Physicians Perspective

To Screen or Not to Screen, That Is the Question…

Physicians like to have all the answers and be able to remain in control of every situation. We are trained to think about broad differential diagnoses, but, in the end, we expect to have an answer and to be able to say with little doubt that we know what’s going on and what we should do. Even when we don’t know the cause of something, we can resort to using the term “idiopathic”; in other words, a nice way of saying “we do not know” without sounding too ignorant to our patients.

For many years, I have followed the controversy surrounding whether physicians should advise their

Words to Live By, From George Carlin

Ever since George Carlin died this past June, I have been impressed by just how many people have openly admitted to liking his stand-up comedy, each sending me a favorite monologue or video from YouTube to watch and hopefully enjoy as much as they did. While perhaps best known for his censored “Seven Words You Can Never Say on Television” routine, Carlin amazed many with his wit, wisdom, and insight into mainstream America. His views on the aging process were no less thought-provoking and, I think, worthy of sharing with readers.

August: A Month of Important Births and Other Events

Dr. Gambert is Chairman, Department of Medicine, and Physician-in-Chief, Sinai Hospital of Baltimore, and Professor of Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
August has always been a special month to me (and not just because it contains my birthday). I thought I would share some facts with you about August events, and end with one that forever changed the way people function in their daily lives—a phenomenon that has opened new horizons to the practice of medicine an

Physician-Assisted Suicide: A Resident’s Dilemma

While I have been writing this column in Clinical Geriatrics for some time now, I thought you might appreciate the following “Physician’s Perspective” from an Internal Medicine resident still in his first year of training. Clearly, learning to be a board-certified internist takes more than memorizing a list of differential diagnoses, understanding medication use and side effects, and developing physical examination skills. It requires a mastery of the Six Core Competencies established by the Accreditation Council for Graduate Medical Education (ACGME)

The Growing Insurance Crisis in America: Uninsurable, Unaffordable, Unacceptable

Dr. Gambert is Chairman, Department of Medicine, and Physician-in-Chief, Sinai Hospital of Baltimore, and Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Although there are currently between 46 and 48 million persons in the United States without health insurance, and there is talk among the Presidential hopefuls of finding some solution to this growing crisis, an equally important crisis is the growing number of “uninsurable” Americans—even if one is willing to fund his/her own heal

Medication Error: An All-Too-Common Preventable Problem

I have written previously about National Patient Safety initiatives and the need to ensure that all physicians do whatever possible to reduce medication errors. Whether it is writing more clearly, using only “approved” abbreviations, monitoring side effects, or other techniques, morbidity and mortality from medication use can be reduced. A couple of months ago, I watched on national television as a celebrity couple discussed a medication error that occurred when their twins were born. Apparently, the babies were given one form of heparin that contained 10,000 u

“Don’t You Think They Should Have Told Me?” Is Full Disclosure Always Necessary?

We hear a lot about the need to provide “full disclosure” to our patients—and rightfully so—but what exactly is appropriate? Just listen to the ads on television for various medications; one is struck by the litany of possible side effects that would make anyone fear taking the medication if they gave it any thought. Is this the right forum in the first place to let the public know about a medication for a specific problem? Some would argue that it is not.
What exactly is full disclosure, and when is it okay to hold back

Weighing the Benefits and Risks of Searching for the Fountain of Youth

"Healthy aging,” “life extension,” “successful aging.” These phrases are frequently used to promote a special lifestyle, diet, medication regimen, or treatment. While the eternal search for the Fountain of Youth remains elusive, it is easy to see how normal aging and age-associated illness can bring thoughts of vulnerability and the need to do something “different.” While some are searching for a prolongation of the lifespan itself, others are merely trying to live healthier and more productive lives for as long as possible.

The Answer Is Often Right Before Our Eyes

Ms. J is a 62-year-old woman with a long and difficult medical history. Suffering from diabetes mellitus for most of her life, she underwent renal transplantation 16 years ago, at the same time she had a pancreatic transplant. She took insulin daily as well as a number of immunomodifying medications, including steroids. In the past few years, she was diagnosed with congestive heart failure (CHF) for which she also took a myriad of medications, including an anticoagulant. One night, Ms. J awoke complaining of

Exploring Complaints of Fatigue in Older Patients

In preparing for the annual rite of teaching clinical skills to medical students, I was once again reminded of the importance of obtaining an “accurate history,” performing a proper and thorough physical examination, and obtaining necessary and pertinent laboratory testing. How easy it is to go down the wrong diagnostic path if one has erroneous information and makes the wrong assumptions. One excellent example is the frequent complaint of “weakness” when in fact the person is really complaining of feeling “fatigued.” There are over 10 million visits pe