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The weight of it: a pediatrician’s thoughts on how words last a lifetime

Physician

November 6, 2019

Start at the origin. Over two, up four. Down three, right six. Left five, up one. Keep connecting the dots. Everything will take shape.

I liked graphs. Plotting coordinates — whether it be for a parabola or ellipse — was always calming for me: numbers told you exactly where you needed to be.

But my numbers scared me. My 8-year-old feet would hesitantly step on the scale at the doctor’s office. I …

What if you are one of the 2 percent?

Samuel M. Chen, MD

Conditions and Diseases

November 5, 2019

I’m a member of the ACR (American College of Radiology). One of their recent online postings is entitled: Choosing Wisely.

Number three (of ten things physicians and patients should question) is: “Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.”

In only 2 percent of cases, will it make a difference in management.

Thirteen years ago, I was working on the queue of cases …

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What if you are one of the 2 percent?

Why physicians should adopt the role of guides

Hans Duvefelt, MD

Physician

November 5, 2019

The family doctor used to be almost the only source of medical information patients had access to. Now, few people need us to bring them the latest news. It’s there for everyone to see. There’s even too much of it.

Today, our role is to help make sense of it all. In order to do that, we must possess and project authority, but we have no reason to put ourselves on …

Letting go when people let go of their lives

John A. Dodson, MD

Physician

November 5, 2019

My 83-year-old patient had outlived peoples’ expectations on several occasions. Faced with a critical illness three years ago, she underwent emergency surgery and spent several months in the hospital with a series of complications, including septic shock, renal failure, and hospital-acquired pneumonia.

I’d seen her in the office for a new visit soon after she was discharged. It took nearly 20 minutes to go through her history before walking into the …

What rushed patient encounters are doing to patients and physicians

Hisla Bates, MD

Physician

November 5, 2019

Research shows that as many as 50 percent of physicians report some level of burnout that manifests as depression, dissociation, indifference, and even substance use disorders. Medicine has become focused on monetary gains by large corporations, major hospitals, and insurance companies. As much as doctors want to focus on quality patient care, they are forced to focus on electronic medical records that are cumbersome, seeing multiple patients with quick assessments …

The doctors guide to making a good real estate offer

Cory Fawcett, MD

Physician Finance

November 4, 2019

An excerpt from The Doctors Guide to Real Estate Investing for Busy Professionals.

Only make offers on property you think would be good for you to own for 40-plus years. Don’t mistake this statement to mean if you are 70 years old then you shouldn’t buy real estate. Positive and …

When physicians are complicit

Ann Colbert, MD, MPH

Physician

November 4, 2019

The other day I asked myself why do I focus my attention on immigrants when there are plenty of other underserved and neglected populations. When an opioid crisis surrounds me, why do I speak of a crisis at the border? When structural and overt racism contributes to an infant mortality rate of 10.97 for black women’s babies, twice the rate for the nation as a whole. When only 18 states …

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When physicians are complicit

Why primary care will soon only treat chronic conditions

Hans Duvefelt, MD

Physician

November 4, 2019

In most other human activities, there are two speeds, fast and slow. Usually, one dominates. Think firefighting versus bridge design. Health care spans from one extreme to the other. Think code blue versus diabetes care.

Primary care was once a place where you treated things like earaches and unexplained weight loss in appointments of different lengths with documentation of different complexity. By doing both in the same clinic over the lifespan …

How the administrative burden contributes to physician burnout

Philip A. Masters, MD

Physician

November 4, 2019

A guest column by the American College of Physicians, exclusive to KevinMD.com.

The administrative burden associated with caring for patients in today’s health care system has emerged as a primary driver of the loss of joy in the practice of medicine and the epidemic of burnout among physicians.

No medical specialty is immune from the upward …

Over 2,000 prayers for the dead. This was my hardest.

Rev. Jef Gamblee

Conditions and Diseases

November 4, 2019

The day began in Mom’s room with a 10:00 a.m. conference at Upper Valley Medical Center, west of Columbus, Ohio. In attendance were my 93-year-old mother Joanne (now in her third week of hospitalization), her palliative-care nurse Richard, her Episcopal priest Mother Nancy and myself.

Mom was on high-flow oxygen therapy delivered through a nasal cannula. Despite this, her blood-oxygen levels were well below normal. Clearly, her lung function was declining. …

Has health care lost its humanity?

Linda Girgis, MD

Physician

November 3, 2019

As doctors, most of us went into medicine with a true desire to help other people. What was once a noble profession is now being worn down by outside forces trying to control us. Third-party insurance companies are driven by profits, not by optimal care of patients. Politicians are driven by their own political agendas and party alliances without even acknowledging the real problems existing in the health care system.

Most …

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Has health care lost its humanity?

To fight physician burnout, empower nurses

Claire Hebner, MD

Physician

November 3, 2019

Twenty-five years ago, when I entered medical school, clinical notes were written in paper charts that were filed numerically on shelves. We didn’t have the electronic medical record (EMR), and burnout wasn’t on the radar.

In the past few years, this has changed. Burnout rates among medical providers have increased dramatically as professional fulfillment has decreased. We have the burden of EMRs weighing us down with excessive nonclinical work. We are …

How this physician reset her life

Dena George, MD

Physician

November 3, 2019

It hasn’t always been this way.

For years, I worked at the typical high-achiever pace, like many striving to become a doctor. Upon entering medical school, I set challenging expectations of myself — graduate at the top of my class, study a relentless number of hours, score at least one standard deviation above the mean for boards (two would be better). It was an exciting time fueled by the desire for …

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How this physician reset her life

Are our senior presidential candidates mentally fit?

Michael Brant-Zawadzki, MD

Conditions and Diseases

November 3, 2019

Did you know, one in four people over 65 have abnormal memory impairment? This is the finding from screening with an objective test. In half of those who test abnormal, there were common conditions – such as depression and medication interactions – which can be addressed and even reverse the memory problem. But for the other half, the memory problem is a sign of mild cognitive impairment, which can be …

What can I do differently in the ER?

Edwin Leap, MD

Physician

November 2, 2019

In the emergency department, we see them all the time. The person with a medical problem too serious to ignore, but not quite bad enough to require admission. The patient referred to the specialist who comes back to the ER. “I couldn’t afford the cash upfront.” The new cancer in the uninsured. The pneumonia without a doctor. The homeless not eligible for Medicaid.

The senior barely able to stand, but whose …

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What can I do differently in the ER?

“I did not want a baby”: A medical student faces her hardest choice

Anonymous

Conditions and Diseases

November 2, 2019

I did not want a baby. As a 26-year-old third-year medical student who had quite recently ended a far from ideal relationship — of this, I was certain.

On vacation, in New York City, walking in Soho carelessly, I laughed with my friend Noelle over the fragility of condoms. “Trust me,” I said. “They break.”

How many months in my sexually active life did I apprehensively count and recount the number of …

How to structure financial incentives in our health care system

Taylor J. Christensen, MD

Health Policy

November 2, 2019

Next in a series.

In my previous post, I explained the basics of my Healthcare Incentives Framework, which enumerates the jobs we want a health care system to do for us and links them to the parties in the health care system that have the greatest incentive to fulfill those jobs. If you haven’t read that post, I recommend you read it first. For those …

MKSAP: 28-year-old woman follows-up after a pre-employment physical examination

mksap

Conditions and Diseases

November 2, 2019

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

A 28-year-old woman undergoes follow-up consultation regarding a pre-employment physical examination. She reports feeling well, with no recent illness. Medical history is notable for gastroesophageal reflux disease. Her only medication is omeprazole. She is black.

On physical examination, vital signs and other examination findings are normal.

A peripheral blood smear shows …

Parallel thinking won’t solve problems in health care

Paul Pender, MD

Health Policy

November 1, 2019

A lot of media attention, including television, print, and online sources, is focused on various plans to revolutionize the delivery of health care in America. Critics point to medical errors, waste of resources, and lack of access among the numerous factors requiring the replacement of our health care system. To many politicians and think tank experts, the combination of government support programs (including Medicare, Medicaid, and Social Security disability) plus …

What physicians should know about good debt vs. bad debt

Altelisha Taylor, MD, MPH

Physician Finance

November 1, 2019

As a young college student or post-grad, you may have accumulated credit card debt. I certainly did. However, somewhere in the process of “adulting,” you may have realized that having lots of debt isn’t a good thing. You may have even heard investment gurus like Dave Ramsey preach that all debt is bad and insist that people do any and everything to rid themselves of the terrible “D-word” as fast …

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