“Before I leave, I want to talk to you about something very important. I want to make sure that nothing is ever done against your wishes, so it doesn’t matter if you’re 18 or 98 years of age, if you’re a patient being admitted to the hospital, I need to ask you some questions. You’re stable — so I hope I don’t alarm you with this discussion. Have you ever …
Have difficult conversations now to avoid chaos later
I had my first mammogram at age 35, and for the next 35 years I had mammograms regularly. On my way, I’d pass the entrance to the Thomas Johns Cancer Hospital, outside of Richmond, VA, never thinking that I’d one day cross that threshold myself.
When I heard the “C” word, I didn’t know what to do. I wanted to run far, far away. After much grief, however, I realized that …
A patient’s experience of chemotherapy and radiation
At the age of 17, my younger sister Elisabeth noticed a change in her body — enlargement of the front of her neck. “I just thought I was building muscle from working out,” she innocently rationalized. A series of laboratory tests and imaging followed and led to a much more grave discovery — cancer.
There are days my family will never forget, like the day of my sister’s diagnosis. My older …
This is what the face of resilience looks like
A true allergic reaction is one of the most terrifying events in medicine. A child or adult who is highly allergic to bee stings or peanuts, for instance, can die within minutes without a life-saving epinephrine injection.
But one of the most commonly reported allergies — to penicillin — often isn’t a true allergy at all. The urgent question that faces physicians every day in emergency rooms and operating rooms is …
Why it’s important to determine who’s truly penicillin-allergic
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Those of us who provide clinical care inevitably have patients who simply don’t do what we tell them. And this isn’t limited to only primary care but is encountered in all specialties and by subspecialists and consultants alike.
Not only can this be frustrating …
Why patients don’t do what physicians tell them
Everyone thinks of “Medicare for all” as a liberal idea, an extremely liberal one embraced by the socialist wing of the Democratic Party. It’s an idea Democrats were hesitant to embrace in the Obama era, for being too far out of mainstream political thought. It was thought of as an idea that was too easy to demonize as socialism.
What everyone seems to be forgetting is that “Medicare for …
The conservative appeal of Medicare for all
I have two Achilles’ heels. Two mental health issues that continually challenge me no matter how introspective and self-aware I become. One is food. I have talked before about how food was my money. As annoying as that can be, I feel like I have a good hold on that one. With the right intentions and self-control, I no longer have to wrestle with this demon as frequently. …
A physician’s experience with time stress
Nearly a quarter of a century ago (good heavens, I can hardly believe I have to say that!), when I was just starting out as a junior faculty attending, I remember one of my mentors taking me to the hospital with him on morning rounds to see all of his patients who were admitted to the hospital.
He was an eminent cardiologist, incredibly gifted and well-respected, and we walked the wards …
We need to make better use of the health team and technology
It was a slow day in the emergency department. I was sitting across the bedside from my patient who came in for a left forearm infection checkup. She was a 73-year-old female with a history of diabetes. She was elegant and soft-spoken. Prior to examining her wound, which had been worsening, I asked her what her A1c number is. She wondered what an A1c number was, and I explained that …
Explain hemoglobin A1c in 2 minutes
The dawn of 2018 brought new hopes and new promises for me as I began the third year of my medical school journey. This marked the beginning of a challenging era, one that would test my capabilities to the fullest but also one that was the culmination of countless sacrifices and the fulfillment of years of yearning. After all, this was what I had come to medical school for.
Third year …
Here’s what the third year of medical school taught me
Preparing for medical school demands displaying your passion for both medicine and helping others. Like medical schools, other graduate school programs (think: business or law) require strong grades, test scores, leadership experience, and resumes. But medical school requires so much more than that. Good extracurricular activities for medical school are a particularly important part of the application process.
Through your application — personal statement, AMCAS experience list, secondaries, and interviews — you must …
What kind of extracurricular activities do medical schools look for?
Everything is being rated these days. But who is rating the ratings? As a public service, I have been blogging about the shortcomings of various rating systems since 2010. Two recent papers on this topic are worthy of review.
In a randomized controlled study, investigators from the University Hospital of Münster, Germany found that medical students who were provided cookies during academic course sessions rated the experience significantly higher than …
Patient satisfaction: Who is rating the ratings?
Two years ago, when I was still in residency I happened to be on overnight call the day prior to election day.
An associate program director of my residency program asked me if I wouldn’t mind being a doctor of record who evaluates whether I agree a patient is too sick to go to the polls. They forwarded to me names of patients who expressed interest in voting and were already …
Help hospitalized patients vote by requesting emergency ballots
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We’ve all heard about the importance of greater stakeholder collaboration in health care. It’s the premise of current movements aimed at improving the outlook on some of the most costly, chronic conditions.
Like most physicians today, I maintain a tight work schedule to keep bottom-line margins in the black. On a daily basis, I see between 25 and 30 patients while also serving as the medical director of employee health for …
3 ways physician-pharma partnerships are improving quality of care
Doctors need to vote.
Everyone should vote, of course, but doctors have a unique perspective on some of the most important issues of the day, and it’s time we express that perspective in the one place it matters most: the ballot box. Whether it’s the actual effects of bullets on tissue, or the value of having health insurance for you and your children we are …
Doctors need to vote. And doctors need to help them.
During my urgent care shifts, I see 20 to 30 people with viral upper respiratory infections. They are all feeling miserable, and they just want to feel better. They want an impressive-sounding diagnosis to justify their suffering to themselves, their spouses, and their bosses. They want a prescription medication which will immediately cure their illness, so they can get back to their lives. Their faces fall when they receive their …
Prescribing unnecessary antibiotics is the path of least resistance
It’s a common scenario: a patient shows up to my office lugging a bagful of over-the-counter supplements, defiantly informing me that they “don’t believe in prescription drugs.” In the very next breath, they present a lab slip with a list of bloodwork that their alternative medicine doctor wants me to order to help diagnose their myriad symptoms.
I’ll admit, my initial natural reaction in this situation was a feeling of annoyance …
When Western medicine fails patients and clinicians
I had a strange thought that both delighted and frightened me in my intern year: I was sitting in my parent’s living room, exhausted. I had been fortunate enough to complete residency near my parents and visited with them pretty regularly. I realized that being a doctor is like no other job because you eat, breath and sleep medicine, it becomes your life. You are a doctor when you are …
Physicians are more than their jobs
This article is sponsored by Careers by KevinMD.com.
When searching for a new job, building strong relationships is an important part of the process, especially when you’re working with a physician recruiter. The relationship you create with your recruiter will set the tone for your job search and ultimately have an effect on whether or not you …
6 ways to better work with physician recruiters
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 79-year-old man is evaluated for pain in the buttocks region. He was diagnosed with non-Hodgkin large B-cell lymphoma 6 months ago. Although his lymphoma has responded well to therapy and he is without evidence of active disease, he required hospitalization three times for chemotherapy-associated complications during his treatment course. He has been …
MKSAP: 79-year-old man with a sacral ulcer
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