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Featured Posts

Effect of Upcoming US Elections on Reproductive Rights

As a healthcare provider I have been struggling with the issue of reproductive rights and their relevance in the upcoming US presidential election. On the one hand, my job is to treat patietns and care for them - not dictate policy. On the other hand, if policy interferes with my ability to care for my patients in the best way possible, should that not influence how I vote? My question is if you think healthcare policy is something doctors should be outspoken about and should lobby for? Is this something that should be left up to lawmakers? Thanks in advance for contributing to the interesting conversation. 

M&M - 3 year old girl in septic shock with delay in fluid resuscitation and antibiotics

I would like to share a case I recently presented at a morbidity and mortality meeting. This case has deeply affected me and I am comitted to learning the hard lessons so as not to repeat them. I would love to hear your constructive criticism about this case. Ciritcal details have been altered to protect the patients identity.

Lucy, a 3-year-old girl with no relevant past medical history, arrived at the emergency department with high fever, lethargy, and rapid breathing after two days of worsening illness, including a sore throat, mild cough, and decreased responsiveness. Upon arrival, Lucy had a fever of 40.3°C, tachycardia of 155 bpm, tachypnea of 45, and borderline hypotension with a blood pressure of 82/50. Her capillary refill time was prolonged at 4 seconds, and she appeared visibly distressed.  Recognizing the seriousness, I ordered a sepsis workup, fluids, and broad-spectrum antibiotics. However, treatment was delayed due to a busy ER with limited resources and staff availability that evening, which led to a backlog in addressing critical cases. At first, this delay was not considered significant - we anticipated that timely IV access could be achieved in a straighforward manner at whch point we would focus on stabilization. When it became evident that obtaining IV access would be harder than usual, given no immediate signs of rapid clinical decline, it seemed reasonable to continue with attempted IV access rather than shift to an intraosseous (IO) access. This, however resulted in the administration of fluids and antibiotics being delayed by close to an hour. 

As Lucy’s condition deteriorated, the team administered additional fluids and antibiotics, but her signs of septic shock persisted, requiring her transfer to the PICU. En route, Lucy became unresponsive and was intubated. Despite aggressive intervention, blood cultures later confirmed Streptococcus pneumoniae septicemia, and she developed multi-organ failure, succumbing to her illness within 36 hours.

What are some pro tips you have for triaging patients in shock given an overwhelmed ER? Should I have switched to IO access sooner to get fluids and antibiotics in her faster? 

Thank you for your helful insights and thoughts. 

45 year old woman with constipation and dyspareunia

I have a 45 year old patient with constipation and dyspareunia. She is healthy and never been pregnant and still getting her period. We have tried a host of different laxatives though none have been effective. She has also undergone a cystoscopy for bladder related issues  that revealed no abnormalities. She experiences pain during intercourse that lasts for hours after. I was talking to a friend who is a physical therapist who said the constipation and pain during sex could be related. He explained that constipation can cause cramping of the pelvic floor leading to painful sex and that physical therapy could really help my patient. 

Has anyone heard of this connection before in your clinic (or personal life)? 

17 year old with skin lesions

A 17-year-old girl presented with linear lesions on her face and abdomen that had persisted for 11 months, causing significant school absenteeism. The lesions appeared suddenly, were asymptomatic, and healed quickly but left behind pigmentation changes and scarring. Despite normal hematological investigations, the patient exhibited an apathetic demeanor and provided an incomplete history. Clinical examination revealed well-defined excoriations, erosions, and scarring, primarily on the face. Dermoscopic findings showed distinct zones of hyperpigmentation, hypopigmentation, and central crusting. 

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How would you continue managing this patient's care?

How old is too old to be a practicing doctor?

Medical Boards around the world are considering new regulations for doctors aged 70 and older due to an increase in complaints against them. In Australia, for example, they are proposing options that include mandatory detailed health assessments or general health checks to ensure their fitness to practice. The current rule, requiring doctors to self-assess their health, might be retained. Concerns about age-related cognitive and physical decline and the rising number of patient complaints have driven these proposals. While aiming to enhance patient safety, these measures might be seen as discriminatory and could potentially prompt older doctors to retire, affecting the healthcare workforce...Read more

What appropriate and respectful  measures could help ensure fitness to practice? 

The University of Sydney 

Severe hyponatremia, unsure if head injury related or drugs?

Hello, a case with a 47 y/o male with a history of diabetes and hypertension, who presented to the emergency department with headache, blurry vision, and nausea. He was knocked over by some wavesat the beach four days ago and suffered from a brief episode of loss of consciousness. He also has a history of heavy alcohol use. 3months ago, he started taking 50mg of chlorthalidone. Now he hashas severe hypoosmolar hyponatremia of 99, potassium of 2.2, magnesium of 1.1, lactate of 3.7, high anion gap of 14, glucose of 212 and serum osmolality of 214 (mOsm/kg). Urine output is normal. CT head also didn't show any findings. We are currently waiting for urine osmolality results and we have updated the nephrology team as well. Given his dire situation, what could be the cause of his severe electrolyte imbalances, is the loss of consciousness relevant?

Over 50% of physicians feel underpaid a G-Med Poll reveals

G-Med has conducted poll exclusively for physicians to gain insight into physician satisfaction with their current income. The poll included 336 physicians who were asked whether they believed they were being paid what they're worth. According to the results, over 50% of physicians did not feel that they were being paid what they deserved, with only 20% stating that they were content with their current income. Additionally, 20% of the respondents believed they could earn more if they worked in a different country, which could indicate that there are significant pay disparities in different regions of the world. Moreover, 4% of physicians reported that they earned more before the COVID-19 pandemic, which suggests that the pandemic may have had an adverse impact on physicians' salaries.

It is crucial to acknowledge the importance of fair compensation for physicians' dedication and expertise. These results reveal that there is a significant proportion of physicians who do not feel adequately compensated for their work. This could have implications for physician recruitment and retention, as well as patient care quality. It is vital for healthcare organizations and policymakers to address the issue of physician pay and ensure that physicians are fairly compensated for their contributions.

Why It's Still Hard to Get Into Medical School Despite a Doctor Shortage

With a worsening doctor shortage, with more than half of med school applicants being rejected from medical school. Dr. Jesse M. Ehrenfeld, president of the American Medical Association, highlighted this crisis, noting the severe impact on rural communities and medical education. The demand for physicians is projected to rise significantly by 2034, but simply increasing medical school admissions, which has been happening significantly in the past 22 years, is not enough due to limited clinical training sites and faculty. Experts emphasize the need for more residency programs and teaching doctors, as well as innovative solutions like those implemented by Texas A&M's Rural and Community Health Institute, to effectively address the shortage and improve healthcare access.

Regardless of where you practice medicine (in the US or not), please weigh in in the comments about how the doctor shortage has effected your practice... Read More

U.S. News

Do reports like this make you anxious about the future of healthcare?What do you think we can do to most effectively address this issue?

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