January 2018

January 28, 2018Jan 28, 2018

I finally finished reading the many journals piled up on my dining room table, which have been shunted to other flat surfaces for projects or the visits of friends. I didn't read them all well, but I touched them all…

I finally finished reading the many journals piled up on my dining room table, which have been shunted to other flat surfaces for projects or the visits of friends. I didn’t read them all well, but I touched them all and read what interested me.

The early October edition of the Annals of Internal Medicine particularly caught my eye. There were two major articles that looked at determinants of health in …

Physician finance

This physician bailed on the stock market in 2008. What now?

James M. Dahle, MD

January 28, 2018Jan 28, 201811

Q. Should I get back into the stock market? I am 11 years out of residency and have made many of the mistakes you have listed on the site. The primary one was getting OUT of stocks entirely with the…

Q. Should I get back into the stock market?

I am 11 years out of residency and have made many of the mistakes you have listed on the site. The primary one was getting OUT of stocks entirely with the 2008 crash. Oi. Now I have all this cash and some bonds, and I want to reinvest, slowly, and think the market is overvalued. I hate the thought of getting back …

Health policy

Pay for performance: Have we gotten what we’ve paid for?

Joshua Liao, MD

January 27, 2018Jan 27, 20183

In a research article published in Annals of Internal Medicine, investigators studied performance in Medicare’s Value-Based Payment Modifier program (VM) -- a prominent pay-for-performance (P4P) program that adjusts providers’ Part B payment rates on the basis of their performance on…

In a research article published in Annals of Internal Medicine, investigators studied performance in Medicare’s Value-Based Payment Modifier program (VM) — a prominent pay-for-performance (P4P) program that adjusts providers’ Part B payment rates on the basis of their performance on a set of quality and cost measures. The authors were interested in 2 questions: Is engagement in VM associated with changes in provider performance on quality or cost measures? Does …

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Conditions and diseases

So the flu shot is only 10 percent effective. Here are 5 reasons to still get it.

Jennifer Variste, MD

January 27, 2018Jan 27, 20184

So you heard the flu shot is 10 percent effective. With so many sources of information available, the primary care provider’s role increasingly becomes that of educator. It is important to me that the parents of my patients make informed…

So you heard the flu shot is 10 percent effective.

With so many sources of information available, the primary care provider’s role increasingly becomes that of educator. It is important to me that the parents of my patients make informed decisions, so when I have a parent decline the influenza vaccine, I make an effort to ask why. The number one response I hear has been “What’s the point? The flu …

Physician finance

Is private college and medical school worth it? One physician’s story.

Dads Dollars Debts, MD

January 27, 2018Jan 27, 20187

College I went to a fairly expensive college, George Washington University. I think at the time (1998) it actually was one of the, if not the most expensive schools. Why did I decide to go there? Well, my brother was…

College

I went to a fairly expensive college, George Washington University. I think at the time (1998) it actually was one of the, if not the most expensive schools. Why did I decide to go there? Well, my brother was attending the school and living in Washington, DC seemed amazing to a suburban boy from Tennessee. Sure, I had gotten into University of Tennessee with a scholarship, but adventure won over …

Conditions and diseases

MKSAP: 22-year-old woman with abnormal involuntary movements

mksap

January 27, 2018Jan 27, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 22-year-old woman is evaluated for a 2-year-history of abnormal involuntary movements. She describes these movements as a quick elevation of the left shoulder…

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

A 22-year-old woman is evaluated for a 2-year-history of abnormal involuntary movements. She describes these movements as a quick elevation of the left shoulder followed by a rolling movement of the neck from side to side. The patient is able to suppress the movements completely for brief periods but then feels pressure building at the …

Conditions and diseases

How to tell seniors they’re too old for cancer screening

Peter Ubel, MD

January 26, 2018Jan 26, 20187

Cancer screening can save lives. Mammographies reduce the chance women will die of breast cancer; and colonoscopies reduce the chance people will die of colon cancer. But should my 93-year-old father receive a screening colonoscopy? The test is uncomfortable, carries…

Cancer screening can save lives. Mammographies reduce the chance women will die of breast cancer; and colonoscopies reduce the chance people will die of colon cancer.

But should my 93-year-old father receive a screening colonoscopy? The test is uncomfortable, carries risks, and costs money. Even more importantly, my dad probably won’t live long enough to benefit from the test. That’s why most medical experts think people like my dad—people unlikely to …

Physician voices

The truth behind that Baltimore patient dumping video

Zubin Damania, MD

January 26, 2018Jan 26, 201815

A young woman stands in the freezing cold outside an urban Baltimore hospital. The woman, covered only by a thin hospital gown, moans incoherently at the man capturing her suffering on cellphone video. As seen on the now-viral video, she’d been left there by security personnel employed by the supposed place of healing just a few yards away. It hurts to watch.

Mass …

Medical education

Studying to be a doctor, while living as a patient

Claudia Martinez

January 26, 2018Jan 26, 20185

Walking up to the admissions desk I knew the routine. I stretched out my arm for my hospital band. A name, a number, and a doctor were what defined me during my many hospital stays. It was simple; my brain was too large for my skull. Brain surgery after brain surgery has occupied my life for many years, all while I have been studying to become a doctor.

I just finished …

Patient voices

What Celine Dion can teach us about patient care

Edward Leigh

January 26, 2018Jan 26, 20183

During a recent Las Vegas performance, an intoxicated concertgoer got on the stage and stood next to singer Celine Dion. This situation could have been handled in multiple ways, but Ms. Dion never lost her composure and handled the situation with grace and kindness. She brilliantly was able to diffuse the situation without anger while maintaining her dignity and that of the fan. The way she handled the situation and …

Physician voices

When a breast cancer surgeon gets breast cancer: being on the other side of the scalpel

Anne Peled, MD

January 26, 2018Jan 26, 2018

Six weeks ago, I was diagnosed with invasive breast cancer. As a breast cancer and breast plastic surgeon, I see women all the time who are in the exact same place I’ve been since receiving the phone call from the…

Six weeks ago, I was diagnosed with invasive breast cancer.

As a breast cancer and breast plastic surgeon, I see women all the time who are in the exact same place I’ve been since receiving the phone call from the pathologist. Shocked and terrified by the news, overwhelmed by what this is going to mean for their life in both the short- and the long-term, waiting for results from what seems like …

Physician finance

How this doctor eliminated $500,000 in debt

Cory Fawcett, MD

January 26, 2018Jan 26, 20182

In my last post, I told my story of how I got out of medical school with only $18,000 of debt. By the time I left residency, I had that whittled down to $6,000 at 3% interest. Then during the…

In my last post, I told my story of how I got out of medical school with only $18,000 of debt. By the time I left residency, I had that whittled down to $6,000 at 3% interest. Then during the next three years after starting my practice, I had accumulated almost $500,000 of new debt.

Initially, I didn’t think anything of this new large debt, after all, I …

Conditions and diseases

My husband was dying. I was being ignored.

Debbie Moore-Black, RN

January 25, 2018Jan 25, 201814

It was a long December. A few years ago, my husband of 37 years got his death sentence: recurrence of liver cancer with mets to his lungs and lymph nodes. He had a “Whipple” — a surgical procedure for pancreatic…

It was a long December.

A few years ago, my husband of 37 years got his death sentence: recurrence of liver cancer with mets to his lungs and lymph nodes.

He had a “Whipple” — a surgical procedure for pancreatic cancer — on Dec 24, 2015, and the surgeon discovered liver cancer too. So it was a 16-hour surgery. We were told he might die on the table.

His eyes haunted me as …

Physician voices

What exactly does an emergency physician do?

Edward Lew, MD

January 25, 2018Jan 25, 20185

I am an emergency medicine physician. I save lives. As an ER physician, my job is frequently misunderstood. A common question that patients ask is, “What specialty are you hoping to go into?” The misconception is that emergency rooms are…

I am an emergency medicine physician.

I save lives.

As an ER physician, my job is frequently misunderstood. A common question that patients ask is, “What specialty are you hoping to go into?” The misconception is that emergency rooms are staffed by cardiologists, internists, etc., who are trying to make extra income. That’s likely not the case anymore. Some also believe that we can take the place of their family doctor. Or …

Medical education

Scenes from a medical student’s rotation in psychiatry

Natasha Abadilla

January 25, 2018Jan 25, 20183

My classmate and I were walking back to the residents’ workroom when we realized one of the psychiatry patients was trailing along behind us. I glanced over my shoulder and found a very short gentleman in a patient gown walking…

“Serena,” he said, smiling at me.

I looked at my classmate. We were on inpatient psychiatry, and he looked as nervous as I was. Our …

Physician voices

A physician mother to her sons

Sasha K. Shillcutt, MD

January 25, 2018Jan 25, 20182

Dear Boys, I am so blessed to be your mom. You each have amazing personalities, unique talents, and special characteristics. I know someday you will grow up and be strong men. Kind men. Respectful men. Successful men. Men like your…

Dear Boys,

I am so blessed to be your mom. You each have amazing personalities, unique talents, and special characteristics. I know someday you will grow up and be strong men. Kind men. Respectful men. Successful men. Men like your grandfathers. Men like your father.

Someday when you go out into the world, you will find yourself working with all different kinds of women. You will work for women, beside women, and …

Read more…

A physician mother to her sons

Physician voices

A physicians care for patients in jail and wonders: Could it have been prevented?

Maria Yang, MD

January 25, 2018Jan 25, 2018

Some of the people under my care in the jail right now are quite ill. (This statement is always true, but it seems that the intensity of illness is greater now than usual.) As a result, the perennial question seems…

For some of them, it seems that the answer is No. Some of them sought out psychiatric services, attended …

Physician finance

The Tesla and a failure of stealth wealth

DocG, MD

January 25, 2018Jan 25, 20185

I loved my Prius. I’m not a car guy. I’m really not. But when my Prius started to fail after 120K miles, I took an active interest in picking my new mode of transportation. I had a few caveats. I…

I loved my Prius.

I’m not a car guy. I’m really not. But when my Prius started to fail after 120K miles, I took an active interest in picking my new mode of transportation. I had a few caveats. I was driving 100 miles a day. I wanted either a hybrid or fully electric car. And I needed something safe for the snow. Preferably four-wheel drive.

My first instinct was to get …

Physician voices

How to avoid #MeToo in medicine

Karen S. Sibert, MD

January 24, 2018Jan 24, 201822

Let me say first that any woman who has ever been harassed or assaulted should never be made to feel that it is her fault. It is always the perpetrator’s fault. Men can be boors, or worse, and testosterone can…

I went to Princeton University at a time when the ratio of men to women was 8:1, graduated from medical school in the 1980s, and raised two daughters. I’ve …

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How to avoid #MeToo in medicine

Physician voices

10 steps to keep physicians sane

Suneel Dhand, MD

January 24, 2018Jan 24, 2018

These are tumultuous times for practicing physicians. The health care landscape is changing at breathtaking pace and less and less of our time is spent doing what we were actually trained to do: taking care of patients. I absolutely love the patient care part of my job, do everything possible to always remember why I went to medical school in the first place, and maintain focus on the aspects of …

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10 steps to keep physicians sane

January 2018

Real physician voices, twice a week

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