| KevinMD.com

Emergency care coverage denial policies put lives at risk

Health Policy

July 27, 2018

A guest column by the American College of Emergency Physicians, exclusive to KevinMD.com.

Emergency medical care in the United States is a unique success story. Born from military tactics, emergency medicine has grown exponentially in size and sophistication from its early days. What was once a patchwork of inspired professionals cobbled together at a moment’s notice is now a highly esteemed medical specialty; singularly trained and expertly equipped …

Tips for fellowship applicants from a program administrator

Geri Herling, MHA

Medical Education

July 27, 2018

The season has opened, and panic has spread among senior year residents, chief residents, and hospitalists out in the community. Fellowship applications are live and being viewed by the programs applicants think they want to rank one, two, and three. These incredibly intelligent physicians are refreshing student document network daily now and soon to be hourly as the weeks go on. The anxiety is building as people are waiting to …

The culture of perfection in medicine is a disease

Andy Cruz, MD

Medical Education

July 27, 2018

I was always worried about doing well on board exams. I didn’t want to simply pass them; I wanted to excel. Before I took exams, rumor had it that a person would have to intentionally fail Step 1, 2, or 3 and that failing Step 2 CS was virtually impossible. The truth, I learned, is that thousands of physicians-to-be fail one of these exams every year.

I know, because I’m one …

The consequences of taking patients at their word

Thomas D. Guastavino, MD

Physician

July 26, 2018

A recent stir was created regarding a California pediatrician Dr. Bob Sears. Dr. Sears is sympathetic to parents who do not want their children vaccinated. Apparently, Dr. Sears got in trouble with the California State Medical Board for not producing medical records to support a parent’s claim that their son could not take vaccines because of adverse reactions, including “loss of urinary function and going limp,” and instead, just taking …

There’s a fine line between stupid and clever in medicine

Raj Waghmare, MD

Physician

July 26, 2018

In the 1984 rock mockumentary This is Spinal Tap, a fictional band discusses the controversy surrounding one of their album covers. “There’s such a fine line between stupid and …” the lead singer says, realizing where they’d crossed the line of tastefulness.

His guitarist finishes his thought, “… and clever,” he says. In life, in rock and roll and in medicine, there is indeed a fine line between stupid and clever.

During …

A good physician will never be out of a job

Ali Chaudhary, MD

Physician

July 26, 2018

“After this, there is no turning back. You take the blue pill — the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill — you stay in Wonderland, and I show you how deep the rabbit hole goes. Remember: All I’m offering is the truth.”
– Morpheus from The Matrix

Many physicians submit to a life of sterility and dullness — …

3 steps for doctors who are grieving

Michelle M. Kittleson, MD

Physician

July 26, 2018

As an advanced heart failure and transplant cardiologist, I witness plenty of tragedy. But I don’t lay awake at night anymore grieving bad outcomes — that is the privilege and purview of loved ones. While family and friends may move through Elizabeth Kubler-Ross’ classic stages of grief, doctors do not have that luxury. To give tragedies a purpose, I take three steps when faced with bad outcomes: Separate fault from …

Read more…

3 steps for doctors who are grieving

Be willing to fail your patients

Kevin Haselhorst, MD

Physician

July 26, 2018

“I remember you,” said Gracie with the look of having found a long-lost friend. “You gave my husband the option to be treated aggressively in the hospital or return home with palliative care. He chose to go home.” I hesitated to ask, “How did he do?” Gracie went on to say that her husband had passed in the last month, yet lived nine months following our brief encounter in the …

Read more…

Be willing to fail your patients

Should I or shouldn’t I? The dilemmas faced by the chronically ill.

Toni Bernhard, JD

Patient

July 26, 2018

After many years of being mostly housebound by chronic illness (which includes chronic pain), here are a few of the dilemmas I’ve faced over and over. I’m confident that I’m not alone in my “should I/shouldn’t I?” world.

Do I accept an invitation from a friend to get together or do I refuse it?

If I refuse the invitation, depending on who issued it, it may be the last one I’ll receive …

Every doctor should have a plan B. Here’s why.

DocG, MD

Physician Finance

July 26, 2018

I’ve written previously that financial independence is plan B. Plan A, of course, is life. Your work and time are precious, and life is too short to be wading through a morass of unhappiness only to get to some endpoint or goal. While I definitely believe in front-loading the sacrifice, the cost should not have to be misery. Physicians, in particular, tend to look at their …

How urgent care rejuvenates this primary care doctor

Hans Duvefelt, MD

Physician

July 25, 2018

I volunteered to work Saturdays. And to do walk-ins. And to take all comers, not just our patients.

It has been an interesting journey.

Some clinics put their newest, least experienced clinicians on the very front line of doing urgent care. Here, it’s the opposite. I’ve got 39 years under my belt, and I see everything from sore throats to people who left the emergency room in the middle of a workup …

The pathologic manifestations of professionalism

Michael Edmond, MD, MPH

Physician

July 25, 2018

Four years ago after moving back to Iowa City, I needed to find a new primary care doctor. I went to the University’s website and scanned the list of general internists. There I noted a physician that I had known when she was a medical student during my prior stint at the University of Iowa 20 years prior. She had been an amazing medical student, very bright, hardworking, conscientious, and …

When family separations become a threat to existence

Claudia M. Gold, MD

Conditions and Diseases

July 25, 2018

The face of a 2-year-old Honduran girl, dwarfed by the adults who only appear as legs in the photo, communicates undeniable anguish. Used to represent the horror of children separated from their parents at the U.S.-Mexico border, the photo became a lightning rod for controversy when it turned out that this particular child was not actually separated from her mother. In an interview for CBS News the border patrol officer involved …

NP/PA vs. physician: Why is there a productivity gap?

Tracy Cardin, ACNP

Physician

July 25, 2018

So out in the varied land of hospital medicine, I have noticed something that I have no clear explanation for. It turns out there is often a gap in productivity between that of NP/PA providers and physicians. The range of the gap varies wildly – I just got off the phone with a group leader who has observed a 50 percent difference to a smaller gap of perhaps 10 percent. …

Health care needs more physician CEOs

Alexi Nazem, MD

Health Policy

July 25, 2018

If Atul Gawande’s first week as CEO of a health care startup was anything like mine, I hope he is able to get away from it all and enjoy a completely relaxing weekend. He will have earned it.

After Gawande was named to head the joint venture between Amazon, Berkshire Hathaway, and JPMorgan, some critics said that choosing …

Read more…

Health care needs more physician CEOs

Vaccine opponents think they know more than medical experts. Why is that?

Matthew Motta, PhD, Steven Sylvester, PhD, and Timothy Callaghan, PhD

Conditions and Diseases

July 25, 2018

One of the most contentious areas of health policy over the past two decades has been the safety of vaccination. Vaccines prevent the outbreak of diseases that used to be widespread, like polio, and scientific consensus strongly supports their safety. Yet many Americans refuse or delay the vaccination of their children out of fear that it could lead to autism, even …

A physician’s gratitude

Maria Yang, MD

Physician

July 24, 2018

“Expressers significantly underestimated how surprised recipients would be about why expressers were grateful, overestimated how awkward recipients would feel, and underestimated how positive recipients would feel.”
– Undervaluing Gratitude: Expressers Misunderstand the Consequences of Showing Appreciation

The past 30 days have been unusual because of the number of professional gestures of gratitude I’ve received:

I received a clinical faculty award from psychiatry residents for my teaching efforts.
An hospital administrator …
Read more…

A physician’s gratitude

After you die, what will your legacy be?

James Turner, MD

Physician Finance

July 24, 2018

As part of my job as an anesthesiologist, I get called to truly horrific airway events. Sometimes they are down in the emergency department after a bad car accident, drowning, or burn. Others are in ICU’s. Sometimes they are even in hallways or bathrooms where people have stopped breathing or collapsed from cardiac arrest. It’s part of the job.

Recently, I was called to an airway in an ICU in what …

Love smart functions in your EMR? This doctor doesn’t.

Fred N. Pelzman, MD

Health Technology

July 24, 2018

How smart do we want our electronic health record to be?

Somewhere between as dumb as a piece of paper and a pen, and too smart for our own good.

Many, many years ago, before we spent the majority of our office visit staring at a flatscreen LED and typing away, our charts were simple manila folders with those bendy metal bars that allowed you to insert new pages, separated into multiple …

MKSAP: 46-year-old man with intermittent rectal bleeding

mksap

Conditions and Diseases

July 24, 2018

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

A 46-year-old man is evaluated for intermittent rectal bleeding of 3 months’ duration. He is otherwise well and takes no medications. His father had a few polyps removed from the colon when he was 71 years old, but no other details are known about his father’s medical history. The patient and his wife …

Most Popular

Past Week

Past 6 Months

Recent Posts

Subscribe to KevinMD and never miss a story!

Most Popular

Past Week

Past 6 Months

Recent Posts