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Reflecting on the end of residency training

Medical Education

January 27, 2015

We’ve almost made it.

Long gone are the purgatory stints of library study, slaving to solve esoteric problems relating to planks and pulleys. Innumerable several-day exams have been conquered and tucked far away in our memories, hopefully never to haunt us again. The last of our forced smiles and faux-eager nods have been displayed toward ambivalent instructors and medical teams during the throes of our student rotations.

Post-graduate training is also nearing …

Medical conferences feel like funerals. Here’s why.

Pamela Wible, MD

Physician

January 27, 2015

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A friend just got back from a big medical conference at a fancy hotel. The cleaning ladies actually pulled her aside to ask, “What’s with all the grim faces and sad eyes?”

Do doctors realize medical conferences look like funerals? That’s what the cleaning ladies think. I bet they’re not the only ones.

Why do medical conferences feel like funerals? Maybe because doctors …

The medical testing industry needs to become extinct

David Mann, MD

Physician

January 26, 2015

Times change, and, as with Darwinian natural selection, those who adjust survive and those who don’t perish. Henry Ford’s assembly line greatly ramped up the production of automobiles but put many people out of work. The elevator operators of my childhood are long gone. Those who have embraced new technology have usually thrived; those who have fought it or failed to understand it have suffered. Witness the success of Amazon versus …

How much testing should you do in chronic abdominal pain?

Michael Kirsch, MD

Conditions and Diseases

January 26, 2015

I see patients with abdominal pain every day. Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable. I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion. With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal …

To remember who is the customer and who is the servant

P. J. Parmar, MD

Physician

January 26, 2015

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I’m a family doctor working in underserved medicine. My friend Pierre Wolfe was one of Denver’s top restaurateurs for decades. When we get together I often think of the parallels between our industries.

A postcard of Pierre’s Quorum Restaurant from the 1960s shows Pierre at the front door of his restaurant, holding a menu, and says “Pierre Wolfe himself greets you at …

The Affordable Care Act’s Medicaid bait and switch

Kevin R. Campbell, MD

Health Policy

January 26, 2015

As we enter year two of the Affordable Care Act, we have seen many issues arise during implementation. Through both executive order and executive memorandum, President Obama has unilaterally changed the law more than 100 times in order to advance his political agenda.

When it became important to publicize enrollment and increased coverage of the uninsured, the president, and the ACA provided for an increased payment scale for patients with Medicaid. …

The patient’s son is a doctor. But he’s also scared.

Tracy Cardin, ACNP

Physician

January 26, 2015

Recently I received an elderly patient who had been transferred from another hospital where she had been admitted for two weeks. The pertinent information about this patient is that her son, a doctor, a pathologist, had arranged the transfer.

The worst thing to have is a patient with a doctor for a relative. No, the worst thing is to have a patient …

Dear health IT: Please understand our frustrations

Edwin Leap, MD

Health Technology

January 26, 2015

Dear health IT staff,

I know that, on many levels, physicians must be the absolute banes of your existence. We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems. We call you because we forgot our passwords, then because we forgot the new passwords. We call because the system …

What have we lost with the progress of medical training?

Karan Chhabra

Medical Education

January 25, 2015

Every third-year has heard it: “When I was in your position, I was taking 24-hour calls every other night. If my resident was there, I was there …”

We’re regaled about the glory days, without shelf exams, without phlebotomists, and — by God — without those work-hour restrictions. The days when medical students wouldn’t dare ask their residents for help, or residents their chiefs, or chiefs their attendings, and so on. …

Doctors moonlight as nurses to stay competitive

GomerBlog

Physician

January 25, 2015

Nurse Shannon Wilkens on floor 4 west thought she saw someone she knew in scrubs walking into room 414.

“He was tall, I swore he looked familiar. Our charge nurse informed me he was recently hired and volunteered to work nights,” Wilkens recalled. “So being that it was slow, and I had only three patients as opposed to …

The time to regulate e-cigarettes is now

Ruth Macklin, PhD

Medications

January 25, 2015

A new revelation has added to the ongoing controversy over the health risks of e-cigarettes. Some commentators have viewed the use of this electronic delivery system for nicotine as a way for smokers to cut down on tobacco cigarettes or quit the habit altogether. Others have contended that e-cigarettes can be a “gateway” to smoking and may actually increase …

What are doctors thinking when you’re talking in the exam room?

Lucy Hornstein, MD

Physician

January 25, 2015

Ever wonder what your doctor is thinking while taking your history? If we’re doing it right, we’re looking at you instead of a computer. We’re making appropriate eye contact while displaying welcoming body language. And we’re letting you tell your story with as few interruptions as possible. Clearly we are listening intently, but did you ever wonder what’s going through our minds while you’re speaking?

I’ve been thinking about this lately …

Here’s why we need evidence-based pediatrics

Chad Hayes, MD

Physician

January 25, 2015

There have been countless instances in which the traditional practice of medicine has been disproved when someone actually took the time to perform a study. But who cares if a treatment doesn’t work — why does it really matter? Let me walk you through why it’s important, starting with the Hippocratic oath.

As physicians, our top priority is to “do no harm.”

But this priority often clashes with the patient’s reason for …

Stop yelling at your kids. Here’s how to do it.

Claire McCarthy, MD

Conditions and Diseases

January 24, 2015

Everyone yells at their kids. Oh, I’m sure there are some truly perfect parents out there who don’t (and some who don’t because they are physically unable to yell), but the rest of us do. Parents are human; we all get frustrated, angry, exhausted and scared and, well, yell.

But yelling rarely helps. It usually makes things worse. And it makes us …

What do you value most at the end of life?

Anne Katz, RN, PhD

Conditions and Diseases

January 24, 2015

A friend of mine died after outliving her prognosis for more than a year. I was with her at almost all her appointments with various oncologists. She had asked me to be the note taker for these appointments so that she could focus on the discussion as it happened and then have the notes to review afterwards.

Her treatment course was …

Do physician assistants and nurse practitioners really save money?

Dr. Saurabh Jha

Health Policy

January 24, 2015

In his popular tome, The Innovator’s Prescription, Clayton Christensen proposes several cures to health care’s cost disease, known as disruptive innovations. One is the replacement of physicians by advanced practice clinicians (APCs). That is, by nurse practitioners and physician assistants. APCs meet the requirements for Christenson’s disruptive innovators: They cost less (than physicians) and are good enough.

There is little doubt that APCs …

The gifts of burnout: An evolutionary wake-up call for doctors

Lisa Chu, MD

Physician

January 24, 2015

It has been fourteen years since I graduated from the University of Michigan Medical School. I have journeyed far from the field of medicine, and yet my heart keeps hearing the call to return to my physician communities and share what I have learned. I simply cannot ignore my sense that the pain within our health care system – now felt at every level, including patients, physicians, and payors — …

MKSAP: 25-year-old woman comes for a preconception evaluation

mksap

Conditions and Diseases

January 24, 2015

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

A 25-year-old woman comes for a preconception evaluation. She has a history of hypertension that is well controlled with lisinopril. Medical history is otherwise unremarkable.

On physical examination, blood pressure is 134/86 mm Hg in both upper extremities; other vital signs are normal. Results of the cardiovascular examination are unremarkable. There is no …

Relax the rules for approving medical devices

Kevin R. Stone, MD

Physician

January 23, 2015

How informed are doctors? The answer is not obvious. Doctors know enormous amounts of data and have years of clinical experience. Many have solid science backgrounds and some conduct research keeping them at the top of their field. Most rely on published studies to make their decisions on which products to use.

However, only a small percentage of all published studies are level 1 studies: the studies with data that is …

This is exactly why surgeons are so fragile. All of them.

Kathryn A. Hughes, MD

Physician

January 23, 2015

You are human and fallible.
– Charlotte Bronte, Jane Eyre

Alas, the frailty is to blame, not me — for such as we are made of, such we be …
– William Shakespeare, Twelfth Night

Sha-doo-bee, Shattered …
– Mick Jagger, “Shattered”, The Rolling Stones, Some Girls (1978)

The image of the surgeon is synonymous with strength. Surgeons are stereotypically charismatic, commanding, confident, even arrogant. Strong minds, strong bodies, strong wills. Leaders, especially …

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