How this pediatrician practices medicine. Her way.

Physician
August 11, 2016

My thoughts settled on the Frank Sinatra song, “My Way,” when asked about necessary resources for rural health care to survive. Seven years ago, my father and I changed office buildings.  We closed the office that Friday to allow three full days to get settled.  However, we ended up seeing sick patients in the parking lot (seriously), while the movers were loading up the truck.

“All we need is a stethoscope, …

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How this pediatrician practices medicine. Her way.

A physician mother as the breadwinner. Here’s how she did it.

Physician
August 10, 2016

I was afraid.  Really, I was more anxious.  This wasn’t any of the typical new mother fears I had been warned about. If fact, I didn’t even see this one coming.  I knew that it would be tough going back to work 3 months after my first daughter was born.  I knew I would miss her terribly.  I knew I had to figure out a pumping schedule with my colleagues …

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A physician mother as the breadwinner. Here’s how she did it.

Can flawed doctor ratings harm patients?

Physician
August 10, 2016

Can you trust online physician ratings? Many people believe you can.

But here’s what a recent article in the Harvard Business Review (HBR) about the reliability of online user ratings regarding buying a product. The authors concluded that online ratings were generally not to be trusted for three important reasons:

  1. The reviews are usually based on a small sample of users. The authors said, “We can be more confident …

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Can flawed doctor ratings harm patients?

Health care has far too many medical panels

Conditions and Diseases
August 10, 2016

We are assembling too many panels of people in the name of health these days. Too many.

They usually seem like a good idea. I’ve been supportive before. I assumed we needed them. More of them.

I might have been wrong.

There was a day when I believed my food would be toxic, my medicine harmful, and my safety gone without them. But, I’ve come to believe I was mistaken.

I was wrong because …

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Health care has far too many medical panels

Caring and dedicated physicians are being driven out of medicine

Physician
August 9, 2016

Last week, a patient with severe gastroparesis came in for an unexpected visit. She seemed very upset, on the verge of tears. Instead of asking her why she was in, I asked her why she was so sad.

“My hematologist just retired; I was her last patient. I don’t know who will take care of me like she did. And she wasn’t even old enough to retire,” she said. This took …

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Caring and dedicated physicians are being driven out of medicine

This oncologist says the USPSTF gets it wrong on skin cancer screening

Physician
August 9, 2016

In July 2016, the U.S. Preventative Services Task Force (USPSTF) published updated skin cancer screening guidelines in JAMA, concluding “current evidence is insufficient” to screen for skin cancer in adults. The guidelines were formulated on a literature review of studies conducted in asymptomatic patients 15 years and older at general risk for skin cancer from 1995-2015; after identifying nearly 13,000 articles spanning two decades of work worldwide, the authors selected …

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This oncologist says the USPSTF gets it wrong on skin cancer screening

Multiple choice questions are a terrible way to test doctors

Physician
August 9, 2016

Most people are surprised to hear that the way doctors are recertified every ten years is through a multiple choice test. “Really?” they’ll say. “You take a multiple choice test? As a doctor?”

Unfortunately, after all these years that’s the most efficient way we can think of to evaluate professionals. But the method is so flawed. And your ability to answer questions on the multiple choice test isn’t necessarily linked with …

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Multiple choice questions are a terrible way to test doctors

Surprise billing surprises everyone, except the insurance companies

Physician
August 8, 2016

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

In the past several years, there has been a dramatic increase in media attention concerning bills patients receive from health care professionals who are not in the network of providers their insurance company contracted with to provide health services. The out-of-network bills these patients …

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Surprise billing surprises everyone, except the insurance companies

Military tests of the Zika virus mosquito

Physician
August 8, 2016

It is a master of stealth, stretching less than half an inch long and weighing in at 2.5 milligrams with as estimated air speed of 1 to 1.5 miles per hour. It is virtually soundless in flight, registering zero decibels from ten feet. Its tracking systems hone in on targets by detecting infrared radiation from warm bodies, chemicals such as carbon dioxide and lactic acid, body odors from as far …

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Military tests of the Zika virus mosquito

At the end of life, searching for the right word

Patient
August 8, 2016

During the first few days that my mother spent in hospice, I silently sat by her bed watching her chest rise and fall, listening to her moan, counting her doses of Ativan, Tylenol, and Morphine, and tallying the days she’d been without food and water.

On day five of my vigil, I asked her nurse, “How long can Mom live like this? She hasn’t opened her eyes or eaten or had …

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At the end of life, searching for the right word

The dilemmas faced by the chronically ill

Patient
August 8, 2016

After more than fifteen years of being mostly housebound by chronic illness (which includes chronic pain), here are a few of the dilemmas I’ve faced over and over. I’m confident that I’m not alone in my “should I/shouldn’t I?” world.

Do I accept an invitation from a friend to get together or do I refuse it?

If I refuse the invitation, depending on who issued it, it may be the last one …

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The dilemmas faced by the chronically ill

Finding the right balance in pain relief: A physician’s story

Physician
August 7, 2016

After surgery for my broken tibia, I realized that there were only four points on the pain scale that really mattered to me:

  1. I’m OK. This acetaminophen/ibuprofen/whatever is enough.
  2. I wouldn’t mind a little something more, preferably something that binds mu
  3. Um, could you please hurry that up?
  4. NOW! NOW!  I need it NOW!

On the 0 to 10 pain scale, who really cares if you are at a 2 or …

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Finding the right balance in pain relief: A physician’s story

Social determinants matter most to a person’s health. Here’s one story.

Physician
August 7, 2016

To close out my first week of medical school, the class was treated to a talk by a stuffy but soft-spoken lecturer on the relationship between poverty, education, and poor population health. “Social determinants of health,” he labeled them, a clunky and unwieldy term if ever I’d heard one. In those days, audiovisual aids consisted of an overhead projector for black-and-white transparencies. And boy did that talk have transparencies. Chart …

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Social determinants matter most to a person’s health. Here’s one story.

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Sexism in medicine is a public health issue

Physician
August 7, 2016

Author.  President.  Teacher.  Doctor.  These are all gender-neutral words which happen to relate to a person’s profession.  However, I find it particularly interesting that while “doctor” is a gender-neutral word, the field of medicine is riddled with institutional sexism.

Let me begin by explaining that I am a military physician currently training to become a gastroenterologist.  If being the only woman in any room bothered me, my journey would imply that …

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Sexism in medicine is a public health issue

Do physicians play God?

Physician
August 7, 2016

After rotating in the ICU, I began to wonder about the limitations of modern medicine. In a short time, we have come a long way with the discovery of antibiotics, high-resolution imaging, and the development of advanced surgical procedures. The medical field saves millions of lives. Nowadays, people do not go to a hospital to die; they go to be healed. As physicians, we are very skilled at extending life.

Heart …

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Do physicians play God?

A love letter to those on the primary care journey

Physician
August 6, 2016
YouTube video

We are standing at a crossroads in health care. Behind us lies a long-lost, nostalgia-tinged world of unfettered provider autonomy, sacred doctor-patient relationships, and a laser-like focus on the art and humanity of medicine. This was the world of my father, an immigrant and primary care physician in rural California. The world of Health 1.0.

While many still pine for these “good old days” of medicine, we shouldn’t forget that those days weren’t really …

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A love letter to those on the primary care journey

Even if doctors are demonized, they do make a difference

Physician
August 6, 2016

As a long-distance truck driver, he did not have time to visit a doctor. In fact, the last time a doctor ever examined him was decades ago. When his leg started hurting, he ignored the pain for months before it got too severe and started interfering with his ability to drive.  He showed up in my office in severe pain and limping. And while he tried to joke it off, …

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Even if doctors are demonized, they do make a difference

Who cares about our turf wars? Patients don’t.

Physician
August 6, 2016

Recently a measure was proposed to allow APRNs full practice authority in the VA health care system.  With this measure, the embattled VA hopes to help optimize access to health care for our veterans. A measure to help with the firestorm of problems we witnessed unravel at the Phoenix VA system two years ago. Sounds great, right?

Nothing is ever that simple in American medicine. The professional organizations are, once again, …

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Who cares about our turf wars? Patients don’t.

MKSAP: 26-year-old woman with recurrent feelings of fear and anxiety

Conditions and Diseases
August 6, 2016

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

A 26-year-old woman is evaluated for a 10-year history of recurrent episodes of acute-onset feelings of fear and anxiety. These episodes initially occurred approximately 4 times per year but for the past 3 months have been occurring once or twice per month, especially when she is under stress. She describes the episodes as …

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MKSAP: 26-year-old woman with recurrent feelings of fear and anxiety

Insurance constraints drive shortcomings in health care delivery

Health Policy
August 5, 2016

It is no secret that mental health conditions are prevalent, and recent years have seen an increase in the dialogue on their causes and consequences. However, we do ourselves a disservice when discussing mental health outside the context of the broader system in which care is provided, and the insurance constraints that drive shortcomings in health care delivery.

SAMHSA estimated that 58 percent of adults have a medical …

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Insurance constraints drive shortcomings in health care delivery

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