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Latest Posts

How To Micro-Tweak Diagnosis And Treatment

A common problem in healthcare is the number of times that small adjustments are needed in a person’s care. Often for these little changes, a physical exam and face-to-face time have nothing to do with good medical decision making.

Yet the patient and doctor are locked in a legacy-industrialized business model that requires the patient to pay a co-pay and waste at least half of their day driving to and from the office, logging time in a waiting room, and then visiting five minutes with their practitioner for the needed medical information or advice.

Today I’d like to visit the case of a patient I’ll call “DD,” who I easily diagnosed with temporal arteritis (TA) through a 15-minute phone call after she’d spent four weeks as the healthcare system fumbled her time with delays and misdirection via several doctors without establishing a firm diagnosis. Read more »

Descriptive Charting And The Physical Exam

Our relatively new electronic medical record (EMR) product has prompts and clicks for everything imaginable. One of them, which we can use during the physical exam, is the long list of “constitutional” findings that we perceive on generally looking over the patient.

They include things like: Obviously ill, comfortable, uncomfortable, pale, well-nourished, well-hydrated, well-dressed, alert, chronically ill, contracted, emaciated — and so on.

But these descriptors don’t always cut it. I mean, people are both amazing and annoying, so why not add a few more to the list? Read more »

*This blog post was originally published at edwinleap.com*

A Humorous Look At The Physical Exam

People are asking for more physical exam posts.

People asked for more Millli Vanilli too.  People aren’t always smart.

But you ask, I give.  I am just that kind of guy.  It’s been a long time (since October) since I have done a post on this subject.  So for all of you “newbies” out there (I just wanted to use that word and sound like a nerd), I want to give you a recap of what I have already done on the physical exam.  That way people who have not inflicted upon themselves read the old ones can get all caught up.  To be honest, this is one of my favorite series as well.  Or is that “serieses?”  Where’s Grammar Girl when you need her? Read more »

*This blog post was originally published at Musings of a Distractible Mind*

A Stethoscope App for the iPhone: Is It Better The Old Fashioned Way?

It’s out there. It makes a cool picture, but I wonder how many medical students realize how unimportant apps like this have become to today’s cardiovascular care. Don’t get me wrong, it’s good to hear the difference between a systolic and diastolic murmur, or for the really talented, a diastolic rumble on physical exam. Recognizing the difference between mild and severe aortic stenosis is also very helpful. After all, the physical exam remains the most cost-effective instrument in medicine. Read more »

*This blog post was originally published at Dr. Wes*

When Bad News Surprises Us

It’s that part of the job that I’ve never gotten used to.  I hope I never do.

I saw a man recently with an unexpected finding on his exam – a “lesion” that should not have been there.  I was seeing him for his diabetes and blood pressure, and was doing my “ritual” physical exam, when the “lesion” blared into my vision.

I say “ritual” exam because the exam itself had little to do with his medical problems.  It is just my practice to do a cursory  exam of the head, neck, chest, and lungs of most everyone who comes to the office.  I guess it’s the “laying on of hands” part of the practice of medicine that makes me do this; there is something about the human touch that makes a doctor’s visit different from a visit to the accountant. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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