There’s an adage I often think about: “A physician’s job requires the expression of confidence. The researcher’s role is to express doubt.”
This was never more apparent than when I transitioned from the research environment into the clerkships of medical school. The language of decision-making had abruptly changed — in the lab, a year’s worth of experiments is summarized with “seems” and “suggests,” and every assertion is carefully calibrated to acknowledge uncertainty and a high standard for proof.
As a student on clerkships, I couldn’t quite wrap my head around the residents’ ambitious plans for patients: Read more »
*This blog post was originally published at Blogborygmi*
Seems like I’ve been on a real run of chest pain patients lately. Which is fine — it’s part of the gig. I did have a very interesting pair the other night. They were seen in sequence, right next to one another, in room 7 and room 8. They were both totally healthy women in their mid-fifties. And they were both over-the-edge, crazy, crawling-out-of-the-gurney anxious.
Anxiety is an awful red herring in the work-up of chest pain. People who are having an anxiety attack often if not always manifest some chest pain (pressure, tightness, whatever) as a prominent symptom of their anxiety. On the other hand, someone having a heart attack who is experiencing chest pain will also be anxious — and for good reason! Read more »
*This blog post was originally published at Movin' Meat*
Sometimes in this job you just get lucky. You have an elusive and/or dangerous diagnosis just dropped in your lap. Something devastating that you would never have been able to tease out otherwise just gets handed to you by the patient. There’s a catch, though: you have to be smart enough to know when to listen to the patient, when not to blow off their crazy talk as just crazy.
So it was recently when I saw a guy with back pain. From the chart, it didn’t sound like anything complex: a middle-aged to older guy, maybe 60 or so, with a history of chronic back pain and multiple surgeries for the same. He was on Oxycontin 80 mg three times daily (a very high dose, and a red flag for an ER doc naturally suspicious of drug-seeking behavior). I went to see him, and it was clear in seconds that this dude was JPN: Just Plain Nuts. Read more »
*This blog post was originally published at Movin' Meat*
The case of the haunted scrotum. A 45-year-old man was referred for investigation of an undescended right testis by computed tomography (CT). An ultrasound scan showed a normal testis and epididymis on the left side. The right testis was not visualized in the scrotal sac or in the right inguinal region. On CT scanning of the abdomen and pelvis, the right testis was not identified but the left side of the scrotum seemed to be occupied by a screaming ghostlike apparition (Figure 1). By chance, the distribution of normal anatomical structures within the left side of the scrotum had combined to produce this image. What of the undescended right testis? None was found. If you were a right testis, would you want to share the scrotum with that?J R Harding Consultant Radiologist, Royal Gwent Hospital
And I might add that “The Haunted Scrotum” would be a great name for a punk rock band.
*This blog post was originally published at Movin' Meat*
It’s said that everything comes with a price. The average American now lives almost thirty years longer than a hundred years ago. But for millions of people, the price of longevity has been Alzheimer’s disease. The greatest fear my patients express to me is, “I think I’m losing my mind.” Read more »
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