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The day the music died and how a hospital lost its joy

Physician

January 30, 2015

There’s a great song by Don McLean called “American Pie.” The chorus talks about “the day the music died.” I thought about that song in my hospital a couple years ago, when the music died there, too. I’ve noticed that our physician burnout and nurse frustration have increased in the years since the music died. Could it be a coincidence?

McLean’s song was about a plane crash in 1959 that claimed …

Want to practice primary care and be debt free? Here’s how.

Charmaine Chan, DO

Physician

January 30, 2015

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A medical student asked to speak to me about a month ago at the Philadelphia College of Osteopathic Medicine, where I am an instructor of family medicine. He has been very active in our school’s Primary Care Scholars program and community health outreach activities. “Dr. Chan,” he said, “I am so torn. I really love primary care, but I am so …

Kids need more sleep and later school start times

Marvin Wang, MD

Conditions and Diseases

January 30, 2015

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Last August, the American Academy of Pediatrics (AAP) issued a statement regarding school start times, really a plea to all middle and high schools to start the school day no earlier than 8:30 a.m.

The statement emerged as a result of accumulating evidence showing that earlier school start times effectively restrict an adolescent’s ability to get regular healthful sleep.

The timing of the AAP’s …

Inactivity kills more than obesity: Let’s go beyond the headline

David L. Katz, MD

Conditions and Diseases

January 29, 2015

A new study about physical activity, obesity, and mortality has been propagating so many headlines and so much commentary, it’s pretty much a given that if you are seeing this, you have seen something like: “Inactivity kills more than obesity.”

As is generally true in such cases, few of the people opining about the study seem to have actually read it. I suppose that’s understandable — once you get to particulars …

We forget to ask patients what their goals are

Mitch Kaminski, MD

Physician

January 29, 2015

Mr. Dwyer isn’t my patient, but today I’m covering for my partner in our family practice office, so he’s been slipped into my schedule.

Reading his chart, I have an ominous feeling that this visit won’t be simple.

A tall, lanky man with an air of quiet dignity, Mr. Dwyer is eighty-eight. His legs are swollen, and merely talking makes him short of breath.

He suffers from both congestive heart failure and renal …

Stop with the curbside consultations. They don’t help anyone.

Miranda Fielding, MD

Conditions and Diseases

January 29, 2015

Recently a friend of my husband’s in San Diego had a mammogram that showed some suspicious microcalcifications in her right breast. She underwent a stereotactic biopsy which revealed ductal carcinoma in situ, the earliest form of breast cancer also known as stage 0 breast cancer. This type of cancer is non-invasive and does not metastasize, however, if untreated it can progress or recur as a more serious type of breast …

Let’s be judicious in our use of surfactant

Danielle Moriates, RN

Conditions and Diseases

January 29, 2015

When babies are born prematurely, they often lack surfactant: a soapy substance produced in the lungs that helps to keep the air sacs open. Without surfactant, these tiny babies fight to breathe, a condition known as infant respiratory distress syndrome. Within the past 50 years, the delivery of artificial surfactant therapy has revolutionized neonatal care, saving many lives that previously would have had no chance at survival. As a neonatal intensive …

Doctors who attack other physicians

Jordan Grumet, MD

Physician

January 29, 2015

Her heart was failing; her ejection fraction was unmeasurable. Her hip was broken, and she developed a pulmonary embolism post-operatively. She was painfully close to death. Yet at some point, the hospital finished and spit her out at the nursing home.

She was confused.

I tried to take the best history that I could. Her answers where usually no more than a single word. Her physical exam revealed a desperately weak woman, …

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Doctors who attack other physicians

You’re lucky to be a patient in America. Here are 3 reasons why.

Suneel Dhand, MD

Physician

January 29, 2015

As part of the increasing push for health care quality improvement, a lot of energy is being focused on improving our communication with patients and making sure that patient-centered care is more than just a buzz phrase. Gone are the days when the doctor-patient interaction was a wholly paternalistic one, where the doctor’s word was taken as final and absolute, and patients weren’t encouraged …

A house call is worth a dozen tests. And then some.

Hans Duvefelt, MD

Physician

January 28, 2015

Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that?

Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren …

To the doctors who have lost patients. This is for you.

BirdStrike, MD

Physician

January 28, 2015

We all went into medicine to save lives. Deep within even the most cynical of us, is still that pre-med hopeful that believes we can and should restart each non-beating heart, make the non-breathing breathe and fill with blood those who’ve bled, filling them back with life. We expect that a patient’s condition will improve while under our care, or at …

Avoid the blame game during inpatient emergencies

Benjamin T. Galen, MD

Physician

January 28, 2015

Patients admitted to the hospital ward sometimes get sicker instead of getting better right away. Often this can happen acutely. Depending on the circumstances, ranging from a “rapid response” for unstable vital signs to a cardiac arrest (a “code”), previously uninvolved hospital staff might be called on to help. Despite the commotion, these events are a period of time for the health care team to shine. At inpatient emergencies, …

The spookiness about sudden death

Farokh Jamalyaria, MD

Physician

January 28, 2015

You live like this, sheltered, in a delicate world, and you believe you are living … And then some shock treatment takes place, a person, a book, a song and it awakens [you] and saves [you] from death.
– Anais Nin

On June 12, 2013, my driver and I were on our way to Sierpe, Costa Rica from Manuel Antonio when the road entered a palm tree plantation. About 50 meters in …

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The spookiness about sudden death

A doctor quits. Before doing the same, consider these 5 things.

Anonymous

Physician

January 28, 2015

This place sucks had become my mantra as I powered through every bloody, chaotic, understaffed shift.

Fresh out of residency, I had accepted a job in the ER of a community hospital which — though it had appeared calm, functional, and replete with helpful consultants during the 15-minute tour I took during my interview — had turned into exactly the opposite when I …

A tragic physician story the match doesn’t want you to hear about

Cory Michael, MD

Physician

January 28, 2015

I will always remember my awkward medical school interviews. Filled with bioethical scenarios and questions to measure my ability to prevent an impaired physician from practicing, the interviewers seemed hardly interested in my prior career achievements or humble beginnings.

Such discussions carried on through the first two years of medical school. They never taught us how health care reimbursement works or why …

Forget the ivory tower: We need more Disney in medicine

Rocky Bilhartz, MD

Physician

January 27, 2015

This isn’t a debate about vaccines.

The fight here has nothing to do with that. For the record, I strongly support the concept of vaccination. Public health is better in the 21st century because of it. Measles? Mumps? Oh, I can find you in the United States, but we aren’t living our lives every day petrified of an outbreak. Smallpox? Polio? Where did you go? Not here, that’s for sure. And, …

After a doctor’s murder: All you hear about is deflated footballs

Shirie Leng, MD

Physician

January 27, 2015

This week the local and national attention has been riveted on accusations that Bill Belichick and the Patriots football team deliberately deflated the footballs used in the division championship game. Football, remember, is a multi-billion dollar industry in which the commodity being sold is grown men throwing brown, oblong balls at each other and knocking each other down. Boston.com, a …

Truth in advertising: When is a doctor really a doctor?

Daniel Campos, MD, MPH

Physician

January 27, 2015

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

In an emergency, the first question people often ask is: “Is there a doctor in the house?” When you have a medical problem, the best advice is, “Ask your doctor.” Most people automatically assume that “doctor” in this context refers to a physician with a …

Money matters, despite what medical students say

Michael McClurkin

Medical Education

January 27, 2015

In a recent article posted on this site, the author (a radiologist) waxed rhapsodic about a young medical student that was convinced to pursue primary care. When the author asked the student about the economic downsides to primary care, he responded by saying, “I’m not in it for the money … What matters to me isn’t the money — it’s making a difference in my patients’ lives.”

Well, good for him. Time …

How to start your own board certification organization

Edward J. Volpintesta, MD

Physician

January 27, 2015

1. Before anything, advertise yourself as a protector of the public against incompetent physicians.

2. Design the examinations for each specialty with a “one size fits all” approach. You can achieve this by disregarding the fact that many physicians prune their practices over time to accommodate to the demographics of their communities and their availability of specialty care. This has particular significance for internal medicine and family medicine.

Also, by including a large …

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