Be the honest doctor instead of the confident one

Physician
October 30, 2018

This is an article about certainty, or maybe lack of certainty?

It is about the need for confidence, without having overconfidence.

Doctor! Don’t be arrogant — listen to your patient — they are telling you the answer.

So believe them, but be a skeptic!

Better yet, figure out the diagnosis, but then don’t believe yourself.

Try to prove yourself wrong at every turn.

The definition of the word hubris is important to understand. One definition of hubris is “exaggerated pride or …

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Be the honest doctor instead of the confident one

Should there be mandatory state enforced nurse-to-patient ratios?

Health Policy
October 30, 2018

On November 6th voters in Massachusetts are facing a very important health care-related question. In addition to voting for political parties in the midterms, they also face three ballot questions. The first of these is whether there should be mandatory state enforced nurse-to-patient ratios. For a general medical or surgical floor, this will be no more than four patients for every registered nurse. For other types of adult floors and the …

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Should there be mandatory state enforced nurse-to-patient ratios?

3 hurdles to financial independence

Physician Finance
October 30, 2018

I have talked in the past about how I try to tackle the philosophy of financial independence.  Part of the reason is that there are so many other amazing voices that manage the mechanical side.  The other part is my profound belief that the grand majority of Americans can either cleave a path to financial independence or at least substantially improve their economic situation.  Yet, the majority don’t. …

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3 hurdles to financial independence

The Ellen Show broadcasts potentially harmful information about ovarian cancer screening

Conditions and Diseases
October 30, 2018

Ethical OB/GYNs everywhere sighed heavily when they realized from the action on their Facebook and Twitter feeds that the Ellen Show broadcasted incorrect and potentially harmful information about ovarian cancer screening to almost 4 million people. Millions more will likely hear about it on social media.

Ellen Pompeo, who plays a doctor on the television show Gray’s Anatomy, decided to play doctor in real life and used her celebrity platform to recommend …

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The Ellen Show broadcasts potentially harmful information about ovarian cancer screening

How should physicians pay off their debt?

Physician Finance
October 29, 2018

By this point, a lot of people have heard the famous Dave Ramsey quote, “If you live like no one else, later you can live like no one else.”  Ramsey is known for being a proponent of attacking debt aggressively when people ask, “How should I pay off my debt?”

He proposes one method that I think works for the vast majority of Americans, but today I’ll argue that method isn’t necessarily …

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How should physicians pay off their debt?

What does financial freedom mean to you?

Physician Finance
October 29, 2018

Financial freedom means different things to different people, but to me, it’s when you can quit your day job and be able to cover your expenses with other sources of income. The dollar amount depends on your unique situation, where you live, and the lifestyle you lead.

I believe all physicians can attain financial freedom, but some encounter obstacles that delay them from reaching that point and sometimes keep them from …

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What does financial freedom mean to you?

4 things this family physician wants patients to know

Physician
October 29, 2018

Dear patients:

A few things come up daily in my office that need to be addressed. I’m just going to put these out there in the blogosphere in the hopes that someday they’ll be shared widely and save myself and other doctors a whole lot of hair-pulling (as an alternative to crowdfunding a Super Bowl ad).

1. Stop apologizing

So many people apologize out of habit for way too much (I’m guilty too), …

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4 things this family physician wants patients to know

5 lessons on doing research as a resident

Physician
October 29, 2018

I remember sitting in my residency academic adviser’s office as I was discussing the plans I had designed for my community project at the end of my intern year. I can only imagine what she thought as I looked at her with a blank stare when she had suggested I should create an original research project around this. “What?” was all I had managed to mumble out of my mouth. …

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5 lessons on doing research as a resident

Health care is expensive. It’s time to treat the cause.

Health Policy
October 29, 2018

We do not rely on the benevolence of the butcher, the brewer, or the baker to feed ourselves — Adam Smith observed in the “Wealth of Nations” (1776) — but on their regard for their own interest. The desire to pursue a profitable living also holds true for doctors and nurses, notwithstanding the moral dimensions of their labor.

Health care is a service like any other. We ought to expect price …

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Health care is expensive. It’s time to treat the cause.

The gift of suffering in medicine

Physician
October 29, 2018

“There will always be suffering. It flows through life like water …”

Those famous lyrics sung by Nick Cave in his Lime-Tree Arbour ring true for many of us. They take on an entirely different layer of meaning for physicians.

Even the very journey of becoming a physician is marked by suffering. While many of our classmates frequented football games, nightclubs, and social events, most of us were studying day and night …

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The gift of suffering in medicine

What I wish I knew on the residency interview trail

Medical Education
October 28, 2018

I still remember the warm, fuzzy feeling of receiving my first few interview invitations. Unlike medical school, I received much more “love” from residency programs. Since I was part of the inaugural class of a new medical school, I interviewed for a lot of programs: 16 anesthesiology, six transitional years, and three preliminary medicine programs. After my first few interviews, it became apparent that most residency interviews tend to be …

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What I wish I knew on the residency interview trail

Female physicians prioritize patients over profits

Physician
October 28, 2018

Gender politics aside, let’s talk about why the way doctors get paid matters to you as a patient. Female physicians don’t just get paid less because they prioritize their families, they get paid less because they prioritize patients. In the fee-for-service model, doctors are paid per patient visit, so the more patients they see, the more they get paid. This means that the worst doctors are paid the most. Health …

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Female physicians prioritize patients over profits

Expanding the scope of emergency medicine

Physician
October 28, 2018

Yes, this is a piece on observation medicine as the expansion of our specialty.  My oh my, have things changes since my days of training where I learned to care for all comers irrespective of their money, background, color or creed.  I learned to stabilize, evaluate and treat then admit or discharge.  Clearly, I’m simplifying though, historically, our disposition decision was binary, patient in or out.

Then overtime as I practiced emergency medicine (EM) …

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Expanding the scope of emergency medicine

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How do I keep my kids out of the ER this Halloween? 

Physician
October 28, 2018

I have worked most of the last 20 Halloweens in the pediatric emergency department (ED), so I’ve seen how a split second can ruin your child’s holiday.  Here are some things you can do to plan ahead and avoid the ED.

1. Avoid trip hazards

It’s a recipe for mishap. Your child is in a costume that may have long hems or unusual shoes or a mask limiting their normal vision. A …

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How do I keep my kids out of the ER this Halloween? 

How much is micromanagement of your time worth?

Physician Finance
October 27, 2018

Some of us like to micromanage.  Obviously, this trait is useful only for certain tasks that you need to accomplish.  Managing money can take some attention to detail, but fortunately, many issues work themselves out if you follow broad principles.  How much you should micromanage your daily expenditures really depends on your own tolerance and your individual financial situation.  We’ve all seen discussions about the cost of daily artisanal cups …

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How much is micromanagement of your time worth?

Millennials want convenient care

Health Technology
October 27, 2018

The Kaiser Health News article, “Spurred By Convenience, Millennials Often Spurn The ‘Family Doctor’ Model,” caught my eye. Millennial patients want “convenience, fast service, connectivity, and price transparency” while doctors and health experts worry about “fragmented or unnecessary care, including the misuse of antibiotics” and loss of  “care that is coordinated and longitudinal.” It’s as if the needs of the patients and the concerns of doctors are …

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Millennials want convenient care

Should a HIPAA-questionable good deed go unpunished?

Physician
October 27, 2018

On a Saturday morning, Michael, a physician, was making his way through the hospital atrium after his weekend rounds.  On his way out, he noticed a family he knew well.  They were talking quietly and appeared distraught.  He asked them if they were okay.  They said that the husband’s mother had been admitted overnight with a malignant pleural effusion, and since all beds on the oncology floor were full, she …

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Should a HIPAA-questionable good deed go unpunished?

MKSAP: 30-year-old woman is evaluated for a 2-month history of diarrhea

Conditions and Diseases
October 27, 2018

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

A 30-year-old woman is evaluated for a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps, bloating, intermittent nausea, and mild anorexia that has resulted in the loss of 2.3 kg (5.0 lb). She has had no fever or blood in the stool. She works …

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MKSAP: 30-year-old woman is evaluated for a 2-month history of diarrhea

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