"COVID-19 wreaks havoc on multiple areas of the body, and myself and my fellow frontline workers across the globe have been forced to quickly identify what tools work best in our quest to keep our patients alive. While we’re working to identify which technologies can improve our patients’ outcomes, it’s encouraging that ...

Read more...

I started my medical training in the late 1990s. This was after the AIDS epidemic; that is to say, by that time, the human immunodeficiency virus was known, and there were already proven treatments. So, for doctors of a certain age, this is the first time we have battled an emerging disease. This has created a torrent of confusion and therapeutic missteps. The gold standard double-blinded, randomized, well planned, placebo-controlled ...

Read more...

It’s well known that New York City was hit hard by the COVID-19 pandemic in the spring, having been the epicenter of U.S. cases for several weeks. As I write this, more than 245,000 of my fellow New Yorkers have been stricken, and an estimated one in ten of them have died. In fact, the COVID-19 mortality rate here reached such heights it was projected one New Yorker was dying every ...

Read more...

My group of nephrologists is trying to convince our 75-year-old colleague to retire from full-time clinical practice.  I think he truly believes that the day he retires, his essence, soul, chi -- whatever you want to call it -- will be forcibly removed from his body, and he will cease to exist. He has told me, more than once, that he will be dead in less than a year if ...

Read more...

“I’m one of the doctors taking care of your dad.” As a resident, I made this call countless times.  Even more than breaking bad news to patients, I feared surprising their families at night by telephone.  Nearly always, though, people were calm and certain despite the circumstances, and their response was always the same:  “Do whatever you have to do.”  As a fellow, I looked forward to leaving those calls behind.  ...

Read more...

A couple of months ago, I had a lecture on the "Principles of Epidemiology and Public Health." I remember looking at the graphs taken from the American Heart Association and noting that the incidence of developing coronary heart disease or myocardial infarction was higher in black men compared to their white counterparts. I thought to myself, "So this means that race is a risk factor in ...

Read more...

In anticipation of the strain on resources and staff in New York City, part of the battling strategy included deployment calling for providers from all areas to directly devote their efforts in the care of COVID-19 patients.  Despite being relieved temporarily of the role of a nephrologist, the COVID-19 population soon showed that managing renal disorders was still part of daily duties. With COVID-19, providers have been ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old man is evaluated during a follow-up visit after presenting to an urgent care clinic for back pain 1 week ago. Laboratory studies at that time were significant for a serum creatinine level of 1.4 mg/dL (123.8 µmol/L); other laboratory studies, including urinalysis, were normal. A ...

Read more...

In recent times, physician burnout has rightfully surfaced as a social concern for the medical fraternity. Physician burnout is a thing, and lately, I was thinking about it related to nephrology. Many national physician organizations and local hospital systems are developing strategies to reduce work-life stress and improve the engagement of the workforce. In November 2018, I represented the Renal Physician Association at the interim meeting of the American Medical Association ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old man is evaluated for anorexia, dizziness, and weakness. He was discharged from the hospital 5 days ago after transsphenoidal pituitary surgery for a pituitary macroadenoma abutting the optic chiasm. His postoperative course was uneventful, and his postoperative hormone evaluation was normal; he did not require ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated during a follow-up visit for primary membranous glomerulopathy. Diagnosis was made by kidney biopsy 4 months ago, and she was found to be positive for anti–phospholipase A2 receptor (PLA2R) antibodies. Medications are furosemide, losartan, and simvastatin. Recent age- and sex-appropriate cancer screening tests were ...

Read more...

She placed the stack neatly aside with all forms diligently signed and dated. The inbox was cleared. Being finally rested, her tasks of staying on top of duties and focusing on executions became briefly easier. A few patient callbacks, an eight-page disability form to fill out, a doctor to connect with, seven notes to complete and two test results to review and relay would round off the already pregnant day. ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 69-year-old woman is evaluated in the emergency department for new-onset dependent edema that began 3 weeks ago. She says it is difficult to walk, and she has gained 4.5 kg (10 lb) of fluid weight. History is significant for obesity and hypertension. Her only medication is lisinopril. On physical ...

Read more...

Even during medical school, there was always the running joke about getting kidney stones. With the frenetic pace of many rotations, it was always difficult to squeeze in bathroom time, and I suspect many of us adopted the same solution – drink less water. That is certainly how I survived my month on vascular surgery. After a nine-hour case, I was told by one of the residents that everyone was ...

Read more...

These are trying times for health care optimists. Despite all the hype surrounding breakthroughs in clinical practice and technology, American medicine is stuck in in neutral. Though the engine is revving loudly, little progress is being made. This unfortunate truth came into clearer light last week when I was preparing lesson plans for the health care strategy course I teach at the Stanford Graduate School of Business. During the first class of ...

Read more...

World Kidney Day reminds us of the 850 million people globally affected by kidney diseases. It draws attention to the 1 in 7 American adults managing Chronic Kidney Disease (CKD) and the 660,000 Americans with end-stage renal disease (ESRD). It also reminds us that kidney disease is the 9th leading cause of death in the United States. But perhaps one of the most important statistics on World ...

Read more...

How did I miss his hypokalemia? Two weeks into my intern year and my patient’s potassium returned at 2.9. Minutes later, he coded. And I felt responsible. As I explained to my partner how my patient had become pulseless after diuresis of his heart failure, she looked at me and said, “Physicians kill patients, it’s inevitable. Has no one told you it’s part of the job?” There is truth to this ...

Read more...

Last week I had a patient with mild kidney disease and a high potassium. I thought that it would be easy to take care of. We called around to all the pharmacies from Bangor to Ellsworth to Belfast, and nobody had Kayexalate, the time-tested antidote, in stock. It happened to be on a Tuesday night with my Suboxone group starting at 5 o’clock. The patient had been there since 4; his ...

Read more...

Before I could see her, I could hear her. My patient, a young woman with messy braided hair, was grunting with every effort to breathe. The noises quieted slightly when I reached her bedside, but her tears continued to fall between gasps. Her body movements were exaggerated, rooted in the rhythm of her labored breathing — several violent shudders with every expansive inhale, and a wave of quivers with every ...

Read more...

As a family physician, I treat patients of all ages – children to those nearing 100 years old. One issue that plagues young and old alike is lack of sleep. In fact, according to the Centers for Disease Control and Prevention’s (CDC) 2016 Morbidity and Mortality Weekly Report, more than one-third of American adults do not get enough sleep on a regular basis. This is a common ...

Read more...

6 Pages

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories