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The medical record often doesn’t capture the care of the clinician team

Physician

August 20, 2019

While my forty-year parts warranty expired some time ago, leaving me with a snapped fibular styloid process not long after, the ensuing twenty-five years have not resulted in any serious medical encounters until last week. Following a very pleasant early evening session with our Congresswoman and a sweet snack at home, abrupt abdominal pain progressed in under two hours to a clinical acute abdomen. As I got dizzy and dependent …

Communicating honestly with patients about uncertainty

Kunal Shetty

Medical Education

August 20, 2019

When looking at the way medical education and patient care is delivered, there is no question that there is a culture of “knowing.” From the moment a pre-med enters high school, they are bombarded with tests that assess knowledge. This extends throughout medical training, where the development of an assessment and plan in residency is paramount in the transition to an attending physician who must make autonomous decisions for their …

It’s time for physicians to bring clarity to their lives

Stephanie Wellington, MD

Physician

August 20, 2019

I meet doctors in different arenas: clinical settings, conferences, and referrals. I am noticing a trend. We are keenly aware of what we do not want in medicine. We talk about physician burnout and its impact on doctors’ lives. We know firsthand the effect the EMR has on the doctor-patient relationship as doctors spend less and less time in direct patient care activities. And we are learning how to navigate …

Health insurers and physicians are not partners

Thomas Stark, MD

Physician

August 20, 2019

On the face of it, this seems like a fairly simple business arrangement. My patients or their employers pay money to a health insurance corporation so they, in turn, have sufficient funds available to pay medical claims for services I render. That simple system seems to work for auto, home, and life insurance.

First of all, a little background about me. I am a board-certified otolaryngologist who did my residency through …

Convincing patients to stop cancer screening isn’t always easy

Nancy L. Schoenborn, MD

Physician

August 19, 2019

During my training to become a primary care physician, the importance of preventive cancer screening was ingrained in me. The idea of catching cancer at an early stage so we can better treat it made intuitive sense. But as I’ve learned over the years, the simplicity of this concept can obscure its limitations and make it difficult …

What is low-value care, and why does it matter?

Edward Hoffer, MD

Physician

August 19, 2019

Doctors and policy wonks hear a lot these days about “low-value care.” What exactly is that, and should you care?

The term refers to tests, medications, and procedures that add little to a patient’s health or well-being but which cost them or the system more money than any benefit warranted. Some of the earliest research that looked at this was done at Dartmouth, where they found enormous variations in the cost …

Work getting you down? What you watch on TV might be making it worse.

Ara Feinstein, MD, MPH

Physician

August 19, 2019

As a trauma surgeon, it’s my job to diagnose and fix the violent destruction of the human body. One of the questions I get asked very frequently is, “How do you deal with that?” My standard answer is, “After a while, you get used to it.”

And while I recognize there is some truth to that, lately I’ve been more honest with myself about the emotional toll that violence …

Asking patients the right questions isn’t as easy as you think

Mary Braun, MD

Physician

August 19, 2019

I made my 10:20 a.m. patient wait while I told my support staff about my day off.

“I was getting an ice cream when I saw a car accident. By the time I got there, it was clear that there were no serious injuries and all I did was to distract the passenger so she wouldn’t panic while we waited for EMS. Her husband hit a tree with their van, and …

To raise future scientists, address our innate curiosity

Jason J. Han, MD

Medical Education

August 19, 2019

Michelangelo once said, “The sculpture is already complete within the marble block before I start my work.”

The same insight applies to the scientific potential that resides inside young people. Curiosity is imbued within every human being since our birth, and before we can find the words to explain why, we experience the urge to turn over rocks.

Often, efforts to promote science among young people aim to impress upon them what …

4 reasons why this radiologist loves practicing teleradiology

Katie Lozano, MD

Physician

August 18, 2019

Some radiologists perceive teleradiology as the “dark side” of our profession. I may have counted myself among those skeptics, but I now see the light and am happy to share a place among the converts.

Most of my career has been in traditional private practice, but there’s not a great deal of difference in how they operate versus a teleradiology practice. Both organizations exist to provide clinicians and patients with diagnostic …

Breastfeeding is best, but why do some countries struggle?

Melvin Sanicas, MD

Conditions and Diseases

August 18, 2019

Breastfeeding provides ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Breastfeeding has numerous health benefits for both the mother and infant. Breast milk contains all the nutrients infants need in the first six months of life. Breastfeeding protects against diarrhea and common childhood illnesses such as pneumonia and may also …

Why millennials in medicine want a different dress code

Casey Hribar and Carolyn S. Quinsey, MD

Medical Education

August 18, 2019

The millennial generation is known for its desire and ability to change the status quo. As this group continues to enter and dominate the workforce, particularly as our current residents and medical students, employers are adjusting their long-held practices to reinvent their culture and ensure long-term access to young, top talent.

Can you give this generation the same dress code as you did the baby boomers and expect the same result? …

How coding is like Scrabble

Therese Zink, MD, MPH and Andrew Saal, MD, MPH

Physician

August 18, 2019

One of the great nuisances in medicine is diagnosis coding. According to Medicare and insurance companies across the U.S., each and every disease must have a unique number. Everything must be quantified and recorded. Why? To facilitate analysis, number-crunching, regulations, reimbursements and, of course, we sometimes joke, to perpetuate the jobs of the coders. They usually know the nuances better than the doctors.

Is it truly possible to describe Mrs. Brown’s …

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How coding is like Scrabble

10 reasons why doctors get sued

Ton La, Jr., MD, JD

Physician

August 17, 2019

The one thing doctors want to avoid like the plague is a lawsuit — a medical malpractice lawsuit.

To be sued means the doctor loses precious time from work, endures emotional personal and family distress and is unable to fully invest oneself in providing the very best medical care possible. It is a dark cloud that hovers over the majority of physicians at least once in their lives. Some medical specialties, …

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10 reasons why doctors get sued

4 actionable tips for new medical interns

Liang Chen, MD

Physician

August 17, 2019

People often compare internship to drinking from a fire hose. Overwhelmed by new information and workflow, interns (especially international) usually do not have a clear direction about how to optimize their working/learning experience. Here are some tips for interns to smooth their transition from a newbie into a high-functioning intern in the setting of medicine inpatient wards.

Success leaves clues

Don’t explore yourself, specifically ask your upper-level resident about the most productive …

The trauma of separating young children at the border

Nickey Jafari, MD

Physician

August 17, 2019

Being a medical resident is really hard. This is not only due to the infamous number of hours you work, but you are truly responsible for patient care for the first time. That is a heavy responsibility, especially when you constantly feel inadequately prepared. You never feel like you have enough time to read, and you never stop feeling like you could be doing a better job.

Despite the schedule and …

MKSAP: 25-year-old woman with chest pain after a motor vehicle accident

mksap

Conditions and Diseases

August 17, 2019

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

A 25-year-old woman is evaluated in the emergency department for chest pain after a belted motor vehicle accident. She is pregnant at approximately 23 weeks’ gestation. She reports no additional symptoms and is otherwise well. Her only medication is a prenatal vitamin.

On physical examination, the patient is afebrile, blood …

I’m a jail physician. Here’s what likely happened to Jeffrey Epstein.

Jeffrey E. Keller, MD

Physician

August 16, 2019

Jeffrey Epstein’s apparent suicide while in custody at a Manhattan detention facility has focused intense media scrutiny into jail suicide prevention procedures. Suicide is the biggest cause of death in jails in the U.S. — by far. Because of this, all jails (including the facility where Epstein was housed) have a suicide prevention policy. Since the process was an epic …

Clinical performance data: a physician’s friend or foe?

Robert Pearl, MD

Physician

August 16, 2019

According to a recent Harvard report, physician burnout is “a public health crisis that urgently demands action.”

Half of all doctors report troubling symptoms: depression, exhaustion, dissatisfaction, and a sense of failure. These physicians are twice as likely to commit a serious medical error, research finds. Experts predict that if left unaddressed, burnout will further erode the mental health of doctors and radically undermine …

New doctors are prioritizing the wrong things

Fred N. Pelzman, MD

Physician

August 16, 2019

Every year, there’s this rite of passage, the passing of the baton, as our graduating senior residents move on to fellowships, or into spots as hospitalists, or to practice jobs here in New York City or other cities, and a fresh new group of newly-minted physicians arrives ready to take up the gauntlet of training as Internal Medicine doctors under our …

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