| KevinMD.com

A clear case of suspected child abuse turns out to be something else

Physician

March 31, 2018

The emergency room staff was immediately suspicious. His father said that Peter, just over six months old, was pulling himself up to a standing position by grasping his pant leg. Peter fell back, screaming. The extreme distress, entirely unusual for Peter, continued until some Tylenol helped him fall asleep. The next morning Peter was screaming again, and his mother took him to the emergency room.

X-rays showed a fractured leg. The …

Opioids: The pendulum has swung too far in the wrong direction

Lisa Kehrberg, MD

Physician

March 31, 2018

I’m a 43-year-old physician who retired due to illness at the age of 39. I have a rare genetic disease called acute intermittent porphyria (AIP). It’s an extremely painful and disabling illness. Due to an enzyme deficiency in the heme biosynthesis pathway in the liver, porphyrin precursors accumulate and are neurotoxic causing visceral neuropathy. The symptoms of the disease are neurological with the most notable being abdominal pain. It is …

MKSAP: 57-year-old man with chronic hepatitis C infection

mksap

Conditions and Diseases

March 31, 2018

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

A 57-year-old man is evaluated during a routine examination. His medical history is notable for chronic hepatitis C infection with cirrhosis, which was diagnosed 3 years ago. He undergoes surveillance ultrasound for hepatocellular carcinoma every 6 months.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 110/82 mm Hg, pulse rate …

Diagnosing your cancer is my cross to bear

Millennial Doctor, MD

Physician

March 30, 2018

Today, you came to me with a chief complaint: right breast lump.

You told me you’ve only been aware of it for the last three weeks. Your eyes told me your terror of not realizing it was there sooner.

You told me there wasn’t a history of any breast, endometrial or ovarian cancer in your family. But you held back that you knew there isn’t always a family history.

You told me you …

Learning the health care ecosystem is an uphill battle

Mohammed Ahmed

Medical Education

March 30, 2018

The short white coat, breast pocket full of colorful pens, side pockets bulging with gauze pads and suture kits, a simultaneous look of bewilderment, excitement and fear. Pathognomonic signs of the third-year medical student on wards. Third year of medical school is a period of learning how to diagnose disease, treat patients and understand what it means to be a doctor in this health care landscape. There is not enough …

3 ways to fight physician burnout

Sara Taylor, MD

Physician

March 30, 2018

Identifying signs of burnout in yourself, or someone else, is the first step to tackling a solution — as with anything, awareness is key. If we don’t see it, we don’t know how to approach the problem. Even if we know burnout exists, now what? How can we begin to manage something this big given its multifactorial contributors?

I wanted to spend some time on the solution aspect of burnout, as …

Read more…

3 ways to fight physician burnout

This primary care physician does all his work through conversation

Hans Duvefelt, MD

Physician

March 30, 2018

One of the ways a doctor can document the value of an office visit is by keeping track of the number of symptoms the patient has and the number of items included in both the review of systems and the physical exam of the patient.

This way, for example, we can get paid more if we do an extensive evaluation of a dizzy patient by looking for both inner ear, cardiovascular …

This National Doctors’ Day, conquer the physician shortage one mentor at a time

Heather Smith, MD, MPH

Physician

March 30, 2018

March 30th is National Doctors’ Day, a day set aside to recognize physicians, their work, and their contributions to society and the community. Though we are used to thinking of the profession of physician as something many parents hope their children aspire to, the reality is that fewer and fewer students are choosing that path.

According to a March 2017 report by the Association of American Medical Colleges, the U.S. will …

How to become debt free without sacrificing anything

Cory Fawcett, MD

Physician Finance

March 30, 2018

One of the biggest complaints I hear when I discuss becoming debt free is the dread of living on a shoestring. We did enough of that in medical school, and we don’t want to do it again. Let me make something perfectly clear right up front, you absolutely do not need to scrimp and sacrifice to get out of debt and live debt free, but if you choose to, it …

How silence can help us learn from our patients

Anne Katz, RN, PhD

Conditions and Diseases

March 29, 2018

As the patient talked, I found myself nodding my head. In so many ways, she was just like me. Highly educated, a professional, a woman who had worked hard and long to get where she was. And then cancer took it all away, or at least that’s the way she described it. She was diagnosed with metastatic cancer one year …

The health insurance industry is like a house of cards

Linda Girgis, MD

Health Policy

March 29, 2018

You go to your doctor because you are suffering pain, fatigue, or some equally debilitating ailment. Your doctor examines you and is worried there may be a serious underlying medical reason for your symptoms and orders a test. But, before you can have that test done to determine the cause of your symptoms, the insurance company must agree that you need it in order for them to cover the cost …

What this medical student learned from running a marathon

Shoshana Weiner

Medical Education

March 29, 2018

“4 ounces water every mile, half an electrolyte ‘gu’ pack over 2.5 miles, ¼ energy bar every 6 miles” — a.k.a. how did you manage training for a marathon while in medical school? The simple truth: I decided to run a marathon, so I did. Longer story: months of rigorous training, more moments of doubt than I care to recall, and insights already positively impacting my medical training.

Training for and …

Are there too many female OB/GYNs?

Jennifer Gunter, MD

Physician

March 29, 2018

The Los Angeles Times recently published a piece on the lack of men in OB/GYN. Only 17% of new trainees (residents) in OB/GYN are men and the male OB/GYN physicians who weighed in worried that this “lack of diversity could weaken the field.” Apparently, it sends a “horrible message to men,” and with the lack of men we might “lose the next person who is going to find a cure …

Read more…

Are there too many female OB/GYNs?

What is the perfect fee-for-service system?

Matthew Hahn, MD

Health Policy

March 29, 2018

It is wildly popular to say that the chief culprit in the U.S. health care system is the traditional fee-for-service payment system, which rewards physicians for volume but not quality, leading to high-cost, low-quality health care. It supposedly follows that the fix is a system of “value-based” payments.

Despite the popularity of these arguments, both aspects have been shown to be wrong. Studies show that the rising cost of American health …

How this doctor teaches his kids about money

DocG, MD

Physician Finance

March 29, 2018

We shop a lot.

Now I didn’t say we buy a lot. But we spend countless hours on the weekend walking through malls and shopping centers. I’m not sure exactly why. It may be that there is enjoyment in the visualizing without actually having. Or, more likely, as a family of four with two growing children, we have many items on our purchase list to check off.

Inevitably, repeatedly, our kid’s eyes …

What should physicians look like? Should it matter?

Maria Yang, MD

Physician

March 28, 2018

I don’t remember her name, but I do remember her light brown hair, the simple nose ring that looped out of her left nostril, and the calm and centered presence she had with patients. She came across as unassuming, professional, and caring. We were both in medical school, though she was two years behind me. I admired how she treated people.

I don’t remember his name, but I do remember that …

How do you tell your child’s doctor that you’re a physician?

Joelle Borhart, MD

Physician

March 28, 2018

My son is 16 months old, and I’ve never told his pediatrician I’m a doctor.

More than a decade after becoming an MD, I still struggle with the “reveal” of my identity as a physician when a family member or I am a patient. On one hand, I want the treating doctor to know my background to allow for a more sophisticated (but not too sophisticated!) conversation. On the other hand, …

The evolving meaning of the body mass index

J. Leonard Lichtenfeld, MD

Conditions and Diseases

March 28, 2018

A recent news story in the Journal of the American Medical Association (JAMA) reminds me that lots of things in our lives are changing these days, not the least of which is the shape of our bodies.

Oh, my. This aging thing isn’t so easy, and that is really the message behind Rita Rubin’s timely piece about shifting body mass and muscle as we age and its implications. Although focused …

Too much testing: Are patients to blame?

Kevin Lomangino

Conditions and Diseases

March 28, 2018

Our health care system in the United States is notorious for providing a lot of unnecessary medical care — something we’ve written about extensively.

Doctors may provide that unnecessary care because they perceive that patients are expecting or requesting it.

If health care professionals don’t provide the aggressive care that patients believe they require, the thinking goes, patients won’t be satisfied, and the doctor-patient relationship will suffer. Plus, the patient will just go …

What this doctor decided to do about physician suicide

Natalie Newman, MD

Physician

March 28, 2018

My physician advocacy began in February of 2017. I was reading a Medscape article about a doctor who was discussing the issue of physician suicide. She had her own website and newsletter.

After discovering the staggeringly high number of physician suicides, of which I was unaware, I signed up for the newsletter because I wanted to learn more. One day I received her newsletter; within it was a story about an emergency medicine (EM) physician …

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