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Latest Posts

Test That Could Tell Physicians When To Give Antibiotics

From the pages of CSI: Miami… a commonly used forensic chemical called luminol to identify traces of blood at crime scenes has been modified to be used in a novel medical test that can help differentiate a viral infection from a bacterial infection.

Why is this important?

Not uncommonly, it is sometimes hard to differentiate between a bacterial infection which is treated with antibiotics from a viral infection which is NOT treated with antibiotics. Unfortunately, in the healthcare system, too often, antibiotics are given if an infection is present whether viral or bacterial which is leading to multi-drug resistant infections like MRSA.

Well with this test, Read more »

*This blog post was originally published at Fauquier ENT Blog*

Asymptomatic Strep Throat: Should We Treat It?

Occasionally, I see patients who have received throat swabs for strep that have come back positive… even if they have no signs or symptoms of pharyngitis.

In this situation, there are 2 main actions a physician may take (I am biased towards one):

1) Prescribe antibiotics until throat cultures are normal
2) Do nothing

Personally, if a patient is without throat symptoms and has no history of rheumatic fever or kidney damage, I would not have even bothered obtaining a strep test. What for??? Read more »

*This blog post was originally published at Fauquier ENT Blog*

Taking The Emergency Medicine Board Exam In NYC

I took my board exam this week, and I think I liked it.

Which is not to say it was easy, or even altogether fair. And though I felt a little bit better upon finishing than these folks, I could be grossly deluded in my estimation of the number and trickiness of truly tough questions.

But there was a point in the exam, three or four hours into it, when I was overcome by the sheer variety of extraordinary patient presentations — the environmental catastrophes, bizarre overdoses and bites from creatures great and small. Overcome, not because I’ve never seen patients like this (for the most part, I haven’t) or because I didn’t know how to diagnose and manage them (I think I did), but really because these questions underscored what an amazing specialty I’ve chosen. Read more »

*This blog post was originally published at Blogborygmi*

Blood Tests Save Lives If You Know What To Look For

To be a great internist you have to be great at blood gas interpretation. And you have to be able to do it quickly and efficiently. You have to understand what all the numbers mean and you have to get a good clinical sense of how to interpret them and how to change management based on their result. And you have to be able to do it without pulling out your formula books. In six years as a hospitalist I have never calculated what the compensatory responses should be. I just know.

Sometimes blood gases change your management or your medical opinion on what’s happening. Take for example my patient with advanced MS. She presented through the emergency department with “oropharyngeal bleeding of unclear etiology”. Her original BMP:

Na 137
K 4.0
CL 99
HCO3 36
BUN 35
CR 1.0
Read more »

*This blog post was originally published at A Happy Hospitalist*

A Patient Outwits His Doctor

One of our patients came off sedation and was extubated.

A few hours later, the doctor came by to assess the patient’s mental status.  He asked,

“How old are you, Mr. Smith?”

The patient replied, “I was born in 1924.”

It wasn’t really the answer the doc was looking for, so he asked again,

“But how old are you?”

And the patient looked up at the doctor and said,

You do the math.”

**This post originally appeared at Gina Rybolt’s CodeBlog.**

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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