As a college health physician, I see my fair share of fainting patients, including syncopal episodes within the clinic itself, typically while they are using the toilet, or after venipuncture and vaccinations.  Our staff is as proactive as possible to avoid these predictable occurrences, listening for problems in the restrooms, putting students in a recliner chair for their blood draws and observing them for awhile post-injection for lightheadedness.  Despite taking ...

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"There are three kinds of men. The ones that learn by reading. The few who learn by observation.  The rest of them have to pee on the electric fence for themselves." - Will Rogers Learning is a universal human experience from the moment we take our first breath.  It is never finished until the last breath is given up.  With a lifetime of learning, eventually we should get it right. But we don't.  ...

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Last night was clear with full moonshine and the owls were busy hunting on our farm, calling back and forth to each other, comparing notes on where to find prey. Thankfully they were not calling my name. At least I don't think so, nevertheless their hoots haunted me. A coastal tribal legend has it that if you hear an owl call your name, your death is imminent. I've had no recent brushes ...

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It is critical for physicians to share unusual patient diagnoses that present to clinic with routine type symptoms.  In a hospital setting, these are cases for discussion and debate at Grand Rounds.  In a primary care setting, we do case reviews when we can with informal sharing for the purpose of teaching and learning.  The bottom line, whether in a formal academic setting, or an informal setting around the lunch ...

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Suffice to say, as a physician, I’m not germ phobic.  If I were, I wouldn’t work as a health care provider in the “culture media” of an ambulatory care clinic.  I certainly respect the pathogens I come in contact with daily, along with the host who harbors them.  For the most part, the virus and the patient know I don’t have much effective artillery to fight back with and my ...

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I’m really miserable and need that 5 day antibiotic to get better faster. Ninety eight percent of the time it is a viral infection and will resolve without antibiotics. But I can’t breathe and I can’t sleep. You can use salt water rinses and decongestant nose spray. But my face feels like there is a blown up balloon inside. Try applying a warm towel to your face. And I’m feverish and having sweats at night. Your temp ...

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There was news of yet another high profile death from an uncertain cause in a star with addiction history.   Media accounts included reference to the "27 club" -- a lengthy list of famous artists who have perished by their own hand, often unintentionally, at the age of twenty seven. The reality is that too many fatal overdoses responsible for the deaths of the famous and not-so-famous are from medications ...

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Any primary care clinic has a schedule that lists the appointments of the day in incremental time slots.   There is a column for the name of the patient, the patient's age, and always there is a place for the reason for the visit--the "chief complaint" according to medical parlance. A quick review of the "chief complaints" for the day gives the physician a sense of how clinic will flow.   There are the seemingly "quick" concerns, ...

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It may not be rabbit season or duck season but it definitely seems to be doctor season. Physicians are lined up squarely in the gun sights of the media,  government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim.   It’s not enough any more to wear a bullet proof white coat.  ...

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It was 1978 and I was a third year medical student when my friend was slowly dying of metastatic breast cancer. Her deteriorating cervical spine, riddled with tumor, was stabilized by a metal halo drilled into her skull and attached to a scaffolding-like contraption resting on her shoulders.  Vomiting while immobilized in a halo became a form of medieval torture.  During her third round of chemotherapy, her nausea was so ...

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‘Twas the week before finals and all through the dorm, few students were sleeping, since Adderall is the norm … What is the state of academic performance and achievement in the age of adult ADHD? Recent media publications feature "neuro-enhancement" sought by college students and stressed professionals through the use of prescribed and non-prescribed medications, particularly stimulants, to guarantee focus, concentration ...

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Sixty five years ago my maternal grandmother, having experiencing months of fatigue, abdominal discomfort and weight loss, underwent exploratory abdominal surgery, the only truly diagnostic tool available at the time. One brief look by the surgeon told him everything he needed to know: her liver and omentum were riddled with tumor, clearly advanced, with the primary source unknown and ultimately unimportant.  He quickly closed her up and went to speak with ...

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shutterstock_118325674 I must have missed the declaration of war on pubic hair. It must have happened sometime in the last decade because the amount of time, energy, money and emotion both genders spend on abolishing every hair from their genitals is astronomical.  The genital hair removal industry, including medical professionals who advertise their specialty services to those seeking the "clean and bare" look, ...

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It’s only been a little over fifty years since vaccinations became routine for the childhood killers like polio, measles, mumps and whooping cough.  People my age and older had no choice but to suffer through childhood infectious diseases given how effectively and quickly they spread through a community. Most of us survived, subsequently blessed with life long natural immunity.  Some did not survive.  ...

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Along with millions of Americans, I've tried to comprehend the tragic shootings in Tucson, reaching deep within myself to find compassion for a young man who has forever changed the world for himself and so many others through his actions. For those of us who assess, diagnose and treat college students struggling with mental illness while trying to succeed in their academic pursuits, the events leading up to his impulsive killings ...

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