A judge overrules the verdict when it ignores evidence that a clinician failed to heed a crucial test. Dr. J, 62, was a primary-care physician in a small northeastern town. Disturbed by the changes in medical practice over the past 15 years, he was looking forward to retiring in a few months until a malpractice…
Does confidentiality mean hiding a plausible threat to safety? Wheredoes a clinician’s duty lie? Mr. B, 26, couldn’t seem to hold a job. Nevertheless, he proposed marriage to his girlfriend of three years and she accepted. With the wedding looming, he was determined to keep his current position on the assembly line of a paper…
Company: Genzyme Pharmacologic class: Phosphate binder Active ingredient: Sevelamer carbonate 800 mg; tabs. Continue Reading Indication: Control of serum phosphorus in patients with chronic kidney disease (CKD) on dialysis. Pharmacology: Patients with CKD can develop hyperphosphatemia as a result of retained phosphorus, which may lead to ectopic calcification. Hyperphosphatemia plays a role in the development…
Company: Abbott Pharmacologic class: Nicotinic acid derivative + HMG-CoA reductase inhibitor Active ingredients: Niacin extended-release 500 mg, simvastatin 20 mg; tabs. Continue Reading Also: Simcor 750/20 Active ingredients: Niacin extended-release 750 mg, simvastatin 20 mg; tabs. Also: Simcor 1000/20 Active ingredients: Niacin extended-release 1000 mg, simvastatin 20 mg; tabs. Indication: Adjunct to diet in primary…
CASE #1 A 45-year-old man reported a generalized ichthyosis since early infancy (he is not sure if the eruption was present at birth). He has no history of bullae or vesicles. The patient has been taking acitretin (Soriatane) 25 mg daily since the late 1990s. Attempts to discontinue the acitretin left his skin redder, thick,…
A six-month-old boy presented with a penile growth that first appeared within weeks of his birth. His mother reported that since then, the asymptomatic lesion had grown and become more verrucous. No warmth or tenderness was associated with the growth. In a letter sent along with the patient, the referring pediatrician expressed concern about whether…
A 48-year-old white man presented to our clinic for redness and scaling. Over the past month, scaling of his scalp and scaly plaques, which had been present for a few years, had spread to involve his entire body. The patient also complained of chills, pruritus, and malaise. Although he was uncomfortable, he had not had…
A 75-year-old man is being treated for asbestosis, chronic bronchitis, emphysema, and hypertension. He has recently completed chemotherapy for lung cancer that had spread to the lymph nodes. Apparently drowsy from side effects of his medications, he passes out while driving and kills a 10-year-old boy standing on a sidewalk. Can the child’s mother sue…
A global traveler puts the diagnostic skills of clinicians half a world away to the test. Ms. W, a healthy 25-year-old American living in Afghanistan, presented with three subcutaneous lumps on her scalp. The lumps, which had been slowly enlarging for a week, exhibited a central hole or scab. Ms. W reported that they were…
Symptoms that were relieved by a two-week course of prednisone flared when the drug was tapered. Mrs. E, a lively 70-year-old, developed aching leg pains so severe that she had difficulty standing. She next developed right wrist pain and bilateral shoulder pain, limiting her ability to put on her blouse. Except for an erythrocyte sedimentation…
