Inaction is driving our collective burnout

Physician
January 9, 2019

I sat knee-to-knee with a nurse practitioner at a school-based clinic in rural Ohio. Choking back tears, she described a patient she couldn’t get out of her head: a middle-school girl, accompanied by her mother and a social worker. Just days prior, the girl was dropped off at her father’s home for the weekend. Before the promised Friday night football game, she discovered him unconscious on the bathroom floor. Within …

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Inaction is driving our collective burnout

What physicians should know about turnkey real estate

Physician Finance
January 8, 2019

If you’ve done any research into real estate investing, you’ve likely heard the term “turnkey real estate.” Businesses calling themselves “turnkey companies” claim to take care of all the hard parts of real estate investing – helping you with all aspects of purchasing and managing a rental property – leaving you to sit back and collect passive income.

That sounds great, but surely there’s a catch, right? Well, …

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What physicians should know about turnkey real estate

Sun exposure makes people both more and less likely to die of melanoma. How can that be?

Conditions and Diseases
January 8, 2019

Quick quiz question: two people are diagnosed with melanoma — Sarah Sunburn, an adamant sun-worshipper, and Paula Pale-All-The-Time, a fanatical sun-avoider. Who is more likely to die of the disease?

The answer is pale-faced Paula. Surprised? Let me unpack this mystery and explain why sun exposure simultaneously kills people, while making the cancers they are diagnosed with appear to be less life-threatening.

I will start with what you probably know already. Melanoma …

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Sun exposure makes people both more and less likely to die of melanoma. How can that be?

Patients and physicians need to talk more and tweet less

Physician
January 8, 2019

Long ago, and far away, I encountered a patient that changed the way I practice. I was with a medical student while examining a middle-aged woman who presented with a dramatic eruption that was probably DRESS syndrome (DRESS syndrome was not yet described). I prescribed prednisone and asked her to come in a few days later so I could assess her progress. She returned – I did not recognize her …

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Patients and physicians need to talk more and tweet less

Residency training, and training in residency

Medical Education
January 8, 2019

Exhausted. Aching. Hungry. Slightly delirious.

Mile twenty-four of a marathon? Or hour twenty-four of a twenty-eight-hour shift?

I am a resident. I am a runner. I am also a rather tired human since, as I type these words, I’m both post-call and post-run. However, this post-call/run state of body and mind is one I have learned to love and embrace during this residency whirlwind.

I’m not myself unless I’m wearing scrubs or running clothes. …

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Residency training, and training in residency

Despite progress in cancer care, cost and equity challenges still must be addressed

Health Policy
January 7, 2019

As a physician who has spent his career taking care of people with HIV/AIDS, cancer and various blood disorders, this is an amazing time to be working in these overlapping fields of medicine.

I began my training when roughly half the people diagnosed with HIV were destined to develop cancer, and nearly everyone died shortly after they progressed to AIDS. In resource-rich countries today, HIV care is often as simple as …

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Despite progress in cancer care, cost and equity challenges still must be addressed

How near-death experiences profoundly change lives

Conditions and Diseases
January 7, 2019

An excerpt from The Science of Near-Death Experiences.

Near-death experiences are an ancient and very common phenomenon that spans from ancient philosophy, religion, and healing to the most modern clinical practice of medicine.

Modern advances in medical knowledge make it possible to revive patients from increasingly severe, life-threatening injuries and illnesses, including cardiac arrest.  Upon being revived, …

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How near-death experiences profoundly change lives

A medical student’s letter to her parents

Medical Education
January 7, 2019

Dear Mom and Dad,

I love you, and thank you. The rest of this letter is an attempt to write something more eloquent and thoughtful, but those are the best and truest words I can ever speak to you. I made the decision to enter the medical field when the rest of our family is from a business and finance background. Despite being unfamiliar with the different hurdles of application cycles, …

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A medical student’s letter to her parents

Physician gives in to police pressure to conduct a forced invasive rectal exam

Physician
January 7, 2019

Recently, news broke about a disturbing act of medical battery carried out by doctors at St. Joe’s Medical Center in Syracuse, New York. The case began when police officers conducted a pretext stop and elected to harass their victim about a small amount of marijuana.

As the situation escalated, the cops took the man to St. Joe’s Medical Center for him to be searched for …

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Physician gives in to police pressure to conduct a forced invasive rectal exam

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Net promoter scoring needs to be tweaked for medicine

Physician
January 6, 2019

Net promoter scoring (NPS) measures customer experience and predicts business growth. Recently it is becoming more common for health networks to adopt NPS. The word “customer” should be a red flag. In medicine, we do not have customers; we have patients.

It is common practice for a patient to receive a text message after they leave an office asking them to rate their experience. It generally looks something like this, “How likely …

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Net promoter scoring needs to be tweaked for medicine

An approach to prior authorization insurance denials

Health Policy
January 6, 2019

Patient access to care is a high priority for all neurosurgeons. Unfortunately, many of our practices are thwarted in these efforts from unwarranted insurance denials. Know, you are not alone. Take this common scenario:

When Ms. Mary Smith (not the patient’s real name) started her new job several years ago, she purchased the premium insurance policy that her company provided. Recently, she developed severe neck and left arm pain. Imaging of …

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An approach to prior authorization insurance denials

How to transfer residency programs

Physician
January 6, 2019

Even though physicians do not talk about transferring residencies, it is more common than is often believed. According to the AAMC website, about 30 percent of residents do not finish the initial program they started. Quantifying that number further, the ACGME recently reported 1,044 residents transferring from their program.

There are a variety of reasons for transferring residencies: A spouse being accepted for a …

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How to transfer residency programs

We need to change the way we talk about climate change

Health Policy
January 6, 2019

There was a point in my life when the words “climate change” would recall pictures of polar bears marooned on precarious chunks of ice, bobbing aimlessly in some foreign landscape of tundra and sea. While tragic, the environmental drama playing out at such extreme latitudes always felt like an abstraction, particularly to a kid growing up in temperate Colorado.

Today, however, as I study medicine and the environmental factors that influence …

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We need to change the way we talk about climate change

Having a baby makes you a very different physician

Physician
January 5, 2019

Beeeeeeeeeeep.

The unmistakable long beep of my bright-red code pager broke the rhythmic sound of my trusty breast pump. I grabbed the pager silently praying it was a “test page.” No such luck. As I read the Code 45 message, I heard the overhead announcement echo: “Code 45, East Tower.” I quickly disconnected the breast pump, whipped off my pumping bras and was mostly dressed as I ran from the lactation …

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Having a baby makes you a very different physician

Stop shoving metrics down nurses’ throats

Health Policy
January 5, 2019

One time, I applied for an emergency department (ED) nurse manager position. I thought I had the job locked up until I was asked during the interview how I would “enforce metrics.”

“Enforce.”

My holistic, qualitative research-based response to this authoritarian-style question was: “I’ll find more organic ways to achieve your metrics without shoving numbers down their throats.”

I didn’t get the job. Someone told me I wasn’t “MBA enough.”

Yet, I stand by …

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Stop shoving metrics down nurses’ throats

The pros and cons of practicing medicine in a rural setting

Physician
January 5, 2019

This article is sponsored by Careers by KevinMD.com.

Wide open spaces. Fresh, clean air. No people for miles around.

The advantages of rural living are plentiful, but there are disadvantages, too, especially when it comes to health care; being way out in the country likely means the choices for doctors, clinics and hospitals are severely limited.

According to the …

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The pros and cons of practicing medicine in a rural setting

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