Use of generic drugs has the potential to reduce annual consumer spending on prescriptions by billions. A study published in the New England Journal of Medicine and discussed in the New York Times’ Economix blog in 2012 looked at Medicare Part D expenditures and correlated them with drug prescribing patterns. The regions of the United States with the highest Medicare expenditures were those where …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is evaluated for a 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type 2 diabetes mellitus 2 years ago. She also reports developing muscle weakness of the lower extremities 6 months ago. Her diabetes is only partially controlled by metformin; her blood glucose …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is transferred to the cardiothoracic intensive care unit (ICU) after undergoing repair of an abdominal aortic aneurysm. She has a 12-year history of type 2 diabetes mellitus.
Her blood glucose level on arrival at the ICU is 289 mg/dL (16.0 mmol/L). Although no longer on a cardiopulmonary bypass pump, she remains intubated …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman comes to the office for a follow-up evaluation. She has had type 2 diabetes mellitus for the past 13 years and has experienced two early-morning hypoglycemic episodes in the past 3 months.
Although her self-monitoring of fasting blood glucose levels over the past …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old man is evaluated in the hospital for poor glycemic control before undergoing femoral-popliteal bypass surgery. He has been on the vascular surgery ward for 3 weeks with a nonhealing foot ulcer.
The patient has an extensive history of arteriosclerotic cardiovascular disease, including peripheral vascular disease, and a 20-year history of type 2 diabetes …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old man is evaluated for recently discovered spontaneous hypokalemia and hypertension. The patient had normal blood pressure at a visit 1 year ago. He has no symptoms and takes no medications.
On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 148/96 mm Hg, pulse rate is 58/min, respiration rate is 18/min, …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 45-year-old woman is seen for routine follow-up. She has type 2 diabetes mellitus, diagnosed 5 years ago; initial treatment included metformin and glimepiride. A daily injection of insulin glargine was added to her regimen 1 year ago.
At present, her hemoglobin A1c value is 8.1%. Mean blood glucose values derived from the past 4 …
It seems like every day in the office I see at least one man concerned about testosterone deficiency. If you look at the symptoms of testosterone deficiency most of us have one or more of these symptoms at least some of the time. Fatigue, depression, weight gain, lack of energy, reduced sex drive, loss of physical strength, and moodiness are all described as symptoms typical of testosterone deficiency. Making the …
Now more than ever, the growing consensus among many is that doctors should avoid seeing pharmaceutical sales representatives, otherwise known as drug reps. A position statement from the AAMC, the head organization of all US medical schools and residency programs, recommends that all academic health centers avoid having drug reps on their campuses, hospital and clinics. Many medical institutions including the VA and Kaiser have also enacted similar policies banning …
Propaganda and non-truths abound all around the Internet saying that mobile health apps are everything from a threat to Big Pharma to a way to save billions of dollars in healthcare costs. There may be a future for mobile apps but a lot of work is yet to be done.
Last year I led some market research into mobile apps across all demographic segments and several disease conditions. While we did …
Physicians as guardians of science have an obligation to teach the facts of life to our patients and our legislators. And today the need to dispel ignorance of biologic facts is more urgent than ever. Just as President Obama is deferring legislation on marriage to the states, I will defer the issue of whether the government can or should regulate marriage to legal scholars and our duly elected representatives. However, …
Physicians and other healthcare professionals often tell their patients with type 2 diabetes to avoid eating too much starch and sugar in order to keep their blood sugar from going too high.
But if the patients follow that advice, they’ll end up eating more fat and more protein, which could increase their risk of cardiovascular and renal complications.
Worse yet, a high fat intake may actually keep the patients diabetic.
It …
Medicaid patients with diabetes and hypertension need better outcomes. To achieve better outcomes, physicians need more consistent information on their patients’ real health behaviors. State legislators are pressing to get healthcare costs under control, while Medicaid administrators need to invest thinly stretched resources simultaneously in direct care and broad public health programs that will keep hospital readmissions down. As director of a network of managed primary care systems (Northern Piedmont Community Care) …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old woman who resides in a nursing home is seen for management of her diabetes mellitus. The patient’s blood glucose log shows levels ranging between 40 and 400 mg/dL (2.2 and 22.2 mmol/L). She otherwise feels well. She has been on insulin for more than …
As diabetic patients and their physicians continue to work together to combat this metabolic disorder, researchers and medical organizations are uncovering new ways to fight this illness. With 26 million Americans currently battling the disease and 79 million already diagnosed with pre-diabetes, this disease poses a serious threat to our society and our overall healthcare system.
With these startling statistics in mind, the Northern States Ambulatory Research Network (NORTHSTAR), a practice-based …
Quality indicators are used to measure the quality of health care delivered to patients. Quality indicators are used extensively in the VA health system, and efforts are underway in Medicare to tie reimbursement levels to performance on quality indicators.
The motivations for using quality indicators are guided by the best of intentions. There are many problems with the quality of health care in the US, and quality indicators aim to improve …
Political correctness and sensitivity training are interfering with medicine and healthcare. In a recent article published in the journal, Pediatrics, a group of researchers published their findings regarding parental perceptions of the terminology that doctors use to describe childhood obesity (ages 2 to 18). The researchers found that it was undesirable to use the term “fat,” “obese,” or “morbidly obese” because they were stigmatizing, blaming, and the least motivating to …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man with a history of coronary artery disease and diabetes mellitus will undergo elective coronary artery bypass graft surgery. His last hemoglobin A1c value was 7.8%, and his plasma glucose level 2 hours prior to scheduled surgery was 238 mg/dL (13.2 mmol/L). Hemoglobin is …
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