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The complex expectations of patients toward their physicians

Patient

November 10, 2018

When my father reached his mid-80s, an accelerating accumulation of physical and mental functioning issues persuaded him to switch to a primary care physician in a concierge medical practice.

Although the doctor’s pedigree proclaimed his competence, he mostly excelled as the medical equivalent of a hotel concierge who can magically procure hard-to-get restaurant reservations at the last minute. The doctor would see my dad on short notice and make sure he …

How to deal with politics in the workplace

Health eCareers

Health Policy

November 10, 2018

This article is sponsored by Careers by KevinMD.com.

Daily headlines in newspapers and on websites across the nation and around the Internet seem to inspire and anger, and it’s only natural that politics is a topic on everyone’s mind. We’re all concerned about the economy. We’re all eager to see our political leaders solve the problem of unemployment. …

MKSAP: 64-year-old man seen after an intraoperative liver biopsy

mksap

Conditions and Diseases

November 10, 2018

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

A 64-year-old man is evaluated in follow-up after recent abnormal findings on intraoperative liver biopsy. Two days ago he underwent right colon resection for a large villous adenoma with high-grade dysplasia. At the time of surgery, an abnormal-appearing liver was noted and biopsy was performed. His medical history is notable for type 2 …

Slow thinking and machine learning in medicine

Drea Burbank, MD

Health Technology

November 9, 2018

Recently, several high-profile institutions have called attention to the issue of inclusion and equity when artificial intelligence (AI) algorithms are applied in medicine. Leaders from the law, medicine, social sciences and computer sciences are speaking out about the challenges of using smart algorithms to solve social problems.

While this topic might easily be dismissed as anti-progress by the tech community, it should be reexamined as a genuine …

8 tips to land the residency of your dreams

Cory Fawcett, MD and Eric Brown

Medical Education

November 9, 2018

After countless hours of hard work and three demanding years of medical school, it’s now time to face the spotlight! If your interview invites have started rolling in and you are feeling intimidated by the thought, follow these tips to land your first choice of clinical residency.

1. Be prompt with your responses to interview invites

Be sure to set your inbox to automatically refresh every hour during the interview season so you …

You can measure the pulse of a hospital by its coffee shop

Ellen Poulose Redger, MD

Physician

November 9, 2018

I think you can tell a lot about how things are going in a hospital based on the amount of consumption of coffee by its employees. Visit the Starbucks, Au Bon Pain, Roasterie, Einstein Brothers, or whatever coffee shop inhabits square footage in your hospital, and I’d venture to say that you can take the pulse of the hospital. Lots of large coffees to go? It’s either just about shift change and …

Doctors are pawns of the health care system

Smart Money, MD

Physician Finance

November 9, 2018

Doctors and other caretakers are the pawns of the health care system. We provide the services that allow hospitals and medical groups to bring in big revenue. Unless we are contracting directly with insurers, doctors will never realize the true financial firepower that we have. As the health care environment evolves, we are seeing fewer individual physician-owned groups and more conglomerates. The larger the system that we belong in, the …

Physicians are trapped between patient satisfaction and unnecessary prescribing

Richard Young, MD

Patient

November 9, 2018

I don’t mean to pick on McDonald’s. Insert any other large retail business where customer satisfaction massively trumps every other consideration of the relationship between employee and customer.

Telemedicine companies have exploded the past few years. I suspect a lot of my readers have already seen this, but just in case not, a recent study in JAMA Internal Medicine measured the correlation between customers with a cold who called …

The carefully crafted way of how health misinformation spreads

Mary Chris Jaklevic

Conditions and Diseases

November 9, 2018

Effective clickbait doesn’t just happen. It’s carefully crafted.

Take this wildly misleading article from CNN: Not exercising worse for your health than smoking, diabetes, and heart disease, study reveals.

It’s one example — among many generated daily by various news outlets — of how a mundane observational study can be transformed into viral internet gold. In the days after it was published, this story was liked and …

The main difference between functional medicine and evidence-based medicine

Alex Lickerman, MD

Physician

November 8, 2018

Figuring out what’s actually true is far harder than most people realize. Our brains are both hypothesis-generating machines and incredibly credulous. As a result, most of the things we believe to be true turn out to be false. We don’t just mistakenly believe that vaccines cause autism, that the flu shot can give us the flu, and that astrology can predict our future. We also mistakenly believe that the salad …

PSA-based screening for prostate cancer: Interpreting the changing guidelines

Kenneth Lin, MD

Conditions and Diseases

November 8, 2018

Comparing the 2018 U.S. Preventive Services Task Force (USPSTF) recommendation statement on prostate cancer screening in the October 15th issue of American Family Physician with its previous recommendation, the first question family physicians ought to ask is: What new evidence compelled the USPSTF to move from recommending against PSA screening in all men to determining that there was a small net benefit for screening in some men? …

Urgent care isn’t the answer to our broken system

Rosalind Kaplan, MD

Physician

November 8, 2018

I’ve only worked four shifts of urgent care so far, but four 12-hour shifts means I’ve seen a lot: a lot of patients, a lot of different ailments, a lot of different reasons that people come to urgent care centers.

I have to admit that this has been a breath of fresh air for me; compared to primary care, I work less frequently, I feel like the monetary compensation is fairer, …

A medical student as storyteller and story-listener

Yoo Jung Kim, MD

Medical Education

November 8, 2018

“Sondor” is a made-up internet neologism that captures the fleeting but poignant sense of “the realization that each random passerby is living a life as vivid and complex as your own — populated with their own ambitions, friends, routines, worries and inherited craziness.”

I think about this word often when I see my patients. Everyone is the main character of his or her life, and during the third year of medical …

A CT scan for kidney cancer? It may depend on where you live.

Peter Ubel, MD

Conditions and Diseases

November 8, 2018

About one in fifty people reading this essay will be diagnosed with kidney cancer at some time in their life. In fact, one out of one people writing this essay has already been diagnosed with kidney cancer. (I had a small tumor removed from my left kidney not long after I turned 50.) But how many people diagnosed with kidney cancer have been overdiagnosed with the condition? And what does moving to Florida have …

We need more behavioral health treatment in primary care

Hans Duvefelt, MD

Conditions and Diseases

November 8, 2018

I don’t know how many times a patient has told me, “I was in therapy once, and it didn’t help.”

My response is always: “That’s like saying ‘I saw a movie once and I didn’t like it’.”

That usually breaks the ice just a little.

In primary care, we certainly run into a few patients with chronic mental health problems that could use some long-term, in-depth counseling. But usually, patients in my practice …

How do health insurance companies harm patients?

Linda Girgis, MD

Physician

November 7, 2018

Health care policy has been a hotly debated political topic for many years now. In recent years, new laws passed the halls of Congress while others failed to gain any traction. Despite the rules that have rolled out, health insurance companies have been in the driver’s seat for decades.

While spokespersons for the health insurance industry will tell you that they do not make medical decisions. As a doctor, I can …

Be a master at your craft by taking time each day to truly rest

Kelly Cawcutt, MD

Physician

November 7, 2018

I am bad at taking vacations — really bad.

It’s not that I don’t take days off or even travel on days off. It’s my near inability to actually unplug and not bring work with me. Despite recovering from a level of burnout a few years ago that left me considering quitting medicine altogether, I still struggle with this.

There is a never-ending to-do list related to work — both the items …

This attending learned so much from her residents

Lisa Sieczkowski, MD

Physician

November 7, 2018

While riding shotgun in the family minivan on the way home from a fall break water park trip, I received the following text message:

I thought of you today! One of the residents here had done a great job with a complex (and really sad) labor and delivery patient, and the nurse was telling me how awesome she was … so I thought to myself that I should do what you …

Read more…

This attending learned so much from her residents

Are physician wellness programs just another checkbox?

Anonymous

Physician

November 7, 2018

Recently, I saw a photo of a slide from the American College of Surgeons Clinical Congress: “The Program Directors Guide to Implementation of Well-being Programs.” While I applaud the ongoing focus in medicine on wellness for both trainees and faculty, I am troubled by the perceived need to standardize and program wellness, creating a “checkbox” that may not improve actual well-being. As a recent graduate now living my best life …

We are in danger of hospitals no longer being safe havens

Andrea Lauffer, MD

Physician

November 7, 2018

On the outside, most American hospitals appear completely modernized. If resources are utilized correctly, they appear equipped for any disaster, any CMS audit and any surprise joint commission inspection that may come. The procedural appearance of hospitals seems robust and reflective to medicine in the 21st century. However, the framework for the daily function of many American hospitals is architecturally weak and weathered (metaphorically speaking). With the progression of times …

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