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Don’t blame doctors for outrageous emergency department prices

Peter Ubel, MD

Health Policy

June 12, 2018

Recently I posted a piece, describing research out of Johns Hopkins, showing that when patients come to ERs — either with no insurance or insurance that is out-of-network — they often face charges that are four, six, or even ten-fold greater than what Medicare would pay for the same services.

After the post, I was inundated with angry tweets and emails, mainly from emergency medicine …

Has the anti-vaccine movement affected vaccination rates?

Christopher Johnson, MD

Conditions and Diseases

June 12, 2018

Vaccines have been hailed by virtually all medical experts, as well as medical historians, as the among the greatest triumphs of public health to occur in the past two centuries. Yet since Jenner first proposed vaccination for smallpox using the vaccinia, or cowpox, virus there have been both skeptics of its effectiveness and people who thought it was dangerous. That is, they had the risk/benefit ratio of vaccination exactly backwards, …

A doctor on a recent winning streak

Hans Duvefelt, MD

Physician

June 12, 2018

There are many days in primary care when you feel like you are treading water; nobody gets substantially better as time and disease progression seem to always win over your own and your patients’ efforts.

But sometimes you hit a winning streak. The past few weeks seemed to bring me one diagnostic or therapeutic coup after another.

There was the depressed man who came in smiling and said: “I’m shaving again.”

There was …

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A doctor on a recent winning streak

The new doc on the block: 7 lessons from my first year of being a doctor

Tracey C. Isidro, MD

Physician

June 12, 2018

Congratulations! You made it through medical school, got your MD/DO degree, and can officially be called doctor! One day, you’re a student. The next, you’re a doctor and with that come the responsibility, trust, compassion, and professionalism associated with our career. But how do you transition?

It starts with your mindset and then deciding to be the best doctor you can be. Your thoughts inspire your words, which direct your actions.

I …

Why physicians should care about structural racism

Akshay Pendyal, MD

Health Policy

June 12, 2018

This year marks the 50th anniversary of the passage of the Fair Housing Act, which formally outlaws racial discrimination in the sale and rental of housing. The Act, passed in the wake of the assassination of Dr. Martin Luther King Jr., had, at its core, the goal of affirmatively promoting equitable and integrated housing across the United States.

Earlier this year, however, the current presidential administration announced that it would suspend an …

This physician vows not to rush

Kristine Tatosyan-Jones, MD, MBA

Physician

June 12, 2018

My last patient of the day was an elderly woman with metastatic lung cancer, a non-smoker who had been battling this terrible disease for more than a year. I was running thirty minutes behind. I had a packed afternoon with difficult cases and patients who required more of my time and care. I peeked into her room, said hello and apologized for running late. Ms. B. greeted me with her …

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This physician vows not to rush

Not me: the story of a female surgical subspecialist

Nina Shapiro, MD

Physician

June 11, 2018

I’ve thought long and hard about writing this, so here goes: I am a female surgical subspecialist. I trained at a Harvard program back in the 1990s, and was one of a handful of women to have completed residency training at a stodgy 125-year-old program. The eighth, to be exact. During that time, I was treated as an inferior, sexually abused verbally, routinely given the bottom of the barrel when …

7 habits of being on call

Angela Seabright, DO

Physician

June 11, 2018

1. You sleep when you can. Despite what medical television dramas portray, call room beds are for sleeping. Period. As you curl up into the bed you have no idea whether you are about to get a couple hours of sleep or a couple of minutes, but in that moment of sheer exhaustion, the drab hospital cot or bunk suddenly transforms into a luxurious sleeping pad. Bonus if you can …

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7 habits of being on call

Identifying social determinants of health is critical to the patient interview

David Velasquez

Health Policy

June 11, 2018

After a semester of medical school, I returned home to the Antelope Valley in California, an area CNN coined, “health care’s nowhere land” because of low health insurance rates and limited provider networks that force residents to travel far for care. I wanted to help my family and neighbors by using the physical exam skills I learned during my first few months as a medical student, but …

How this physician deals with race-based comments

Suneel Dhand, MD

Physician

June 11, 2018

It seems like every other day, there’s a new discussion or debate which emerges about the unique challenges that minorities face in America. This is, of course, a sensitive topic, because minorities in any arena will always have their personal story. Whether it’s because of your color, or anything else that makes you feel like you face extra hurdles — there are indeed lots of ways in which society still …

Colon cancer screening at age 45: Here’s what a gastroenterologist thinks

Frederick Gandolfo, MD

Conditions and Diseases

June 11, 2018

The American Cancer Society (ACS) recently released new guidelines regarding colorectal cancer screening for the average-risk individual. The big news is that they now recommend that screening for colorectal cancer begin at age 45 rather than age 50. This reduction in the starting age was in reaction to recent data showing that colon cancer is increasing in younger Americans for unclear reasons. By screening people at a younger age, the hope is …

5 reasons why you can’t start passive income streams

Passive Income, MD

Physician Finance

June 10, 2018

It seems like everywhere I look these days people are talking about passive income streams: why you should start them, which ones you could start, how they can change your life, and how much money you can make from them.

Doctors commonly look for ways to create passive income as a way of being able to work less while still maintaining the lifestyle they want or honestly to quit …

A better way to follow-up your office visit is needed

Fred N. Pelzman, MD

Physician

June 10, 2018

Actual conversation heard in the hallway outside an exam room earlier this week:

Doctor: “So, we’re going try this medicine for your blood pressure; you keep checking it at home as we discussed. If the numbers remain high, we can increase the dose or add another medicine.”

Patient: “Well, what do we do if the pressure stays high; if this medicine doesn’t work?”

My partner told me later that she had explained the …

Being idealistic is a necessary component in achieving your goals

Gaurav Jain

Medical Education

June 10, 2018

I am a first-year medical student, and just like some of you once did, the primary reason I am becoming a physician is to really make a difference for my patients by [insert x, y or z].

“Wow, that’s really great, but we’ll see how you feel about it in a few years.”

“That’s not how it works once you’re actually out there.”

“Trust me, medicine isn’t what it used to be, get …

Don’t go to the hospital alone

Iyesatta Massaquoi Emeli, MD

Physician

June 10, 2018

Very many years ago, as a medical student, I remember caring for a twenty-something-year-old in the intensive care unit (ICU) with a very severe infection that resulted in her being in the ventilator for months. Let’s call her Jane. Her hospital course was complicated: re-infections, loss of digits, muscle wasting.

The ICU was closed to families during morning rounds which is when all the doctors in their white coats gathered and …

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Don’t go to the hospital alone

How to ace your medical school interviews: evidence-based tips

Dilshan Pieris

Medical Education

June 9, 2018

School interviews are considered the most important factor for selecting candidates for medical school. They allow faculty to meet candidates who look good on paper and see how they fare in person. Though thousands apply, only a fraction are offered interviews. Naturally, candidates feel nervous when preparing for these interviews. This is especially true for applicants with multiple interviews since they must prepare for more than …

When outcomes are tragic, doctors suffer too

Meredith D. Davenport, MD

Physician

June 9, 2018

The vast majority of births and deliveries are joyful ones. Families celebrate the wonder of the new addition to their families, and clinicians go home at the end of the day with a sense of pride, deriving meaning from their professional lives. This is one of the reasons that many of us chose obstetrics in the first place.

But unfortunately, that is not always the case.

As an obstetrician, I know firsthand …

Hospital bylaws saved this doctor from EMR burnout

Thomas D. Guastavino, MD

Physician

June 9, 2018

Physicians do not have a lot of power these days. But if you know when, where and how to look, we can, on occasion, score some victories.

Case in point: hospital bylaws that every physician is required to acknowledge and sign before being granted privileges. It is always a good idea to carefully read before signing anything, and I did the just that before signing my hospital’s bylaws. I asked a …

MKSAP: 78-year-old man with symptoms of dysphagia

mksap

Conditions and Diseases

June 9, 2018

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

A 78-year-old man is evaluated for symptoms of dysphagia that began 2 weeks ago. When he eats, he starts coughing after the first bite of food and occasionally has nasal regurgitation.

On physical examination, blood pressure is 135/90 mm Hg, pulse rate is 78/min, and respiration rate is 12/min. Left-sided weakness is noted in both extremities, …

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