At this skilled nursing facility, the staff was skilled but not compassionate
SNF is the acronym we use in health care for “skilled nursing facility.” Fittingly, it is pronounced “sniff,” a fact that became fitting as I watched my father die in one this past week.
My parents, 86 and 89, bought into a beautiful retirement community 10 years ago. Included was a lovely apartment, full-service dining facility, gym and health center, the last of which included an SNF.
In the past three months, my dad spent several short stays there. Throughout and in between them, I talked to my mother and sister, who lived nearby. With each conversation, I felt the pit in my stomach growing — my dad was dying....
Source: Kevin, M.D. - Medical Weblog - May 5, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/susan-ely" rel="tag" > Susan Ely, CRNP < /a > Tags: Patient Geriatrics Source Type: blogs
I want to quit medicine, and it has nothing to do with patients
I think a lot about quitting medicine lately. A lot.
Then I have a morning like yesterday morning:
I see a patient I’ve known for more than twenty years, caring for him through an adrenal tumor, a major gastrointestinal surgery and now renal failure, for which he needs a kidney transplant. As we review his last set of labs (stable, thank goodness), he is sanguine, hopeful. He may have found a donor, and he might make it to transplant without dialysis. He has to live — he has a wife and a child.
Next, I mess up my schedule entirely by spending more than half an hour with a patient who only came in to talk —...
Source: Kevin, M.D. - Medical Weblog - May 5, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/rosalind-kaplan" rel="tag" > Rosalind Kaplan, MD < /a > Tags: Physician Primary care Source Type: blogs
Changing Lanes
I drive a fast car. Which if you know me, is quite uncharacteristic. I would say that it is one the few possessions that generally doesn't reflect upon who I am. How I chose this car, the make, and model, are a long story not to be discussed here. But let's just say that it has quite a kick.These thoughts jostled through my mind this morning as I pulled into the hospital parking lot. A recent momentous decision, I surrendered my privileges at this hospital and started using the hospitalists. It had all become too hard. The inane compliance issues with the new EMR. The ER attendings ...
Source: In My Humble Opinion - May 5, 2017 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
This gynecological issue is misdiagnosed over 50 percent of the time
As a consultant in gynecologic pathology, I receive requests for second opinions from patients who have been diagnosed with endometrial hyperplasia. My opinion is based upon correlating the relevant clinical history with a review of the patient’s pathology slides and report. In my experience, there is a difference of opinion that leads to a change in treatment in about half of the cases. 75 percent of cases with changed diagnoses are downgraded to a less serious condition or normal variant, and the remaining 25 percent of those cases are upgraded to a more serious condition.
Pathologists are particularly likely to overdi...
Source: Kevin, M.D. - Medical Weblog - May 4, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/roger-reichert" rel="tag" > Roger Reichert, MD, PhD < /a > Tags: Conditions OB/GYN Source Type: blogs
Should we standardize clerkship grades?
I’ll be honest, when I first matriculated into medical school, I didn’t even know what a USMLE Step exam or clinical clerkship was. In fact, the first time I ever heard of them was from another applicant on the interview trail. I have always been a take-it-one-step-at-a-time type of person, but eventually, I would have to succumb to the pressure and ask upperclassmen about the exam. And what did they tell me? Almost unanimously, it was proclaimed to be the single most important exam of medical school, and that I should, “Do well on Step 1 so I don’t have to worry about third-year clerkship grades or Step 2 CK.” M...
Source: Kevin, M.D. - Medical Weblog - May 4, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Education Medical school Source Type: blogs
There she was, hanging in our closet
No matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it’s some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight.
That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali painted some sort of twisted, melted reality on my wall — it suddenly made sense.
You see, five minutes prior, I was sitting in bed less than fifteen feet from the disaster. I had the usual headphones on w...
Source: Kevin, M.D. - Medical Weblog - May 4, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/jacqueline-cory-russo" rel="tag" > Jacqueline Cory Russo < /a > Tags: Conditions Psychiatry Source Type: blogs
Banning Trans-Fatty Acids in Restaurants Saves Lives, Improves Mouth-Feel
Good news for supporters of trans-fatty acid bans: in New York State counties that implemented restrictions on their use in restaurants and eateries, there were significantly fewer admissions to local hospitals for heart attacks and cardiovascular events. Specifically, researchers found a 6.2% decline in admission for hearts attacks and strokes combined, and an even greater […]
The post Banning Trans-Fatty Acids in Restaurants Saves Lives, Improves Mouth-Feel appeared first on The Examining Room of Dr. Charles. (Source: The Examining Room of Dr. Charles)
Source: The Examining Room of Dr. Charles - May 4, 2017 Category: Primary Care Authors: drcharles Tags: Uncategorized Source Type: blogs
More young people are getting colorectal cancer. What do we do?
After years of declining rates of colorectal cancer (CRC), a study from the American Cancer Society raises the specter that not all is going as well as we would have hoped, especially among younger folks born since 1990. And that raises the question of what the future holds for this frequently preventable form of cancer, including a possible reexamination of when it is appropriate to start CRC screening for people at average risk of developing the disease.
The research, published in the Journal of the National Cancer Institute looked at the rates of colon and rectal cancer diagnoses from 1974 through 2013 in several parts ...
Source: Kevin, M.D. - Medical Weblog - May 4, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/j-leonard-lichtenfeld" rel="tag" > J. Leonard Lichtenfeld, MD < /a > Tags: Conditions Cancer Source Type: blogs
Doctors aren ’t cops: We need to change gunshot reporting
On my first trauma shift as a fourth-year medical student, a young, disheveled man with blood-soaked pants hobbled into the emergency department. Wincing in pain, he offered me a bizarre history of being shot in the leg by a nail gun that went off after he dropped it on some stairs while helping a friend move. He lifted his right pant leg and removed the bloody, tattered bandana wrapped around his lower leg to reveal a pea-sized hole in his shin.
After giving the patient some pain medications and briefly examining his wound with my attending, we sent him to radiology to determine the location of the nail and assess ...
Source: Kevin, M.D. - Medical Weblog - May 4, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/shane-collins" rel="tag" > Shane Collins < /a > Tags: Education Emergency Source Type: blogs
What Netflix can teach us about treating cancer
Two years ago, former President Barack Obama announced the Precision Medicine initiative in his State of the Union Address. The initiative aspired to a “new era of medicine” where disease treatments could be specifically tailored to each patient’s genetic code.
This resonated soundly in cancer medicine. Patients can already manage their cancer with therapies that target the specific genes that are altered in their particular tumor. For example, women with a type of breast cancer caused by the amplification of gene HER2 are often treated with a therapeutic called herceptin. Because these targeted therapeutics are spe...
Source: Kevin, M.D. - Medical Weblog - May 4, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/elana-fertig" rel="tag" > Elana Fertig, PhD < /a > Tags: Conditions Cancer Source Type: blogs
Widespread hype gives false hope to many cancer patients
After Michael Uvanni’s older brother, James, was diagnosed with a deadly form of skin cancer, it seemed as if everyone told the family what they wanted to hear: Have hope. You can beat this, and we are here to help.
The brothers met with doctors at a half-dozen of the country’s best hospitals, all with impressive credentials that inspired confidence.
Michael Uvanni was in awe when he visited the University of Texas MD Anderson Cancer Center in Houston, one of the world’s most respected cancer hospitals. It was like seeing the Grand Canyon, said Uvanni, 66, of Rome, N.Y. “You never get used to the size and scope.”...
Source: Kevin, M.D. - Medical Weblog - May 3, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/liz-szabo" rel="tag" > Liz Szabo < /a > Tags: Conditions Cancer Source Type: blogs
Obamacare isn ’t a disaster. Failing to improve upon it would be.
Congress has returned to DC in the wake of the defeat of Paul Ryan’s American Health Care Act. And while shouting “repeal and replace” might win elections, this debacle proves that the American people will not tolerate their families, friends, and neighbors losing healthcare coverage just so rich people can get tax cuts.
Yet, Congress will certainly revisit health reform again. With the Republican caucus fractured, Paul Ryan should seek out the help of moderate Democrats to fix parts of the Affordable Care Act that would still achieve conservative policy goals.
Moderate Republicans and Democrats might find ag...
Source: Kevin, M.D. - Medical Weblog - May 3, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/cedric-dark" rel="tag" > Cedric Dark, MD, MPH < /a > Tags: Policy Health reform Source Type: blogs
Other jobs have strict rules on hours worked. So should doctors.
There has been much talk over the years about resident work hours. How long is a safe shift? With safety being considered for both the patient and the resident. But no one ever discusses attending work hours. If putting in a 24-hour shift is bad for a resident, isn’t it bad for an attending as well? When I was working in critical access hospitals, I usually was on call for seven straight days or 168 hours. There was the potential for a long stretch of continuous work during that 168 hours, especially since there was no other doctor to cover for me if it got busy. Was my safety or my
patient’s safety at risk if I worked...
Source: Kevin, M.D. - Medical Weblog - May 3, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/cory-fawcett" rel="tag" > Cory Fawcett, MD < /a > Tags: Physician Hospital Source Type: blogs
We need to kick our harmful and ineffective addiction to punishment
As New Jersey Governor Chris Christie takes the lead in crafting the Trump administration’s response to the opioid crisis, he and his colleagues need to understand that we can’t fix the problem until we kick our long-term addiction to the war on drugs and accept overdoses for what they are: a health issue.
Although the majority of Americans who consume illicit drugs do so without addiction, opioid overdose has become a deadly reality. Every day, 120 to 140 people in the U.S. die from drug overdoses, more than from gunshot wounds or car accidents. About 90 of these are due to opioids.
A growing number of Americans beli...
Source: Kevin, M.D. - Medical Weblog - May 3, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/marc-krupanski" rel="tag" > Marc Krupanski < /a > Tags: Conditions Pain management Source Type: blogs
An extraordinary day in the life of a physician
Walk with me, why don’t you? It’s time, don’t you think? We have been avoiding this for quite a while. But it’s best to bring this out from the shadows and into the light. Let’s take a walk through part of my day.
Be careful.
You won’t like what you see. I don’t like this much, but I just keep moving forward, one foot in front of the other. Don’t stop. Can’t stop. Movement keeps things blurry. And blurry is less defined. And less defined is fuzzy. And who gets hurt by fuzzy? Fuzzy is soft and safe. Fuzzy can’t hurt. Fuzzy can’t reach into my heart and soul and hurt me from the inside out.
Continue...
Source: Kevin, M.D. - Medical Weblog - May 3, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/jeremy-topin" rel="tag" > Jeremy Topin, MD < /a > Tags: Physician Primary care Source Type: blogs
