Anxiety and Acceptance

23 yo woman who had graduated from college recently. She had a great internship as well as a good performance review. She was very smart with a good GPA from college. However, she did not get accepted in this particular job that she wanted. This situation caused some anxiety with the patient.

She developed acute chest palpitations, dizziness, headaches, and nausea. She felt so faint that she felt like she could pass out.

The patient went to the ER. The ER doctors did a CT of the head, an echocardiogram, EKG and did not find anything wrong with her. But the ER did not bother to ask the patient beyond what she physically presented the ER doctors with.

A few days later, she went back to the ER for the same symptoms when she felt that the heart was going to burst out of her body. The ER physicians stated the same thing and stated that nothing was wrong with her.

She finally decided to see Dr. Upon further review, she concluded that she had anxiety issues. However, the patient refused to accept this diagnosis.

After the visit to Dr., she went to the ER for the third time and then went back to Dr. Who.

Only after the third time back from the ER and with Dr. Who, did the patient finally accepted her prognosis that she was experiencing anxiety attacks.

It was interesting. As a physician, you need to really understand what the patient is going through as a person and not just ask about the physical ailments. Of course, in the ER, physicians cannot ask these kinds of questions as they are trying to see as many patients as possible.

A Generation of Slackers? Not So Much

According to a NYTimes article, ours is really not a generation of slackers or for that matter lazy.  http://nyti.ms/1w1mKmA.  According to the article, "There is ample evidence that young people today are hard-working and productive. The share of college students working full time generally grew from 1985 onward — until the Great Recession knocked many millennials out of the labor force, according to the Labor Department.And while many college students today — like those of yesterday — get financial help from their parents, 44 percent of students today say that work or personal savings helped finance their higher educations, according to a survey of recent graduates by Rutgers University. “I don’t think this is a generation of slackers,” said Carl Van Horn, a labor economist at Rutgers. “This image of the kid who goes off and skis in Colorado, I don’t think that’s the correct image. Today’s young people are very focused on trying to work hard and to get ahead.”

I guess I do not feel too bad for living at home.

Innovation Is Sweeping Through U.S. Medical Schools Preparing doctors—and in greater numbers—for new technologies and methods

http://www.wsj.com/articles/innovation-is-sweeping-through-u-s-medical-schools-1424145650

Okay. It sounds like I may have made a good decision about going to med school...according to the WSJ article, the core structure of the med school curriculum has not changed since...1910.  So, not only will med schools be more focused on real life situations (instead of theories of medicine) but make doctors more actively involved in their communities.  Doctors will take on a public service component, much like cops and firemen.

Patient-Immunoglobulin G Deficiency

Middle aged white woman came in today with a chronic repetitive sinus infection. She complained of a frequent cold and diarrhea. After an allergy test was completed in which the patient did not show any reactions via the skin test, Dr. ordered a blood test. The blood test revealed that the patient had an immunoglobulin G deficiency.

Immunoglobulin G is a type of antibody that protects the human body from a variety of bacterial and viral infections. This particular patient had a subclass deficiency being that she had a deficiency in several different kinds of the immunoglobulin G proteins.

The treatment used was simply an immunoglobulin G injection--now a much more common treatment for patients with this kind of ailment.

Thyroiditis

Usually healthy middle aged woman presented with sore throat, fever, chills, muscle pain, fatigue and cough. She was checked for strep, influenza, all negative. Sent home with possible viral/flu like illness. URI. Few days later she called again, came in complaining of neck pain.

The patient had anterior neck pain. Upon further examination clearly tender thyroid gland. The blood test showed elevated white blood cell count and high sedimentation ESR(erthroycyte sedimentation rate), which indicates infection or inflammation. 

However, the blood test showed normal thyroid function. She was started on low dose of steroids and anti inflammation medications with a a dramatic pain reduction response of the thyroid gland. Ultrasound showed signs of inflammation.

I just find it so crazy that an inflammation of a gland can just happen so spontaneously.

Out of pocket surgery or have it treated in the office?

Today was interesting.

The patient was an elderly Asian man. He complained of a large mass on his left upper anterior chest. After an examination, Doc decided that it could be excised here in the office.

After applying the anesthetic and removing the mass she measured the foreign mass. It was over 3.5 cm in diameter! It was then sent to the pathology lab for analysis to ensure that the mass is benign and doesn't present any further complications.

Most internists would not want to commit to this kind of procedure in the office. Patients would rather have it done at a surgical center or specialty facility. However, this patient was completely willing and trusting of doing the procedure in the office.

I was just amazed by the trust exhibited by the patient with Dr. But I understood the reasoning behind the patient. Think of the convenience on the behalf of the patient.

If the patient had gone to a surgical center, the excision would cost over $3,000 out of pocket. Then add the ridiculous amount of paperwork and waiting time. On top of that, the patient has no existing relationship with those Doc at that particular surgical center or urgent center. The Doc patient relationship is critical in determining the proper treatment for the patient.