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Be mindful of your words. Medical students are listening.

Medical Education

August 21, 2016

As first year came to an end, we were asked to reflect on our experiences thus far. The multitude of tests and memorized facts, anatomy dissections, and patient interactions flooded my mind. Shockingly, it was not the difficulty of the first year of medical school that I will remember the most, rather the jaded comments from physicians and students that attempted to cloud my perspective of medicine.

“Medicine is different now. …

Death is not the enemy. More physicians need to realize that.

Nancy Wang, MD, MPH

Physician

August 20, 2016

I knew it was bad when she couldn’t tell me her name. I watched her face fill with frustration as a word she had uttered countless times over eight decades somehow got lost between her brain and her lips.

It was 2 a.m. and I was on call as the surgical resident. I had been told that a patient with bladder cancer was being transferred from another hospital, and, as these …

Use holistic review to improve diversity in health professions

Valerie Pierre

Medical Education

August 20, 2016

As the health care landscape in America continues to change after the enactment of the Affordable Care Act, we are seeing an even more diverse group of patients seeking care across the nation. As rapidly as these demographics are changing, however, there is still progress to be made in diversity of health care providers who treat these patients. For instance, although 13 percent of Americans are of African descent, Black …

Physician outcomes should be quality measures

Niran S. Al-Agba, MD

Physician

August 20, 2016

Quality measures began as tools to quantify the health care process, using outcomes, patient perceptions, and organizational structures associated with the provision of high-quality health care. Overall, the goals should focus on delivery of care that is effective, safe, efficient, and equitable. Did you notice a particular word missing? Yes, I missed the word physician too, because they have been left out of the conversation entirely.

Measuring quality health care by …

MKSAP: 61-year-old man with generalized weakness

mksap

Conditions and Diseases

August 20, 2016

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

A 61-year-old man is evaluated for a 10-month history of generalized weakness. He reports no pain or myalgia. History is significant for hypercholesterolemia treated with a stable dose of simvastatin for the past 3 years.

On physical examination, temperature is normal, blood pressure is 138/74 mm Hg, pulse rate is 70/min, and respiration rate …

The urge to create controversies in medicine can harm patients

Jonathan D. Gelber, MD

Physician

August 19, 2016

As an orthopedic sports medicine surgeon newly in practice, I read with interest Gina Kolata’s article “Why ‘Useless’ Surgery Is Still Popular.” As a doctor with a research background, I often champion the importance of research and promote a practice rooted in evidence-based medicine. It also came to me as no surprise when my partner and several physician assistants in the practice pointed out the article to me. …

This story shows the humanity of medicine

Jean Robey, MD

Physician

August 19, 2016

“Hello? Hello, Mr. Bertsie. It’s Dr. Robey. I wanted to call you and check on you,” I said into the phone stopping my constant wrestling with papers and resting what was in my hands on my lap. Mr. Bertsie and I were meeting in the equinox.

“Oh, hello Doctor,” he said with a little relief, a little surprise, a little delight in his voice. “I’m doing OK. I walked the dog …

The physician role in the time of Black Lives Matter

Courtney McMickens, MD

Physician

August 19, 2016

In July, I found myself needing to step away from social media and news coverage of the recent shootings in Louisiana, Minnesota, and Dallas. Being a psychiatrist has made me sensitive to the toll of pain and anguish that life may bring, even as a bystander. This occurs even more so when I can all too easily imagine myself as a victim of one of these unfortunate events.

In the aftermath …

A reminder that life is indeed too short

Neha Sharma, DO

Physician

August 19, 2016

I recently took care of a young patient whose case left an impact on me. When I admitted him, he was fighting a lost battle with cancer.

A few months prior to admission, he had been experiencing new headaches. When he sought medical attention, he was diagnosed with an extremely aggressive brain tumor that had spread to his spine, and was given a very poor prognosis.

Unfortunately, his condition deteriorated quickly thereafter, …

Doctors experience the world differently

Starla Fitch, MD

Physician

August 18, 2016

I was in the break room at the hospital scarfing down a power bar between three-hour cases. The truth is, I was multi-tasking: eating, writing on a chart, and checking my email on my phone.

I had received an email from a businesswoman, whom I have known for a few years. She wanted to know if I wanted to join her for lunch next week.

I had to laugh out loud.

The rest …

We can’t agree on the value of the yearly physical

Janice Boughton, MD

Physician

August 18, 2016

“I’m going to the doctor next week for my yearly physical.” So normal. Of course you are. Everyone should do that.

But the concept of a yearly examination of one’s whole body to see if everything checks out fine is a relatively new invention and whether or not it is necessary is a very controversial question.

I just read an article by Abraham Verghese, an internist and champion of physical diagnosis, professor at …

Should guns be discussed in the exam room?

Kevin R. Campbell, MD

Physician

August 18, 2016

Let me preface this blog by stating that I write this to stimulate discussion and debate, not to sway opinions.

Today, doctors are required to spend more and more time doing administrative work — including checking off electronic boxes in the electronic medical record (EMR) — the result is less quality time with patients.

Now, those that are in Washington, DC think that requiring physicians to ask about guns in the home …

Please don’t take gynecological advice from Khloe Kardashian

Jennifer Gunter, MD

Conditions and Diseases

August 18, 2016

The latest celebrity to use the internet like a public speculum is Khloe Kardashian. I know this because my phone blew up recently with reporters texting, e-mailing and sending direct messages on Twitter asking about vaginal vitamin E. So I gave some quotes and thought it would all die down.

But no. Kardashian vagina ranks up there in national significance with the first woman running for the highest office …

When should physicians lie for patients?

Michael Kirsch, MD

Physician

August 17, 2016

Even the most honest among us do not tell the truth all of the time. We are flawed human beings. We covet, we gossip, we steal, we lie, and we stand idly by. You don’t think you steal? Have you ever “borrowed” someone else’s idea and represented it as your own?

A few weeks before I penned this, I was presented with two opportunities to lie in order to save a …

The evolution of a hospital admission

John Schumann, MD

Physician

August 17, 2016

Once upon a time, a hospital was a place you went if you were sick. Doctors would (ideally) figure out what was wrong, offer treatment, and you would convalesce.

The longer you stayed in a hospital, the more the hospital could charge you (your insurance, really — if you had it).

This all changed in 1983, with the advent of the DRG system (it stands for diagnosis-related group). Almost overnight, the incentives for …

Read more…

The evolution of a hospital admission

Can chiropractors be saved? Only they can decide.

Roy Benaroch, MD

Physician

August 17, 2016

Can the chiropractic profession evolve and renew itself as a legitimate part of the health care system? Prominent Australian chiropractor Bruce Walker, who is also the editor-in-chief of the Journal Chiropractic and Manual Therapies, has proposed a 10 point plan to ensure that chiropractors create a profession based on science, knowledge, and genuine healing. He makes a strong case that chiropractors need to embrace research, shun “nonsensical elements,” …

The vaccine crisis we’re facing isn’t the one that you think

Peter Ubel, MD

Medications

August 16, 2016

We have a vaccine crisis in the this country. Not just the one caused by anti-vaxxers like Jenny McCarthy, scaring Americans away from life-saving childhood vaccines with pseudo-scientific claims about autism. Instead, I’m talking about a bigger crisis, one caused by a dangerously thin supply of vaccines. Wise parents who ignore the blatherings of people like McCarthy may soon arrive at their pediatricians’ offices prepared to vaccinate their children, only …

Getting him a new pair of pants was the least that we could do

Heena P. Santry, MD

Physician

August 16, 2016

“Please don’t cut off my pants,” he pleaded. “I am homeless, and they are my only pants. Please.”

He could say these words as we were conducting our initial assessment in the trauma bay so at least he was hemodynamically stable with an intact airway at that moment in time. However, he had arrived seconds earlier with potentially life-threatening injuries as a level 1 trauma activation. Based on the location of …

How can we find the patient within?

Linda Girgis, MD

Physician

August 16, 2016

My medical student found it difficult to get any information from a patient. When she presented the patient’s medical history to me, she was quite flustered and did not know what to say. I went with here to talk to the patient and met the same wall. It is not always an easy task finding the patient within.

Often, when what a patient is saying doesn’t make sense, or it is …

Read more…

How can we find the patient within?

The spectacular incompetence of third-party payers

Dr. Saurabh Jha

Physician

August 16, 2016

To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In health care, incompetence can be found in odd places, such as three recent examples I encountered with third-party payers.

Case 1: Downgrading caviar to boiled salmon

A patient was referred for a CT angiogram run …