August 2016

August 31, 2016Aug 31, 201624

Pharmaceutical companies are brilliant. They make profit off of chemicals that can be potentially life-saving. The list is quite impressive: antibiotics for somebody who would otherwise succumb to sepsis, insulin for someone whose pancreas loses the ability to function, antivirals for chronic viral suppression, antineoplastic agents for somebody whose cells have lost their regulatory mechanisms, just to name a few.

The recipe seems to be quite simple: Charge as much money …

Drugs and prescribing

The maker of EpiPen sticks it to patients

Monique Tello, MD

August 31, 2016Aug 31, 201627

Recently, friends of ours had a frightening experience: They were on vacation, and ordered takeout from an unfamiliar restaurant. They specifically asked about peanuts: "Are the egg rolls fried in peanut oil? Our daughter has an allergy." The server replied:…

Recently, friends of ours had a frightening experience: They were on vacation, and ordered takeout from an unfamiliar restaurant. They specifically asked about peanuts: “Are the egg rolls fried in peanut oil? Our daughter has an allergy.”

The server replied: “No, no peanut oil.”

And so they ordered the egg rolls.

Awhile after eating an egg roll, their school-aged child Anna (not her real name) complained of a tummy ache. Then, nausea. They …

Physician voices

Why psychiatrists should stop diagnosing presidential candidates

Maria Yang, MD

August 31, 2016Aug 31, 20165

The New York Times and NPR recently published articles related to the Goldwater Rule. In short, a magazine sent a survey to over 12,000 psychiatrists in the U.S. with the single question of whether they thought presidential nominee Mr. Barry Goldwater was fit to serve as president. Few psychiatrists responded. Of those that did, more than half — still over 1,000 — said that …

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Medical education

What kind of doctor do you want to be? Think about it.

Brian Sutterer

August 31, 2016Aug 31, 20163

"A doctor’s mission should not be just to prevent death, but to improve the quality of life. You treat a disease, you win-you lose. You treat a person, I guarantee you’ll win, no matter what the outcome.” – Patch Adams…

“A doctor’s mission should not be just to prevent death, but to improve the quality of life. You treat a disease, you win-you lose. You treat a person, I guarantee you’ll win, no matter what the outcome.”
– Patch Adams (1998)

It’s that time of year where everyone begins residency applications, and you commonly hear conversations along the lines of, “What are you going into?”, or, “what type of doctor are you …

Conditions and diseases

Can we break the cycle of chronic pain in patients following orthopedic injury?

American Society of Anesthesiologists & Maureen McCunn, MD & Melissa Yu

August 30, 2016Aug 30, 201631

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. "You are the only one who truly understands your own pain." As one trauma survivor from the University of Maryland Shock Trauma Center in Baltimore told us: “The…

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

“You are the only one who truly understands your own pain.”

As one trauma survivor from the University of Maryland Shock Trauma Center in Baltimore told us: “The pain is with you 24/7. It is nonstop. And that is the hard part, you cannot escape it.”

Pain is classified into two general categories: acute and chronic. While acute pain is …

Physician voices

A wonderful hour of being a real doctor

Justin Reno, MD

August 30, 2016Aug 30, 2016

Sometimes the business plan completely falls apart. I look at my clock; it’s 11 a.m., and I only have two patients remaining for the morning? Something must be wrong. Every fail safe measure to keep the assembly line going must have failed. The initial card with the appointment time to carry in the wallet? Failed. The reminder phone call the day before? Failed. Even the insurance company gift card to …

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A wonderful hour of being a real doctor

Physician voices

To the doctors struggling with depression: You are not alone

Elisabeth Poorman, MD

August 30, 2016Aug 30, 201612

By the end of my first year of residency, I knew I was in trouble. I was overwhelmed by the 15-hour days, the unbearable sadness of the tragedies I witnessed, my feelings of impotence and my fears of making a…

By the end of my first year of residency, I knew I was in trouble.

I was overwhelmed by the 15-hour days, the unbearable sadness of the tragedies I witnessed, my feelings of impotence and my fears of making a mistake.

My life was my work, and everything else seemed to be falling apart: my physical health, my relationships, my ability to sleep after months of night shifts.

Yet, I came to work …

Physician voices

How the power of song connected me with a patient

Pepi Granat, MD

August 30, 2016Aug 30, 2016

She smiled fetchingly and threw her arms around me. She was so happy to have someone to hug. She was large, obese, kyphotic and almost bent double while edging slowly with her walker toward the examining room. She had sent a Christmas card and a birthday card, and I thanked her for them, while secretly praising myself for remembering she had sent them.

She was diabetic and hypertensive and 88 years …

Health policy

Why are ERs so busy? It’s really no surprise.

Manuel Momjian, MD

August 29, 2016Aug 29, 201673

If the emergency room is the most expensive place to receive health care, then why are more patients visiting the ER than ever before? There are no local doctors’ offices that can charge $1,000 to put a Band-Aid on your finger or $8,000 to tell you that your abdominal pain is due to drinking too much coffee. But, I don’t think you would mind paying this premium if you were having …

Physician voices

Jess Jacobs: Thank you for what you taught me

Fatima Z. Syed, MD

August 29, 2016Aug 29, 2016

I never knew Jess Jacobs, and she never knew me. Everything I know about her I have learned from her Twitter feed, her website, and articles written about her. She was the same age as me when she died recently. She was educated. She knew the health care system inside and out, as an expert in insurance and policy and as a patient. But she was more than …

Physician voices

We are nurses: Stop the bullying in health care

Debbie Moore-Black, RN

August 29, 2016Aug 29, 201618

The surgeon is doing a tonsillectomy on a 4-year-old boy. Dr. Jones drops an instrument on the floor of the OR. The instrument is now contaminated and has to be sterilized by a special machine called an autoclave. This was a small hospital, so they did not have a large inventory of duplicate surgical instruments. So the circulating nurse put the instrument into the autoclave. As this machine locked in …

Physician voices

Instead of training more doctors, why don’t we keep the ones we have now?

Jaclyn van Nes, MD

August 28, 2016Aug 28, 201615

In an article from the Pew Charitable Trusts, an upcoming scarcity of OB/GYNs in the U.S. is predicted with a potential shortage of 22,000 OB/GYNs by the year 2050. Reasons given for the shortage are a growing population, female OB/GYNs retiring early and working part-time, residents entering sub-specialties and changing physician attitudes about work-life balance. Suggestions in the article to combat the shortage are increasing OB/GYN residency spots and supporting …

Physician voices

Physicians will rise to take back the bedside

Jean Robey, MD

August 28, 2016Aug 28, 20165

Art explains medicine by explaining human needs. In December of 2015, Dr. Michael P. Jones wrote a piece that had 27K shares: "We’ve killed the way physicians should be." It is interpreted that 27K readers or more identified with what…

Art explains medicine by explaining human needs. In December of 2015, Dr. Michael P. Jones wrote a piece that had 27K shares: “We’ve killed the way physicians should be.” It is interpreted that 27K readers or more identified with what Dr. Jones wrote.

In his essay, he claimed the identity of a physician was being “killed” by the reality of practice demands. The essay referenced an image of the …

Physician voices

A failure in transition of care

Hans Duvefelt, MD

August 28, 2016Aug 28, 20164

Alvion Barr had a four-month delay in his diagnosis. He is technically a patient of my colleague. But he had drifted between two of our regular doctors and a locum tenens physician we hired to work during March, when both…

Alvion Barr had a four-month delay in his diagnosis.

He is technically a patient of my colleague. But he had drifted between two of our regular doctors and a locum tenens physician we hired to work during March, when both other doctors were on vacation.

I saw him late Thursday afternoon for a rash, but he also asked what he could do about his heartburn.

“Tell me more about your heartburn,” I said.

What followed …

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A failure in transition of care

Physician voices

How words create bridges to a therapeutic relationship

Anne Katz, RN, PhD

August 28, 2016Aug 28, 2016

I am sensitive to language and the way we use it in health care; as the editor of the Oncology Nursing Society’s premier research journal, the Oncology Nursing Forum, and as a sexuality counselor, words are my business and the…

The conversation typically goes like this:

Me: “Hello, can I speak with Mr./Ms. X …

Medical education

Medical student: “I was less stressed in Afghanistan.”

Pamela Wible, MD

August 27, 2016Aug 27, 201665

Dear Pamela, Let me start off by telling you that I am a warrior, a protector, and a healer. I am an Army veteran. I’ve worked as an EMT, completed a bachelor's degree and two years of medical school, plus…

Dear Pamela,

Let me start off by telling you that I am a warrior, a protector, and a healer. I am an Army veteran. I’ve worked as an EMT, completed a bachelor’s degree and two years of medical school, plus I’m raising a family. I’ve achieved amazing things, but I have never been defeated like I’ve been over these past few years.

Honestly, I was less stressed in Afghanistan. Medical school is …

Physician voices

The true essence of what it means to be a companion

Amanda Sommerfeldt, MD

August 27, 2016Aug 27, 2016

The world can be a lonely place. Despite technology designed to bring us closer, it seems we've become more isolated. We view profiles rather than embrace complete individuals. We spend hours crafting a persona, a smooth and unblemished public face.…

The world can be a lonely place. Despite technology designed to bring us closer, it seems we’ve become more isolated. We view profiles rather than embrace complete individuals. We spend hours crafting a persona, a smooth and unblemished public face. Raw, unattractive emotions: grief, insecurity, jealousy. We mask those from others and even hide them from our deepest selves. Ultimately, rather than becoming more connected, I suspect we are cast …

Conditions and diseases

MKSAP: 57-year-old man with substernal chest pain

mksap

August 27, 2016Aug 27, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus,…

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual nitroglycerin as …

Health policy

Invest in primary care and you get what you pay for

Niran S. Al-Agba, MD

August 26, 2016Aug 26, 201620

In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a…

The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical …

Physician voices

Politics in the exam room? Here’s what this doctor does.

Steve Schlozman, MD

August 26, 2016Aug 26, 20165

When I was 17 years old, I insisted that my father, a pulmonologist, join Physicians for Social Responsibility. I had just read about the organization in my history class, and I was feeling increasingly hopeless that I would live to…

My father refused to even have the discussion.

I’ll get to why he refused in a minute, but first, a bit of …

August 2016

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