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Medical bankruptcies happen less frequently than you think

Peter Ubel, MD

Health Policy

October 15, 2018

Elizabeth Warren describes medical bills as “the leading cause of personal bankruptcy” in the United States. She bases that opinion in part on her own research, in which she and her collaborators surveyed people who had experienced personal bankruptcy, asked them whether they’d experienced health-related financial distress, and concluded that 60 percent of all bankruptcies in the U.S. result from illness …

A physician’s breakthrough against prior authorization

Niran S. Al-Agba, MD

Medications

October 15, 2018

A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.

The patient was on the state Medicaid …

If you are ready to become a parent, don’t let residency stop you

Cassandra Fritz, MD

Physician

October 15, 2018

I had the fascinating experience of interviewing for residency at 20+ weeks’ pregnant. Although a number of people told me that I was doomed, I found the experience to be quite enlightening. Since I couldn’t hide the fact that life outside medicine was going to be important to me during residency, I felt empowered to ask the “don’t ask” questions during my interviews. What did I have to lose? The …

Take a close look at the number of opioid pills you’re prescribing

Tia Powell, MD

Medications

October 15, 2018

Recently, a generally healthy friend of mine had two small, unrelated surgeries over the course of a few months. For the first, a small operation on his hand, he received a prescription for 30 oxycodone pills. He used one the night after surgery, to make sure pain wouldn’t wake him. Over the next few days he used a few over the counter acetaminophen tablets for his modest discomfort, and then …

The impact of commuting on your financial plan

Smart Money, MD

Physician Finance

October 15, 2018

As we get older, time becomes are more valuable commodity. I clearly remember that as a college student, I was more than willing to wait in line for over an hour simply to get a free sandwich promotion. Nowadays, I’m not even too interested in waiting 20 minutes to be seated at a restaurant. Our priorities evolve.

One interesting aspect of time that remains relatively unchanged over time is our tolerance …

Surprising and unlikely rewards of social media engagement by physicians

Lisa Chan, MD

Social Media in Medicine

October 15, 2018

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

It is not uncommon for my patients and their family members to ask for my credentials at the end of our preoperative interview. Despite reaching my forties, my Asian genes have allowed me to maintain a youthful appearance – often causing apprehension about …

When diagnosing colon cancer isn’t in a patient’s best interest

Michael Kirsch, MD

Conditions and Diseases

October 15, 2018

So much of life depends upon timing. Sure, we plan, but we know how much of our life’s events are unplanned and unexpected. So often, our jobs and our mates — two of our most defining accomplishments — are the result of a chance encounter or a random act. Life does not reliably proceed in an orderly manner.

This is often true in the medical profession. Here, physicians in our quest …

Primary care does what Google can’t

Hans Duvefelt, MD

Physician

October 14, 2018

Non-clinicians skip over some of the most necessary underpinnings of doctoring and speak too much about housekeeping issues: blood pressure targets, aspirin use, mass screenings, immunization rates and so on.

People without medical degrees could do those things. But there are steps that must be taken before we worry about the measurables. These are the essence of being a physician, what people ask for when they come to see us. Most …

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Primary care does what Google can’t

When doctors leave clinical medicine, don’t blame the victim

DocG, MD

Physician

October 14, 2018

I don’t want to be unclear here. I don’t want to mince my words. But I’m mad about an interaction I had on Facebook. I was commenting on the Physician Side Gigs group page when someone riffed on one of my statements. They mentioned that my opinions could be a slippery slope towards a future where doctors no longer see patients. The insinuation was that we as physicians owe it …

How burnout helped this physician find his purpose

James Turner, MD

Physician Finance

October 14, 2018

A common proverb teaches that, “The road to hell is paved with good intentions.” Medicine is a world where people are well-intended. Yet they fail to change a system that is broken and continues to produce burned out, depressed, and suicidal doctors. We can see their final destination, look back, and realize that we helped pave the road that carried them to that destination.

Today, I want to hammer home the purpose …

Best practices in head CT imaging: How are we doing?

Christopher Johnson, MD

Conditions and Diseases

October 14, 2018

Computed tomography, or CT scanning, is one of the most powerful diagnostic tools to emerge during my medical career. Just look at the detail in the brain images above, taken at 90-degree angles through the brain. And I was there at the beginning. I remember well when I was a medical student taking neurology, and the first CT scanner arrived at the Mayo Clinic. By today’s standards, it was incredibly …

Simple words can sometimes make a big impact on physicians

Linda Girgis, MD

Physician

October 13, 2018

Some days in medicine seem like an epic saga in which the world seems to be playing whack-the-doctor. It is easy to vilify doctors and cast much blame at them. And true, we bring some of this onto ourselves.

Today was one of those days, and by the end, I was just all too ready to run out of the office and go home. And then the last patient came and …

The empty celebration room on National Doctors’ Day

Suneel Dhand, MD

Physician

October 13, 2018

A physician recently recalled to me a situation he found himself in on the last National Doctors’ Day. Those of you reading who work in health care, will already be aware that this is on March 30th every year. I have seen this day celebrated in every hospital I’ve worked in since I first came to the United States over a decade ago. I actually think it’s a nice gesture, and …

How to avoid FOMO when investing

Passive Income, MD

Physician Finance

October 13, 2018

At some point in your investing career, you’ve likely heard of a stock that’s gone on a ridiculous run or a certain part of town that has now become the trendiest in the area, and you’ve kicked yourself for not investing. We’ve all been there.

Well, the cliche is true: hindsight is indeed 20/20. In hindsight, who wouldn’t have purchased as many shares as they could of Amazon or Apple back …

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How to avoid FOMO when investing

MKSAP: 36-year-old woman with refractory constipation

mksap

Conditions and Diseases

October 13, 2018

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

A 36-year-old woman is evaluated for a 12-year history of refractory constipation. Her symptoms began after a difficult childbirth. She has constipation marked by straining, bloating, and a constant sensation of incomplete emptying. She sometimes has 4 or more days between bowel movements. When she does have a bowel movement, the stool is …

How positive deviance can address clinician burnout

Diane W. Shannon, MD, MPH

Physician

October 12, 2018

I love the idea of turning a negative approach to improvement in health care — looking for problems — on its head. Appreciative inquiry, a process of focusing on a group’s inherent strengths and fostering positive interactions among group members, is one way of fostering change with a positive approach. Positive deviance (PD) is another.

Basically, PD involves identifying what’s working and usual local solutions owned by the people involved to make …

The key to this patient? Horseshoes.

Bruce Campbell, MD

Physician

October 12, 2018

“Those who suffer illness learn by hearing themselves tell their stories, absorbing others’ reactions, and experiencing their stories being shared.”
– Arthur Frank

We stand together at the clinic room door, preparing to enter.

“Tongue cancer. This is a 78-year-old man with an oral cavity mass and some memory loss. He had an ulcer on the side of his tongue for a few weeks which was biopsied by an outside doctor. No imaging …

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The key to this patient? Horseshoes.

Telemedicine should be easy. Here’s why it’s not.

Dennis Wichern

Medications

October 12, 2018

Who was Ryan Haight?

Ryan Haight was an 18-year-old honor student from La Mesa, California who died on February 12, 2001, from an overdose of hydrocodone ordered from an online doctor he never saw — and shipped to his home from a rogue online pharmacy during the beginning of the opioid epidemic.

The pharmacist, Clayton Fuchs, filled the online prescription …

5 fears physicians face today

Robert Pearl, MD

Health Policy

October 12, 2018

Like prep sports or prime-time television, medical meetings have seasons.

In the spring and fall, my calendar fills with invitations to speak. I try to get to the venue a few hours before I’m scheduled to speak, so I can “take the pulse” of fellow doctors, asking them about their practices, patients and the future of medicine.

Figuratively speaking, the industry’s pulse is racing with fear. I’ve observed that in just the past …

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5 fears physicians face today

How to ease men’s fear of mentoring in medicine

Stephanie Waggel, MD

Physician

October 12, 2018

There has been a recent surge in discussion about men’s fear to work alone with female colleagues in medicine. This reluctance puts both men and women at a disadvantage. Women are being excluded from career opportunities and men are missing out on the benefits of collaboration. As a victim of sexual misconduct during my own medical training, I find the recent increase of acceptance of reporting to be a step …

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