Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 56-year-old man is evaluated for painless intermittent bloody urine of 6 weeks’ duration. History is significant for granulomatosis with polyangiitis (formerly known as Wegener granulomatosis) diagnosed 10 years ago, which is now in remission; he was treated with prednisone for […]
I’m a pathologist and the main way I communicate to the outside world — to your doctor and ultimately to you, the patient is via the pathology report. But the short missives I send from behind the microscope lack any excitement and can fall short of full communication. Here’s the usual story: Skin left scapula, […]
Informed consent is the cornerstone of medical ethics. And every physician must defend this sacred principle from every form of evil that would seek to dismantle, degrade and debase it. If informed consent is the sun, then privacy, confidentiality, dignity, and trust are planets that go around it. For without informed consent, the descent of […]
The surgical team filed out of the patient’s room. I looked over my shoulder to see a shaken daughter holding the wrinkled hand of her quiet, elderly mother who lay in the bed. I shuddered as I thought of the surgery her body would endure the next day. I knew I needed to return to […]
“I want answers!” My mother was upset over the care for her ill husband. Previously able to converse normally, he was now incoherent and disoriented. The recent recipient of a bone marrow transplant to treat his advanced leukemia, he probably experienced a brain infection because of the immune suppression therapy needed to accept the marrow. […]
It usually starts with a phone call: “Doc, can I come and talk to you about something?” The “something” might be erectile difficulties or other side effect(s) from prostate cancer treatment. It might be confusion or indecision about what treatment to agree to. I always inform the caller that any of these issues are better […]
1. Cancer is not rare. Technically, childhood cancer is rare compared to adult cancer, but it’s not as rare as you think. Outside of my work, I can think of 3 people who I know personally that had a childhood cancer. A teammate on my high school basketball team, my sister-in-law, and a high school […]
This must be my eighth cancer scare. (No, I really don’t undergo excessive testing.) Decades ago, I’d noted a possibly normal finding but dropped it after getting no response at subspecialist visits. Recently, following pertinent CME, I asked again and the physician bit. You can guess the rest. One night while dodging traffic I accessed […]
Watching patients suffer and die is not an easy thing to do. Left unchecked, I don’t think most front-line doctors would last too long immersed in that kind of setting. First, the emotional toll would be too high to maintain over a long period of time. Second, working at the extremes of emotion doesn’t allow […]
Recently, a patient came in around 11 p.m., just as the chaos of the day had settled, and I was thinking of rest after 16 hours of work. He was an older gentleman with vague and concerning complaints that would demand a thorough workup. I suspended my thoughts of self-preservation and stepped in to evaluate […]
