January 2018

January 16, 2018Jan 16, 201810

In my travels up and down the East Coast, I have been fortunate enough to work with some fantastic nurses. From what I hear, there was much more of an authoritarian relationship between doctors and nurses a few decades ago — preceding the time I entered the medical profession. This has now morphed into much more of a collegial teamwork approach, as we battle to get our patients better at …

Conditions and diseases

A physician’s descent into guideline fatigue syndrome

Robert Centor, MD

January 16, 2018Jan 16, 20189

It started slowly. My former resident and present colleague, Terry Shaneyfelt first authored "Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature." This paper alerted us to the problem. But guideline fever continued…

It started slowly. My former resident and present colleague, Terry Shaneyfelt first authored “Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature.”

This paper alerted us to the problem. But guideline fever continued to rage. Almost every specialty and subspecialty society decided that they needed to join the guideline movement. They needed to tell us the right way to practice medicine.

While …

Physician voices

Top 10 lies doctors tell themselves

Pamela Wible, MD

January 16, 2018Jan 16, 201817

Pamela Wible: Today I’m sitting here with Sydney Ashland, an expert in physician mental health, who has worked with doctors for decades helping them overcome negative thinking patterns. And we’re going to dive into the top 10 lies that physician’s…

Pamela Wible: Today I’m sitting here with Sydney Ashland, an expert in physician mental health, who has worked with doctors for decades helping them overcome negative thinking patterns. And we’re going to dive into the top 10 lies that physician’s tell themselves. The number one thing that I hear over and over again from doctors is, “I’m stuck in assembly line medicine.”

Sydney Ashland: Yes. I …

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Top 10 lies doctors tell themselves

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Conditions and diseases

Childhood obesity is a grave threat to our nation’s health

Christopher Johnson, MD

January 16, 2018Jan 16, 20182

We’ve known for some time the prevalence of obesity is growing among Americans -- not just adults, but children, too. Obesity is associated with a long list of medical problems, including heart and other vascular diseases, diabetes, and joint problems.…

We’ve known for some time the prevalence of obesity is growing among Americans — not just adults, but children, too. Obesity is associated with a long list of medical problems, including heart and other vascular diseases, diabetes, and joint problems. It is encouraging that recently the seemingly inexorable growth of pediatric obesity prevalence seems to have reached a plateau. But we still have a future problem looming for population health as …

Medical education

What do you say to somebody who knows that they are about to die?

Nathaniel Fleming

January 16, 2018Jan 16, 2018

I’ve had lots of practice comforting people. I’ve had to tell patients that their cancer is back in a busy emergency department. I’ve updated family members of patients who are being kept alive by machines in the intensive care unit. I’ve walked alongside patients as they get rolled into an operating room, and crouched down by a patient’s bed as they writhe in pain. There have been moments of fear, …

Physician finance

5 reasons to keep working after financial independence

Physician on FIRE, MD

January 16, 2018Jan 16, 2018

I was browsing the Bogleheads forum last night, and my eyes naturally gravitated to the thread titled “What is FI if you love your job?” The short answer is that FI is financial independence. Nothing more, nothing less, and it…

I was browsing the Bogleheads forum last night, and my eyes naturally gravitated to the thread titled “What is FI if you love your job?”

The short answer is that FI is financial independence. Nothing more, nothing less, and it doesn’t look any different if you love, hate, or feel indifferent towards your job.

The long answer, after learning that the man asking the question is about ten …

Health policy

Can the dwindling numbers of primary care physicians explain decreased life expectancy?

Niran S. Al-Agba, MD

January 15, 2018Jan 15, 201813

Newborns born in 29 other countries of the world have life expectancies exceeding 80 years; yet, an infant born in the U.S. in 2016 is expected to live only 78.6 years according to recently released statistics. While death rates fell for 7 of the 10 biggest killers, such as cancer and heart disease, they climbed for the under-65 crowd. The irrefutable culprit is the unrelenting opioid epidemic.

Last year, life expectancy …

Conditions and diseases

How cancer treatment is affected by past abuse

Anne Katz, RN, PhD

January 15, 2018Jan 15, 2018

I am in the privileged and humbling position of hearing the stories of patients’ pasts. Sometimes the stories are so horrendous that it takes all my energy to stop myself from crying as they recount the brutality of their experiences. I have heard harrowing descriptions of all manner of abuse done to patients when they were children. The abuse was …

Physician voices

Are you giving examples the minority can relate to?

Sasha K. Shillcutt, MD

January 15, 2018Jan 15, 201810

Recently I had the privilege of an attending a leadership course at a very prestigious institution. I spent a week immersed in self-evaluation and heard great lectures on team building, leadership strategy, economics, conflict resolution, and communication. I met 60+…

The class was full of physicians, health care executives, …

Health policy

Should medical school encourage political thought?

Faiz Kidwai

January 15, 2018Jan 15, 201812

Many medical schools don’t encourage political thought in their students, far less nurture it. That’s a shame because it squanders an opportunity to equip future thought leaders to deal with serious concerns facing the U.S. population, many of which have…

In “Experiencing Politics,” a memoir about his 12-year stint in the …

Physician voices

How can we be patient centered in the age of technology?

Hans Duvefelt, MD

January 15, 2018Jan 15, 2018

Four and a half years ago I read an editorial in JAMA, the Journal of the American Medical Association, that etched a short phrase into my memory. These five words seemed so profound and poignant that I really think they almost define primary care medicine today, perhaps with the alliterative addition of the word “teach”.

Dr. Abigail Zuger wrote of how the computer had changed the dynamic in the …

Physician finance

The Tax Cuts and Jobs Act: What does it mean for medical residents?

Wall Street Physician, MD

January 15, 2018Jan 15, 2018

Donald Trump signed the Tax Cuts and Jobs Act of 2017 late last year. Americans and corporations are feverishly reading news summaries of the bill, trying to figure out how the new bill will affect their taxes. In this post,…

In this post, I will summarize the major provisions of the bills as they apply to medical residents and fellows. I’ll then go through three case scenarios to see how the tax bill might …

Conditions and diseases

Deconstructing the anxiety epidemic

Sarah Sarkis, PhD

January 14, 2018Jan 14, 201817

Anxiety is an epidemic. An estimated 40 million adults have symptoms of anxiety. America spends $42 billion a year on treatment of the condition. Women are 60 percent more likely to develop anxiety than our male counterparts. The average age…

But is there anything we can do to slow these statistics …

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Deconstructing the anxiety epidemic

Patient voices

Doctor-patient relationships would die without this one thing

David Penner

January 14, 2018Jan 14, 201813

As many readers are undoubtedly well aware, the doctor-patient relationship has a place of profound significance in health care. The critical importance of this relationship becomes magnified in oncology, where life hangs in the balance, and fear hangs over every…

In the winter of 2015, a needle biopsy was performed on a mysterious tumor in my …

Physician finance

Earn the right to inflate your lifestyle

Live Free MD

January 14, 2018Jan 14, 20185

Recently, we learned how lifestyle inflation can be toxic. In case you’re wondering, there is a time and place to inflate your lifestyle. However, you can’t just do it whenever you want. You have to earn it. Here’s how it…

The basics

If your goal is financial independence, I recommend that you live on half your income and save the rest.

This means that if you’re making around $50,000 per year, …

Conditions and diseases

A story of 2 torsions

Ronald Zacker, PA-C

January 13, 2018Jan 13, 20182

The kids were asleep, and I could hear a muted, distant moaning coming from our bedroom. It reminded me of labor pains, but there were three things making labor unlikely: my wife’s IUD, the absence of a gravid abdomen and the kind of unintentional celibacy that occurs between working parents raising two toddlers. I tried to ignore the moaning. In part, because it was a Sunday night, and the sound …

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A story of 2 torsions

Conditions and diseases

Learn about Salter-Harris fractures with a Medcomic

Jorge Muniz, PA-C

January 13, 2018Jan 13, 2018

Pediatric physeal fractures have traditionally been described by the five-part Salter-Harris classification system. Type I fractures occur through the growth plate. These injuries may present with normal radiographs, and the diagnosis is often made clinically when tenderness is palpated over…

Pediatric physeal fractures have traditionally been described by the five-part Salter-Harris classification system.

Type I fractures occur through the growth plate. These injuries may present with normal radiographs, and the diagnosis is often made clinically when tenderness is palpated over the growth plate.

Type II fractures occur through the growth plate and metaphysis. Type II injuries are the most common physeal fractures.

Type III fractures occur through the …

Medical education

20 anecdotes that describe the world of female medical students and physicians

Jamie Katuna

January 13, 2018Jan 13, 201822

I recently collected anecdotes from women in medicine who have noticed the same thing I’ve noticed: We’re not as comfortable here as our male counterparts. Despite progress, medicine remains a patriarchy — an “old boy’s club” — and the women in this world are frequently reminded of this status quo. In collecting these anecdotes, I’ve noticed two main themes for the type of advice and comments women receive.

The first one speaks …

Conditions and diseases

MKSAP: 65-year-old man with chronic kidney disease

mksap

January 13, 2018Jan 13, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 65-year-old man is evaluated during a follow-up visit for stage G3b/A3 chronic kidney disease due to diabetic nephropathy. He reports doing well with…

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

A 65-year-old man is evaluated during a follow-up visit for stage G3b/A3 chronic kidney disease due to diabetic nephropathy. He reports doing well with good baseline exercise tolerance and no shortness of breath. Medical history is also significant for type 2 diabetes mellitus and hypertension. Medications are basal bolus insulin and lisinopril, 20 mg/d.

On physical …

Conditions and diseases

Success stories in driving up adult immunization rates

James Appleby, RPh, MPH

January 12, 2018Jan 12, 20183

As we continue to lead longer and healthier lives, too many Americans aren’t taking advantage of an easily accessible set of tools that could protect their well-being into old age: adult vaccines. As a nation, we’ve embraced a regular schedule…

The numbers are staggering: tens of thousands of Americans die each year from flu …

January 2018

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