Patients

MKSAP: 76-year-old woman with abnormal thyroid function tests

Conditions
August 6, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 76-year-old woman is reevaluated after results of thyroid function tests performed 2 weeks ago are abnormal. The patient otherwise feels well. She has a history of hypertension, atrial fibrillation, gastroesophageal reflux disease, and depression. Current medications are metoprolol, amiodarone, warfarin, omeprazole, and sertraline.

On physical examination, …

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The secret in caring for the patient is to care for the patient

Physician
July 24, 2011

Erik’s wife had warned him many times, “Stay off ladders dear, leave it to someone younger.” Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn’t about to slow down for no good reason.

It was an unusually bright crisp November day in Seattle, when Erik …

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The benefits of successful patient self-management programs

Physician
July 22, 2011

The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.

However self-management skills refer to specific curricula of skills that can …

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Do non-compliant patients really sue their doctors?

Physician
July 14, 2011

The non-compliant patient who sues his physician for an adverse clinical outcome is a storied malpractice bogeyman. After failing to follow a screening regimen, show for appointments, undergo recommended tests, make health-related lifestyle changes, or take their medications, these patients (now plaintiffs) have the audacity to blame the doctors and nurses for not being adequately clear or assertive.

Are they real?

Yes and no. Not every “difficult” patient is a potential …

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Sometimes the treatment is worse than the disease

Conditions
June 30, 2011

To do nothing is sometimes a good remedy.
-Hippocrates

Edna Frost is 88 years old, a slender, slow-talking woman with a dry sense of humor and a blood pressure that’s all over the place. At best, she runs ten points higher than any of her previous doctors wanted to put up with. At worst, she flirts with systolics over 200, but that doesn’t seem to be a common occurrence.

Edna has been my …

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Pharmacies selling prescription information to data mining companies

Meds
June 30, 2011

Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.

The data privacy and security concerns surrounding the transfer of de-identified data are significant.  To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal …

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Before getting a CT scan, ask your doctor if its really needed

Conditions
June 15, 2011

How and when do new medical technologies become the standard of care?

A recent study showed that the use of CT scans in hospital emergency departments rose sixteen percent between 1995 and 2007.

Looks a bit like a medieval torture doughnut.

The only thing that surprises me about this is that it’s not more.

Way more.

I remember the first time I actually ordered a CT scan on a patient all by myself, in …

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A history of smallpox in America

Conditions
June 14, 2011

This past Presidents’ Day, I thought it would be a good idea to talk briefly about the role that smallpox played in the life of our first president and it’s important role in the American Revolution. For those who would like to learn about this in greater detail, I would highly recommend the book, Pox Americana: The Great Smallpox Epidemic of 1775-82, written by Elizabeth A. Fenn.

In 1751, when George …

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MRI overuse is widespread, and dangerous to patients

Physician
June 13, 2011

MRI overuse and misuse really make me angry.

Did you know that a growing number of doctors don’t even read the tests themselves? Another shocking aspect of this industry is that some doctors will order an MRI because it’s quicker than doing a full examination. Rushing to an MRI can oftentimes erase clinical correlation, that is, connecting the dots between pain and what the MRI shows.

MRI is unnecessarily overused. In …

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Pain control in a patient with rib fractures and a spinal cord transsection

Physician
June 1, 2011

When I was called to see the patient after a motorcycle accident I expected the worst. The patient sustained a thoracic spine injury with cord transsection at T5 level as well as significant chest wall injury on the right side.

Multiple ribs were broken; some with a significant displacement. Managing patients with a significant chest wall trauma could be a nightmare. Pain control is only one of the challenges.

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Should doctors be addressed by their first name?

Physician
May 29, 2011

I was sitting next to a resident in the preceptor room yesterday.  He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name … but not with “Doctor.”  (e.g., “Hi, this is John Smith from the Family Health Center.”)

I occasionally see the residents’ patients for urgent visits.  When I ask them who their regular PCP is at the office, …

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The three most useful words for a doctor

Physician
May 26, 2011

Here are the three most useful words for a doctor: “I don’t know.”

A close second would be “I’m not sure,” another three that have got me out of trouble more times than I can remember.  The older I get, and more experience I have, the more useful it becomes.

Pattern recognition is essential in effective medical practice.  So often patient complaints are vague and nondescript, and in the absence of physical …

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Why you shouldn’t ignore a swollen knee

Conditions
May 24, 2011

If you develop a swollen knee, please don’t consider it a normal occurrence.

If there was a clear cause, such as a fall to the knee, or some twisting injury to the knee, it’s likely that the cause is due to some mechanical damage. An easily recognized example would be a football or rugby player sustaining such an injury on the playing field. In that case, its typically serious and when …

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