprofen four times daily. He underwent upper GI endoscopy and was diagnosed with a bleeding gastric ulcer from his self-prescribed misuse/overuse of ibuprofen. Fortunately, he recovered, but this ...

Read more...

“Get rest and drink plenty of fluids,” might not sound like adequately aggressive medical advice. If you’ve dragged yourself out of bed to visit an urgent care or your doctor’s office, you will probably feel somewhat cheated by an admonition to head right back to bed and stay there until you feel better. Most likely, you’ll want a prescription for an antibiotic. You might even demand it. Don’t. Antibiotics are not the ...

Read more...

I wrote this a decade ago:

It is a brave new world. I have used an electronic health record in my office for ten years. With a click of a mouse, I can show you how your blood pressure has varied over the last ten years. I can graph your hemoglobin, track your diabetes or tell you if that was the medication we tried last time. But with every two steps forward, ...

Read more...

Moving to the Bay Area from the Midwest was a culture shock in many ways. I was amazed by the diversity, the food, the openness of opinions. And I was struck by the traffic, the stark differences driving from one community to another and the homelessness — you could see signs of it everywhere. As time went on, I acclimated to these changes. Working in the hospital, I got used ...

Read more...

In a previous post on LGBTQ care, Dr. Carlene MacMillan called attention to the importance of respecting patients’ pronouns. As she points out, discrepancies between patients’ chosen names/pronouns and gender markers on official documents can pose real challenges to providing patient-centered care. Even if health care providers know their patients’ self-determined identities, electronic health records and insurance claims can still betray them. The issue of compassionate ...

Read more...

Doctors are regularly deluged with advice on how to engage patients. But how can you, as a patient, get your doctor to engage with you as a person truly? Your health — and even your life — could depend upon it. A perceived absence of empathy can significantly harm physical and mental well-being. At a recent Society for Participatory Medicine (SPM) conference (I’m a member), three ...

Read more...

Corporate health care mentality set up nurses up to be inhuman while holding us to superhuman expectations. We’re told to be caring — but not allowed to do it. It’s time to demand that we stop being abandoned and dismissed by dysfunctional leadership. Early in my nursing career, I was assigned to the pediatric area for one shift in a busy emergency department (ED). Our team received notification of an incoming ...

Read more...

A couple of years ago, I read an article by Dr. Profeta at LinkedIn called "These four words that may offend you ... may also just save you." He was invited to talk about burnout in medicine and did not get a warm reception. "It's just a job." The "it" in this case is medicine. Medicine, just like any other, is just a job. Let that sink ...

Read more...

I'm excited to announce that I'll be keynoting AACE 2019, the annual meeting of the American Association of Clinical Endocrinologists, April 27, 2019 in Los Angeles, CA. Health professionals often hear about social media from a perspective of risk and negativity, especially with the headlines in the past year. But there's another side: One where we can use social ...

Read more...

On a recent vacation, I went out to eat at a small, out-of-the-way restaurant we always visit on our trips to the Outer Banks. There, I spotted a poster on the wall explaining why the cafe no longer uses plastic bags or plastic straws: to keep the material out of the ocean where it never really goes away. Plastic bags, straws, eating utensils, plates, bowls, and cups are everywhere in hospitals these ...

Read more...

As the health care landscape evolves, health care provider roles continue to shift. Industries recognize the power of collaboration and the strength of communication between different providers; among those, the pharmacist and the physician. Unfortunately, doctors and pharmacists have historically had strained relationships. In many cases, communication suffers, which can lead to adverse drug events (ADEs), or harm caused to a patient as a result of medication exposure. It’s worth noting, though, that ...

Read more...

In observing trends among my patient encounters, to me, there appears to be a distinct difference in clinical encounters between more "holistically-minded" patients and more "traditionally-minded" patients, for lack of better terms. One is not necessarily better than the other. There are definite benefits and risks associated with either group. Whereas the "holistically-minded" tend to see western medicine with some degree of skepticism, the "traditionally-minded" tend to be comfortable with ...

Read more...

I am considered a “xennial” physician. Not quite a millennial — but also not fitting into the generation of the respected preceptors I had in medical school and residency. I took my MCAT via paper and pencil. My mini boards during my clinical rotations were on paper and pencil. All of my licensing and board exams were computerized. It was not an option to sit at home and log on to ...

Read more...

“Alice Woods” is dying of metastatic breast cancer, but she cares little for awareness efforts like pink ribbons and catchy hashtags like #stage4needsmore. You see, Alice has akathisia due to an adverse effect from discontinuing Klonopin — a condition that has caused her far more suffering than her terminal cancer. It has also prevented her from receiving adequate cancer treatment and is, therefore, ending her ...

Read more...

An excerpt from Wrongful Deaths. “We will name Memorial Hospital, Dr. Julie Stone, Dr. Vijay Gupta, and ICU nurse Tracy Miller in a malpractice suit involving the wrongful death of Ivy Jackson.” Venjer appeared apologetic. “But Dr. Torrins is correct. It ...

Read more...

I never considered any specialty other than family medicine. I always saw the other specialties as necessary but supportive adjuncts. I always thought that the other specialties were all fascinating in their own way but saw them more as a part of a library that I could access when needed rather than ever feeling the need to delve deep into any specific subject. Specialists were the masters of the marvels ...

Read more...

Health care providers and even consumers who order their own genetic testing should really get to know GINA. Who or what is GINA? Is it some new virtual voice-activated personal assistant? Is she a new Italian superstar? Neither choice is correct. GINA stands for the Genetic Information Nondiscrimination Act, a U.S. federal law that was put in place to protect consumers from discrimination based on their genetic testing. GINA celebrates ...

Read more...

She had everything she needed.  Her husband had died long ago.  But the fortune he left her would suffice.  She had given up on mansions long ago.  There were no children, so who needed the space?  She was happy as can be in her little condo in the city.  The building had the most lavish pool, exercise room, and views.  She absolutely adored the doormen.  They would let ...

Read more...

Two weeks ago, while I was helping with an emergency medicine course that I’m a teaching assistant for, I started feeling extremely light-headed, and the chest tightness that I had dismissed as heartburn earlier that morning got worse. I was tended to by the emergency medicine doctor who I was teaching with, admitted to the ED with a resting pulse rate of 130 beats per minute, later admitted to the ...

Read more...

This seems to be the big take-home message from voters the mid-term elections, which bodes well for preserving gains from the Affordable Care Act and expanding coverage.   Health care was the number 1 issue for voters according to several exit polls, beating out immigration, the economy, and gun violence, among others, with voters strongly favoring Democrats as the party more likely to protect patients with ...

Read more...

Most Popular

Join 147,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 148,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.
close-image