I am a retired family physician (FP) and do extensive traveling in my RV. Since I have multiple medical problems, I attempt to carry with a copy of my medical records with me. I am often surprised by the information that is included in the office dictation or the hospital record and wonder how that information was obtained since it was not elicited by asking me for the info. Case in ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated in follow-up after being diagnosed with severe obstructive sleep apnea 8 weeks ago. Continuous positive airway pressure (CPAP) was prescribed based on a titration during in-laboratory polysomnography. He notes some improvement in his sleep with CPAP, but he still feels drowsy during the day. ...

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As I was reviewing his chart, I noticed under social history that “freelance artist/painter” was listed as his occupation. I've never met a patient of such talent and honestly, I was excited to meet him. When I arrived at the ER, I was introduced to an unassuming elderly man. He wore a pair of worn out jeans and a burnt orange T-shirt. Tufts of white hair emanated from under his ...

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A few months ago, I was on call and admitted a 65-year-old man to the intensive care unit for a flare of his chronic obstructive pulmonary disease (COPD). Although he had only gotten to the point of being unable to speak full sentences between gasps for breath for only a few days, his story started two months earlier when he had gradually started retaining water and getting more short of ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated in follow-up for idiopathic pulmonary fibrosis (IPF), which was diagnosed 2 years ago. He has cough and shortness of breath and now requires supplemental oxygen at rest. Previous evaluations have not identified any cause for his symptoms other than progressive IPF. He has participated in pulmonary ...

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Recently, I entered an essay contest on advice you would give to future medical students. I sincerely believe that the best person to write an article offering advice to younger medical students should come from a person who didn’t match. Also known as me. Why, you say? Well, for everyone else, Match Day is a culmination of four years of mentally, physically, and emotionally taxing work. They might even forget ...

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I was a foreign medical graduate who in addition to some clinical practice, had begun a career first in managed care as a utilization management coordinator and then as a clinical researcher after finishing medical school and then pursuing a public health degree. A few years ago, life took some unexpected turns, and I found myself in a rather new field of health care known as clinical documentation improvement (CDI). I ...

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Walking down the street, I sometimes see people who appear to be strolling in a cloud. These folks are wrapped in vapor they inhale from e-cigarettes — a practice called vaping. Vaping devices first emerged in the late 1990s. They feature a battery-powered heating element that heats up liquid nicotine to create an aerosol, which is free from the toxic byproducts of cigarette combustion. In theory, this ...

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Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma acquired outside of the hospital or less than 48 hours after hospital admission. CAP is classified into typical and atypical subtypes, differentiated by their presentation and causative pathogens. This illustration focuses on the classic features of typical CAP. The most common cause of typical CAP is Streptococcus pneumoniae. It is an encapsulated, gram-positive, ...

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When I was an intern the Durham VA Hospital, there was a sign taped to the ceiling of one of the workrooms. It said in big, bold letters: SUBDURAL HEMATOMA/PULMONARY EMBOLUS. This was to remind all house officers, at work in the middle of the night, about likely diagnoses for mysterious or confusing diagnostic puzzles. When you slapped your head in desperation and looked up, you would see the answer. ...

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