How race plays a role in palliative care

Physician
November 10, 2019

“Black life remains unexpected.”

I have been mulling over these words written by Ibram X. Kendi, in The Atlantic. This followed his piece exploring the “anniversary” of slavery in 2019. He experiences this 400-year marker both with hope and concern given the persistence of a split America: “Black death matters to racist America. Black life matters to African America.” He writes, “there may be no more consequential white …

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How race plays a role in palliative care

Maybe being a physician was just not enough

Physician
November 10, 2019

Do you ever see other people in their careers and think to yourself, “Maybe I could do that?”

I am a board-certified pediatric physician with over 25 years of experience in private practice, and I recently decided to try my hand at acting.

Much to my surprise, I was awful.  It was almost as if there were basic premises of the craft that I did not understand at all. But I suppose that …

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Maybe being a physician was just not enough

Why physicians should never try to time the market

Physician Finance
November 9, 2019

I read a Facebook post asking what people were doing about a recent market drop. As much as I watch the market (very rarely), I didn’t know the market had dropped until I read that comment. This question was raised on a site that is constantly teaching people that there is no way to time the market. Those who follow me always agree with this concept, until the market drops, …

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Why physicians should never try to time the market

What physicians should do when life gets in the way

Physician
November 9, 2019

There are times in our journey as doctors when life gets in the way. Well, life got in the way, and I had to go back to the basics and deepen my understanding and connection to myself and my source to easily navigate the curves and the bumps in the road.

I had to figure out a way to move through the tears that came with the diagnosis and poor prognosis …

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What physicians should do when life gets in the way

MKSAP: 19-year-old man with lightheadedness and nightly fevers

Conditions and Diseases
November 9, 2019

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

A 19-year-old man is hospitalized with a 6-day history of lightheadedness and nightly fevers. He also reports sore throat, headache, joint and muscle aches, and a dry cough. He recalls a blotchy rash on his trunk and arms, which has resolved. He returned home 12 days ago from a …

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MKSAP: 19-year-old man with lightheadedness and nightly fevers

What does a cardiologist think of the keto diet?

Conditions and Diseases
November 8, 2019

Being a cardiologist, the most frequent question coming my way for the last few years is “Doc what do you think about the “keto” [ketogenic] diet.”

All foods contain both micronutrients and macronutrients that are essential for the body to function optimally. The human body requires macronutrients in large amounts, which include carbohydrates, proteins, and fats. These nutrients provide energy for your body in the form of calories. Micronutrients are nutrients …

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What does a cardiologist think of the keto diet?

4 essential tips for residency interviews

Medical Education
November 8, 2019

I have just finished another round of that dreaded process that we call “the interview process.” Without fail, this process has haunted me almost cyclically every 3 to 4 years in the last 11 years of my life. First, there were medical school interviews, residency program interviews, and then lastly, fellowship interviews.

You would think that after so many rounds of applying, it would get easier. You would think after I …

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4 essential tips for residency interviews

Increasing strictness of gun laws correlates with fewer children killed by guns

Physician
November 8, 2019

Between 2011 and 2015 there were over 21,000 children killed by guns. This recent study in Pediatrics, the journal of the American Academy of Pediatrics, further analyzes the question; it compares pediatric firearm fatality rates among the various states and then tests for correlation between children killed and the degree of strictness or not of the state’s gun laws. There are extensive data on whole populations showing that stricter …

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Increasing strictness of gun laws correlates with fewer children killed by guns

A poem for the pediatrician on a Monday

Physician
November 8, 2019

It’s Monday, I recall as I step into work;
“Preparing for battle,” I say with a smirk.
Surviving all weekend with a sick kid in tow,
the parents’ relief as they waited to show
you their child with fever, diarrhea and sneezing,
the one who is too hot, too cold or is freezing,
the one who forgot that a helmet is needed,
the one who is eating too much, they conceded.
The one who still haunts you when …

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A poem for the pediatrician on a Monday

How illusions impact how we practice medicine

Physician
November 7, 2019

We can learn a lot about ourselves by looking at, and thinking about, perceptual illusions and our biases.

Look at the image above. The classic, Muller-Lyer illusion.

We know that the two lines are the same size. But no matter how much we intuitively “know” this to be true, we see the top line as bigger. We can’t unsee it — even if we …

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How illusions impact how we practice medicine

How compensation can affect physician burnout

Physician Finance
November 7, 2019

Burnout in medicine has reached epidemic proportions. A recent systematic analysis found that the prevalence of burnout was as high as 80.5%. All medical specialties are affected, although prevalence rates of burnout vary widely between specialties.

Classically, burnout is defined as a triad of emotional exhaustion, depersonalization, and inefficacy. Recently, moral distress or moral injury has also been recognized as a potential component of Read more…

How compensation can affect physician burnout

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Why diverticulitis can be an elusive diagnosis

Conditions and Diseases
November 7, 2019

I have been treating diverticulitis for 30 years the same way. When I suspect that a patient has this diagnosis, I prescribe antibiotics. This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through.

It is an easy task to miss the diagnosis. Every physician has done this.

The diagnosis can be …

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Why diverticulitis can be an elusive diagnosis

The healing patient-physician analog relationship is in critical condition

Health Technology
November 7, 2019

In the history of medical care, medical records served one purpose and two masters: to record diagnosis and treatment for physicians to refer to and for patients to use to transfer care when they desired. The medical record was a simple 3 x 5 or ledger card in the 1950s. The patient paid directly for care at the time of service. Usually, the physician had a nurse and a spouse …

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The healing patient-physician analog relationship is in critical condition

Health coverage really isn’t covering much

Health Policy
November 7, 2019

I’m a healthy 48-year old, ASA physical class I anesthesiologist. At least I was healthy until an unintentional 20-pound weight loss over the summer, accompanied by an unquenchable thirst, insatiable appetite, blurry vision, and the bathroom frequency of an elderly prostatic.

My lab workup would reveal a fasting blood sugar of 310 mg/dL, an A1C >14, positive urine ketones, low C-peptide, and glutamic acid decarboxylase antibody (GAD-65) level that was off …

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Health coverage really isn’t covering much

Vaping-related illness highlights the complexities of diagnosing rare conditions

Conditions and Diseases
November 6, 2019

When patients started showing up in doctors’ offices and emergency departments with coughs, shortness of breath, chest pain, nausea, vomiting, abdominal pain, diarrhea, fever, chills and weight loss, physicians’ first instincts were that the cause of these symptoms were common illnesses such as pneumonia or flu. But treatments that are usually highly effective for these diseases weren’t helping patients as expected. Many became seriously ill quite quickly and required care …

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Vaping-related illness highlights the complexities of diagnosing rare conditions

When a medical student is victim-blamed

Medical Education
November 6, 2019

After third-year medicine, I was required to withdraw for handing in an assignment late. It was a paragraph of self-reflection; I couldn’t believe I was being kicked out for something so seemingly inconsequential.

My dealings with the faculty became increasingly hostile and negative. I realized that my fellow students had to band together. Otherwise, there will be no change. I have to say that at my medical school, they have been …

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When a medical student is victim-blamed

Why doctors need to be chameleons

Physician
November 6, 2019

Doctors need to be true to themselves, but at the same time, they must be chameleons.

A doctor fills certain roles in the lives and stories of patients. It is a two-way relationship that looks different to each person we serve throughout every workday and even in the most casual interactions we have.

Some patients need us to take charge for a while because they’re exhausted; others need us to listen quietly …

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Why doctors need to be chameleons

Nurturing professional identity and maintaining pass rates: an important goal in medical education

Medical Education
November 6, 2019

The doctor shortage across the United States is coming and has the potential to be painful to millions of Americans. According to the Association of American Medical Colleges, by 2023, the country may experience a deficit of up to nearly 122,000 physicians. With more and more Americans getting access to health care because of policies like the Affordable Care Act and Medicaid expansion, and with the aging population, medical schools …

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Nurturing professional identity and maintaining pass rates: an important goal in medical education

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