"To the people who say that wearing a mask perpetuates the conspiracy: Tell that to the health care workers who have put their lives at risk to face firsthand an unknown disease. Tell that to the families of frontline workers who have contracted and succumbed to COVID-19 while their loved ones save everyone else. To the people who say that COVID-19 does not ...

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It seems impossible that 2020 could have brought another existential challenge to life as a lung and ICU doctor. As COVID-19 broke out earlier this year, I found myself on phone calls with physicians practicing in far-flung areas, helping host regular calls and webinar to keep doctors in my state updated on the rapidly changing science, working on triage protocols for decisions nobody should ever have to make, ...

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The work of our lungs is absolutely essential for the health of our bodies. While the whole world is focusing on protecting our lungs from failing us during the COVID-19 pandemic, we urge a moratorium on the sale of all inhalable products, like cigarettes, cigars, e-cigarettes, vape pens, and respectfully request current smokers to try to quit. We are physicians in the San Francisco Bay Area, concerned for patients ...

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What if I told you that the most important vital sign of the COVID-19 pandemic is likely being incorrectly reported in almost every doctor’s office, urgent care center, and hospital around the country? The everyday citizen probably believes that this is an exaggeration, but most physicians know that this is unfortunately, accurate. Let’s step back a minute. Years ago, terms like sepsis, septicemia, and bacteremia were frequently used in an interchangeable ...

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June 25 Like most physicians, I am bad at scheduling my own doctors visit. This year, despite COVID craziness, I had made an appointment with a new PCP to get Singulair refills (my allergies were a killer, and a drippy nose behind an N95 is no joke). I loved my new PCP! She connected with me on a personal level. She dealt with all my concerns without making me come in ...

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As I held the shaky, sweaty hand of my 52-year-old African American patient, lying in her ICU bed, trembling with fear, tears rolling down her eyes, she gathered enough strength to utter “I can’t breathe.” Her words felt like a punch in my gut, eliciting a visceral reaction, with flashes of George Floyd’s body pinned to the ground, running through my mind. The events of the last few weeks had given ...

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Asthma is one of the most common chronic diseases in the U.S., with a prevalence of 15.2 percent. The condition is manageable when treatment is appropriately prescribed, adjusted, and accessed by the patient. However, uncontrolled asthma can impair various facets of life and may even be fatal. This dichotomy is noteworthy, especially when considering how strongly asthma outcomes correlate with other elements of an individual's social ...

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It's 8 p.m., and I stumble into my apartment and fall into bed. Somehow, I avoided nodding off in the car driving home. I just finished a 36-hour shift, something I thought was an inhumane task. Somehow, I survived on two hours of sleep, incessant phone calls, pages, and a granola bar. This morning I saw a cat in my apartment, except I don't have a cat. I fumbled through patient care all ...

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Recently we had a patient admitted for a diagnosis that did not really fit his problem representation. The diagnosis was a convenient one, and easily treated. He initially responded to treatment, and we discharged him. The diagnosis assumption nagged at me, but I did not push forward with a test that my mind wanted. A week later he returned (the dreaded readmission), with the same symptoms. The admitting resident expanded the ...

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"Boxed warnings" or "black boxes" are the strictest FDA label warnings. They appear on cigarettes, fluoroquinolones (for tendon rupture), Lamictal (for SJS and TEN), Accutane (birth defects), and other products with well-known risks. The industry obviously dislikes black boxes since they reduce sales (though their lobbyists charge the boxes "confuse" and "unnecessarily alarm" patients). So it was no surprise that when the
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Dear Congress: For the vast majority of you, I am not your constituent.  But you should listen to me anyway.  I am writing to show you that health care in America is not a political issue; it is a human one.  The same can be said for immigration or education or any other issue that you work on. Let my patients explain this for me. I walk into clinic to a full ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old man is evaluated for a 6-month history of dyspnea on exertion. He has gastroesophageal reflux disease and Raynaud phenomenon. He does not smoke and has no cough or wheezing. Current medications are lansoprazole and amlodipine. On physical examination, vital signs are normal. Oxygen saturation is 91% breathing ambient ...

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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 ...

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One of the most galling aspects of vaping is not that the industry has targeted minors with candy-like flavors and names. Nor is it that vaping fluid often contains nicotine or THC (one of the principal psychoactive ingredients in cannabis). The most galling thing about vaping is that the industry has managed to convince 3.6 million middle and high school students that vaping is harmless. Recently, the CDC ...

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Actor Peter Fonda, son of Henry Fonda and younger brother of Jane Fonda, passed away August 16 at his Los Angeles home. Fonda, who was 79, is probably best known for his role as Wyatt in Easy Rider, a movie he co-wrote, produced, and starred in. Fonda was nominated for the Academy Award for Best Original Screenplay for that film as ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old woman is evaluated during a posthospital visit for severe COPD with an FEV1 of 30% of predicted. She has been admitted three times during the last year with acute exacerbations characterized by cough, increased purulent sputum production, and dyspnea. She is now at baseline of her exertional dyspnea ...

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The only times I stood in Emily’s room without fear were the day I met her, and the day she died. These days were two long years apart, years of unhealthy snacking and spending most weekends away from my husband and son. When Emily’s name first appeared next to mine as an overnight admission, the resident physician providing the hand-off gave me a clear warning: “Good luck. She is the ...

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Asthma is a common childhood condition. Estimates are that around 8 percent of all children have it. The incidence had been steadily increasing for many years, but some recent data suggest the burden of the disease in children may have leveled off over the past couple of years. That’s encouraging, but the number of children with asthma is still huge. The peak age group is 5 to 14. The ...

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I’ve known Pat McCann (identifying information changed) for many years. He carries a diagnosis of COPD and has a preventative and a rescue inhaler, but he has never really had any serious flare-ups. He fell and broke his hip. Then he went to skilled rehab, one of a half dozen near Cityside Hospital. His stay turned longer than expected because he fell, luckily didn’t break anything, but had to go back ...

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We had just exchanged "I love yous" about 15 minutes before the intercom blared: "Code blue." Just like that, my sister was gone — all from what seemed like a simple knee surgery. Simple in the fact that the type of surgery my sister was supposed to have had that fateful morning was an open reduction and internal fixation (ORIF). Thousands of these surgeries have been performed every day. But something ...

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