January 2018

January 24, 2018Jan 24, 20182

In the early 1960s, President John F. Kennedy said, “The time to repair the roof is when the sun is shining.” It was a clarion call, a full-throated warning against national complacency in an era of great prosperity. It was…

It was during this same period that community hospitals stood as the dominant force in American health care. By the mid-20th century, some 6,000 inpatient facilities had spread throughout the country, often serving …

Physician voices

Being a doctor isn’t glamorous. But this physician keeps coming back for more.

Uzma Khan, MD

January 24, 2018Jan 24, 2018

My last clinic patient of the day was a frail, elderly man. I initially found him to be ornery. He had the air of someone who was chronically irritated. He was also incredibly hard of hearing. Due to the awkward set up of the exam room and computer, his wheelchair was positioned in such a way that we sat side-by-side. His wife sat sleeping in her chair, her red lipstick …

Physician voices

The simple thing patients can do to help doctors run on time

Gawayne Vaughan, MD

January 24, 2018Jan 24, 20188

It happens all too often. I am done with a visit and wrapping things up. Sometimes my hand is even on the doorknob to leave the room. Then the patient says it. “Oh, by the way, doctor …” This is inevitably followed by some symptom they have that is serious and needs further attention. The classic case is when it is chest pain, a grave symptom that needs to be …

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Physician finance

Using a mortgage to force savings: a good idea?

Passive Income, MD

January 24, 2018Jan 24, 2018

I’ve been thinking about mortgages and savings a bit more than usual lately, and with good reason. My father recently retired from his nearly 40-year career as a physician, and in trying to be a good son, I’ve been helping him prepare for the transition financially. This involved taking an account of what he has saved up, his investments, and his expected cash flow. For him, the future that many …

Conditions and diseases

Diagnosing the president disrespects those who truly have mental illnesses

Michael Kirsch, MD

January 23, 2018Jan 23, 20185

Many of my readers do not know who Barry Goldwater was, let alone of the Goldwater Rule established by the American Psychiatric Association in 1973. The rule advises against psychiatrists commenting on the mental health of public figures they have not examined. Obviously, a psychiatrist or any physician who has treated a public figure is prohibited to offer any public comment unless he has been authorized by the patient to …

Physician voices

The dangers of being always connected

Greg Smith, MD

January 23, 2018Jan 23, 2018

The ad is compelling. A surfer rides a blue wave, seen from below in crystal clear reflection. The Apple Watch on his left arm cuts through the surf, elegant, sparkling ripples trailing behind. Suddenly, it breaks the surface, and the…

The ad is compelling.

A surfer rides a blue wave, seen from below in crystal clear reflection. The Apple Watch on his left arm cuts through the surf, elegant, sparkling ripples trailing behind. Suddenly, it breaks the surface, and the screen lights up, announcing an incoming call.

Let’s face it, shall we? We are always connected. We are always wired in. We are always on.

We have become a world of interconnected people, …

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The dangers of being always connected

Medical education

Find the mentors you want in medicine

Jamie Katuna

January 23, 2018Jan 23, 2018

Medicine has been called an anti-mentorship program: In that trainees tend to find a vast amount of physicians who they don’t want to be like, rather than finding tons of inspiring ones who they do want to emulate. So how…

So how do we navigate this? How do we, as trainees, isolate and latch onto the physicians who are full of energy, life, and potential? Who are excited about what they do? Who have brilliant ways …

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Find the mentors you want in medicine

Physician voices

Forget the PC police and telemedicine: Give your patient a hug

Neil Baum, MD

January 23, 2018Jan 23, 2018

Today, the public has criticized health care as too high in technology and too low in touching. Computers take patients’ histories, provide a differential diagnosis, supply educational materials and even submit a bill for the services that we render. A new specialty — telemedicine — offers health care service to rural areas that were previously underserved or couldn’t afford the latest diagnostic technology. Telemedicine, a technology in its infancy, offers …

Physician voices

A lesson from Hurricane Harvey: Compassion has meaning

Neeti Reddy, MD & Praveen Vijhani, MD

January 23, 2018Jan 23, 2018

On September 1, 2017, four children and their grandparents drowned while their uncle was trying to drive them to safety. Their van was swept off the road by rushing floodwaters. The uncle was able to escape through a half-open window as the van sank headfirst into the bayou. As the van sank, he could hear the four children screaming and crying. Two days later, the van was found, with all …

Physician voices

If you are a practicing physician, you need rest

Physician on FIRE, MD

January 23, 2018Jan 23, 2018

“It is neither wealth nor splendor, but tranquility and occupation, which gives happiness." - Thomas Jefferson If you are a practicing physician, you need rest. Why do I say this? Because you have gone through an enculturation process which focuses…

“It is neither wealth nor splendor, but tranquility and occupation, which gives happiness.”
– Thomas Jefferson

If you are a practicing physician, you need rest.

Why do I say this? Because you have gone through an enculturation process which focuses on hyperactivity and super high-level achievement. In training programs and in practice, admitting that you are tired or needing a rest break is a sign of weakness and is discouraged, to say the …

Physician voices

A physician suicide: covered up with a tarp and silence

Pamela Wible, MD

January 22, 2018Jan 22, 2018128

Another young doctor recently jumped to her death in New York City. She landed at the entrance of the building where she lived. Within less than an hour, I received the following emails about her. All published with permission. Hello…

Another young doctor recently jumped to her death in New York City. She landed at the entrance of the building where she lived.

Within less than an hour, I received the following emails about her. All published with permission.

Hello Pamela, I am not a doctor, but a mother of 3 and a wife of a resident physician. Tonight I watched AGAIN the police

…

Physician voices

You can’t separate mind and body in medicine

Peggy A. Rothbaum, PhD

January 22, 2018Jan 22, 2018

According to the American Psychological Association and the American Academy of Family Physicians, well over half of patient visits to primary care physicians are for mental health issues. So, as part of my book, I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship, I asked about mental health.

None of the doctor interviewees disagreed with the important role that …

Physician voices

Should the SOAP note be changed?

Jennifer Middleton, MD

January 22, 2018Jan 22, 20186

Our hospital system's IT department has recently encouraged us all to change our default encounter note template from the traditional "SOAP" format to the "APSO" format. For those not familiar with those acronyms: S: subjective -- the patient's story O:…

Our hospital system’s IT department has recently encouraged us all to change our default encounter note template from the traditional “SOAP” format to the “APSO” format.

For those not familiar with those acronyms:

S: subjective — the patient’s story
O: objective — physical exam, labs, other data
A: assessment — the identified issues/diagnoses
P: plan — details of how to address issues/diagnoses in the assessment

The argument in favor of APSO, putting the assessment and plan …

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Should the SOAP note be changed?

Health policy

Obstruction of medical justice: How health care fails patients with cancer

Miriam A. Knoll, MD

January 22, 2018Jan 22, 20182

Isn’t getting cancer bad enough? That’s the frustrated thought that goes through my mind when I see patients with cancer suffering -- not from their cancer, but from the failure of the health care system. Take Nancy,* a 60-year-old woman…

Isn’t getting cancer bad enough?

That’s the frustrated thought that goes through my mind when I see patients with cancer suffering — not from their cancer, but from the failure of the health care system.

Take Nancy,* a 60-year-old woman with hormone-positive breast cancer. When she came to the emergency room with a fungating breast mass, we knew …

Physician finance

When should physicians retire?

Wall Street Physician, MD

January 22, 2018Jan 22, 20184

The decision to retire is a difficult one for anyone, including physicians. However, with everyone’s investment accounts so flush with money because of the bull market, a lot of physicians younger than the traditional retirement age of 65 have enough…

The decision to retire is a difficult one for anyone, including physicians.

However, with everyone’s investment accounts so flush with money because of the bull market, a lot of physicians younger than the traditional retirement age of 65 have enough money to retire early. Some have chosen to do so; others have chosen to continue to work even though they are financially ready for retirement.

So what are the factors that …

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When should physicians retire?

Conditions and diseases

Opioid addiction is an epidemic. Let’s treat it like one.

Heath McAnally, MD

January 21, 2018Jan 21, 20185

If we want to talk about the opioid epidemic as an actual epidemic, let’s use the same terms we use for communicable disease: agent, vector/environment, host. Virulence. Transmission. Immunity. The media has done a great job of providing descriptive statistics…

If we want to talk about the opioid epidemic as an actual epidemic, let’s use the same terms we use for communicable disease: agent, vector/environment, host. Virulence. Transmission. Immunity.

The media has done a great job of providing descriptive statistics of the epidemic. And recent oversight, both legislative and advisory, have attempted to focus on altering vector (prescriber) behavior in the wake of apparent failed attempts to reduce agent virulence. What …

Physician voices

13 things every doctor wants their patients to know

Joanne Jarrett, MD

January 21, 2018Jan 21, 20189

1. We worry. We lie awake worried sick about you more often than you’d think. The stakes are so high, and we know it. 2. We wonder. I ran into a friend who’d met a patient I’d had sixteen years…

1. We worry. We lie awake worried sick about you more often than you’d think. The stakes are so high, and we know it.

2. We wonder. I ran into a friend who’d met a patient I’d had sixteen years earlier. She gave me some follow-up, and it made my day — maybe my month. It was a year ago, and I’m still thinking about it. She’d had blood cancer. I referred her …

Medical education

A near-death experience taught this medical student a lesson

Johnathan Yao, MD, MPH

January 21, 2018Jan 21, 2018

I had just taken my final anatomy exam and finished a long two-month ordeal dissecting through and memorizing every component of the human body. At the beginning of the course, I had been excited, energized, honored to commence such a foundational experience in medical training. By the end, I was exhausted, wanting nothing more than just to sleep.

The very next day, we began physiology with two weeks of cardiology separating …

Physician finance

Physicians: Beware lifestyle inflation

Live Free MD

January 21, 2018Jan 21, 20182

At some point in our lives, most of us have learned to live on very little. For example, if you’ve ever been a college student, you’ve mastered the art of living in the same house with a dozen other people,…

Back in the early 2000’s, when I was a college student, I estimate that I spent about $15,000 per year on living expenses (aside …

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Physicians: Beware lifestyle inflation

Physician voices

10 ways this primary care physician will work smarter in 2018

Hans Duvefelt, MD

January 20, 2018Jan 20, 2018

I don’t regularly make any New Year’s resolutions, but this year I am tossing around a couple of ideas. One reason is that I have so many things going on that I need to be clever about how I use…

I work four days a week at my regular clinic, and I also work two long days at a clinic in far northern Maine. In addition, there are many …

January 2018

Real physician voices, twice a week

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