Nurses are always right. And 28 other tips for new residents.

Physician
August 1, 2018

This summer, new resident physicians begin their training all across the United States. Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a sideline) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school. Anxiety-filled and debt-ridden, they will embark on four …

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Is double health insurance coverage better?

Finance
July 30, 2018

You have just gotten a job offer that includes health insurance.  You’re lucky enough that your spouse has great family insurance already, but hey that health insurance is going to cover the cracks in the deductible and co-insurance, so you feel great about that double coverage as you sign your contract.

Well, you just got scammed.  That is, double coverage is a scam, and you would have been far better off …

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The double-edged power of the medications we prescribe

Meds
July 30, 2018

My patient, a rugged sixty year old with massively muscular forearms, gray chest hair at the V of his denim shirt, and a voice that suggested years of liquor and unfiltered cigarettes, lowered his voice and leaned forward.

“I’m not usually scared of anything, but for three nights now, ever since I started taking the Levaquin for this pneumonia, I have had the most horrific nightmares. I can’t even talk about …

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Is going to medical school a wise financial decision?

Finance
July 30, 2018

It is no secret that medical school is getting very expensive. Over the past 20 years, the cost of medical school has greatly outpaced the rate of inflation, and medical school debt is rapidly rising.

The average medical student now graduates with over $192,000 in student loans, but with the cost of attendance for the most expensive private medical schools approaching $100,000, there are some physicians who are finishing residency with $300,000 or …

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Urgent care centers prescribe more antibiotics. Why is that?

Conditions
July 30, 2018

Urgent care centers are way ahead in prescribing unnecessary, potentially harmful antibiotics that are doing no one any good – at least no patients any good. The owners of the urgent care centers are the ones who are benefitting. And you and your family are being bilked, misled, and harmed.

A recent study published in JAMA Internal Medicine looked at the proportion of antibiotic prescriptions that were made for viral respiratory …

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The simple, powerful question doctors should ask their patients

Physician
July 29, 2018

As physicians, we are used to asking our patients lots and lots of questions. It’s our job to elicit information, listen, and then come up with a management plan. There’s a standard script every doctor goes through, based on the science of medicine, and we usually have this memorized to a tee. And that’s all very well and good. However, as with many things in life — especially those that …

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What personality type fits your medical specialty?

Physician
July 29, 2018

Both patients and providers realize that an internist is different from a surgeon, but specifically how they differ and how this affects their approaches to patient care is largely under-appreciated. Over the last four years, I have conducted over 250 interviews with physicians across specialties and institutions about what they do and why they do what they do. With each project, I continue finding remarkably distinct, specialty-specific values, perceptions, and …

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The other side of Suboxone

Meds
July 28, 2018

A lot has been written about Suboxone, the buprenorphine treatment drug. For many, Suboxone acts as an effective medication to treat opioid addiction. For others, it’s a highly-valued street drug that is commonly diverted and misused. To understand and acknowledge the darker side of Suboxone we have to look back at its history over the past 16 years.

History of Suboxone

Suboxone was first approved by the FDA in 2002 to treat …

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Tips for fellowship applicants from a program administrator

Education
July 27, 2018

The season has opened, and panic has spread among senior year residents, chief residents, and hospitalists out in the community. Fellowship applications are live and being viewed by the programs applicants think they want to rank one, two, and three. These incredibly intelligent physicians are refreshing student document network daily now and soon to be hourly as the weeks go on. The anxiety is building as people are waiting to …

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There’s a fine line between stupid and clever in medicine

Physician
July 26, 2018

In the 1984 rock mockumentary This is Spinal Tap, a fictional band discusses the controversy surrounding one of their album covers. “There’s such a fine line between stupid and …” the lead singer says, realizing where they’d crossed the line of tastefulness.

His guitarist finishes his thought, “… and clever,” he says. In life, in rock and roll and in medicine, there is indeed a fine line between stupid and clever.

During …

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NP/PA vs. physician: Why is there a productivity gap?

Physician
July 25, 2018

So out in the varied land of hospital medicine, I have noticed something that I have no clear explanation for. It turns out there is often a gap in productivity between that of NP/PA providers and physicians. The range of the gap varies wildly – I just got off the phone with a group leader who has observed a 50 percent difference to a smaller gap of perhaps 10 percent. …

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After you die, what will your legacy be?

Finance
July 24, 2018

As part of my job as an anesthesiologist, I get called to truly horrific airway events.  Sometimes they are down in the emergency department after a bad car accident, drowning, or burn.  Others are in ICU’s.  Sometimes they are even in hallways or bathrooms where people have stopped breathing or collapsed from cardiac arrest.  It’s part of the job.

Recently, I was called to an airway in an ICU in what …

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MKSAP: 55-year-old woman with an eating disorder

Conditions
July 23, 2018

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

A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to 19. She has otherwise …

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A return to the problem-oriented SOAP note

Physician
July 22, 2018

CMS is changing note requirements, among other changes.  Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.”

As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction.  To me the most important change is a focus on notes: “Allowing medical decision making to be …

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Who named our bones? And what were they thinking?

Conditions
July 21, 2018

All of our 200+ bones have names, which facilitates describing them when we cannot actually hold them or point directly at them. It might be easier to remember the names if they were familiar ones like Robert, Sally, and Kevin, but no such luck. Latin was the original language of science, so the bones received Latin names. Some of those were derived …

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Medical students: Welcome to the wards

Education
July 19, 2018

Dear third-year medical students,

Welcome to the wards.

I remember this stage — basking in the glory of completing pre-clinicals, in the excitement of finally switching heavy textbooks for living, breathing people, in the realization that medical education now lies in the hands of those I wanted to heal. I would be sleeping less, but living more, because this was my purpose.

Remember this moment because this will be the most difficult year …

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When attendings come to work rounds

Education
July 18, 2018

Learners value efficiency.  As I recall my residency, nothing caused more angst than unnecessarily long rounds.  In the 1970s just like in the 2010s, I had much to do after rounds ended.

As an attending physician, my responsibilities involve patient care and aiding learning.  I have always worked hard to do that within a time constraint.  The time constraint requires that rounds run efficiently.

Like many things in medicine, efficiency only works …

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