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Physicians: What are your endpoints in personal finance?

Physician Finance

April 16, 2018

Every physician, especially those who work in oncology, have read their fair share of clinical trials. In order to advance the field of medicine, you need to test new drugs against the current best treatment, or the standard of care.

Some trials succeed, and we make progress in our fight against cancer, or hypertension, or HIV. Some trials fail, and these new treatments are discarded.

When designing a clinical trial, you need to …

Reflections on school violence: a psychodynamic perspective

Jonathan Berent, LCSW

Conditions and Diseases

April 15, 2018

The mental health community must increase its clinical acumen regarding complex psycho-pathology consisting of the avoidant personality, social impotence, and related rage. School violence has taken on epidemic proportions since two disturbed adolescents masterminded Columbine and became role models for the mentally ill young men who drive the new culture of school shootings.

While the profile of the school shooter has evolved over the last couple of decades, it’s worth considering …

Emergency physicians are glorified secretaries with medical degrees

Edwin Leap, MD

Physician

April 15, 2018

We had a pretty busy shop when I was in residency. So busy, in fact, that we had three secretaries working simultaneously — one for paging, one for order entry, and one for admissions. I haven’t been back there in a long time, but I hope the secretarial staff has grown commensurately with the volume and acuity of the ED. But from what I’ve seen around the country in my …

A new directive for National Healthcare Decisions Day

Kevin Haselhorst, MD

Physician

April 15, 2018

Other than taxes, the only other certainty in life is death. People don’t like to pay taxes or think about dying. But on April 16th, National Healthcare Decisions Day (NHDD) reminds people to complete their advance directives. Like a passport, an advance directive permits an individual to proceed from one world to another with an easy stamp of approval. Without the proper paperwork, patients at the end of life are …

11 physician finance lessons from The Greatest Showman

James M. Dahle, MD

Physician Finance

April 15, 2018

I love movies. Not the artsy types that win awards; I most enjoy the big, expensive popcorn blockbusters that take you away to a different time and place. However, as our income and wealth has grown, we’ve maintained a few of our “cheapskate” habits from when we were poor. One of these is we see almost all of our movies at the “dollar theater,” a second-run theater where the entire …

America leads the world in high tech care and health care costs

Mark Kelley, MD

Health Policy

April 14, 2018

Why is U.S. health care so costly compared to other developed countries? A recently published report provides some insights.

In a study of 11 countries, Harvard researchers found that while the United States has the highest health costs relative to its GDP, its use of services is average. More specifically, the U.S. ranks lower than nearly every other country in doctors’ visits, hospitalizations, hospital days, and consultative services.

The difference is …

The momentum to treat in America is unmatched around the globe

Samuel Harrington, MD

Physician

April 14, 2018

The momentum to treat in America is unmatched around the globe or throughout history. As a result, we spend twice as much on medical care as the next most …

This doctor stopped prescribing opioids. Other physicians should do the same.

Thomas D. Guastavino, MD

Medications

April 14, 2018

Have you ever had a prescription altered? I have, several times — all opioids. Despite making copies of every prescription to prove what I actually wrote for, dealing with everything from patients who threatened to sue me for false accusations to time spent with the DEA was a real pain. The good news is that during the pre “pain as fifth vital sign” era at least — since my prescribing …

MKSAP: 28-year-old man with right knee pain

mksap

Conditions and Diseases

April 14, 2018

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

A 28-year-old man is evaluated for right knee pain that began 2 days ago. He was playing football when he stopped suddenly and pivoted to make a catch. He heard a popping sound and immediately developed severe pain in his right knee. Within 30 minutes, the knee became swollen. Since the injury, he …

Heal thyself before others

Shalu Ramchandani, MD

Physician

April 13, 2018

Alice wept in my arms as she described her father’s last days. He died of metastatic prostate cancer. She felt lighter as she shared beautiful memories of him. It will never be the same for Alice, nor will it be for me. I was running behind for my next patient, a healthy 86-year-old woman. I apologized for keeping her waiting. She did not mind; she knew I would give her …

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Heal thyself before others

When the doctor becomes the victim

Shaili Jain, MD

Physician

April 13, 2018

Years ago, the police brought a middle-aged man to the hospital for evaluation on a day when I was the on-call psychiatrist. Earlier that morning, the man had walked into his psychiatrist’s office without an appointment asking to see his doctor immediately. When his demand was not met, he caused a raucous in the waiting room, tossing over tables and chairs and alarming the other patients. He refused to leave, …

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When the doctor becomes the victim

Push back on toxic behaviors from other doctors

Todd Rice, MD, MBA

Physician

April 13, 2018

“Don’t get tired! Don’t f*cking move! Don’t you f*cking move, or I’ll f*cking die!”

That’s an excerpt from an OR in St. Louis on March 12th. This is just one of the outbursts that was reported from a single, multi-hour surgery — an attending’s toxic mandate to her resident, who was poised in a precarious situation under the drapes. The rest of the OR staff caught plenty of its own abusive …

Physicians and medical students: Unlearn helplessness

Jamie Katuna

Medical Education

April 13, 2018

Learned helplessness. It’s a psychological concept marked by a perceived loss of power, and it’s prevalent in medicine. We are taught early on how little we are in this colossal world. We are told what to do, when to do it, and what we will get for it. Our objections go unheard or—worse—ignored.

Let me quote a paragraph from The Paradox of Choice by Barry Schwartz:

They were conducting a series of experiments on basic …

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Physicians and medical students: Unlearn helplessness

Just care less: That’s something many doctors cannot do

Millennial Doctor, MD

Physician

April 13, 2018

For the last week and a half, I’ve been lost.

After experiencing compassion fatigue and realizing I wasn’t even close to pulling myself out of burnout, I’ve been racking my brain trying to rethink my situation yet again.

I reached for my old faithful habits. I became more consistent with my lunchtime mindfulness sessions and re-instituted exercise, yoga and hiking. I even went phone free for the weekend, though admittedly this …

Do whatever it takes to have fun and spend time with your family before it is too late

Cory Fawcett, MD

Physician Finance

April 13, 2018

Recently I had three important events happen during a three day period that reminded me of the brevity of our life and the need to live life to the fullest every day.

On July 4th, having planned celebratory events that day with friends and family, a CRNA in my home town awoke feeling poorly just before sun up. He was in great health the day before and lived a very active …

What this physician misses the most

Jordan Grumet, MD

Physician

April 12, 2018

Empathy

My eyes glare across the table. I can feel his shoulders hunch forward as he subconsciously recoils in preparation for my response. The room becomes thick. Nurses, social workers, a chaplain. Everyone waiting for the doctor.

Not just the doctor, but me. Sixteen years out of residency. Battle-scarred and warn by PTSD. The images from residency still so clear. A gasp, a gurgle, flat line. Wailing family members, angry nurses, and …

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What this physician misses the most

The drama of a C-section: It takes a team

Andrea Eisenberg, MD

Physician

April 12, 2018

She pushes her cleaning cart into the bright room. “Looks like the usual mess,” she mumbles to herself, pushing a loose piece of hair back into her blue cap. Methodically, she cleans the room beginning with the operating table, stripping off the bloody sheets. Then cleaning the floor of blood-stained shoe prints, amniotic fluid and bits of paper, needle caps and such, that managed to escape hands and land on …

Taking off the training wheels and becoming a real doctor

Nathaniel Fleming

Medical Education

April 12, 2018

Working in a clinic as a medical student is the best of all worlds. We have the opportunity to expand our knowledge and skills by working with some incredible patients, all while knowing that we have the support and backup of our fully trained, expert attending physicians every step of the way. This apprenticeship type of system is absolutely essential to medical training, allowing us to get our feet underneath …

A radical proposal to save America’s hospitals

Robert Pearl, MD

Health Policy

April 12, 2018

Hospitals serve as the economic lifeblood of their communities. They are the second-largest source of private-sector jobs in the United States, employing 5.4 million Americans who, together, embrace a virtuous mission to heal and help others in need.

And yet, every year, more and more of them are forced to shut their doors. With soaring costs, eroding margins and mounting pressure from competing providers, the American hospital industry is on life …

How writing fiction can free physicians

Sandra Miller, MD

Physician

April 12, 2018

Every person working in medicine has stories to tell, and sharing those stories is a great way to process grief or stress, celebrate triumphs, vent, move on or think more deeply.

Occasionally, writing about an experience helps others facing a similar situation. True narratives of and reflections on medicine are now encouraged, honored, promoted — and sometimes required of medical students.

This is a commendable trend, though the exercise can be affected by …

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How writing fiction can free physicians