| KevinMD.com

MKSAP: 26-year-old woman with a mechanical mitral valve prosthesis

mksap

Conditions and Diseases

February 24, 2018

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

A 26-year-old woman with a mechanical mitral valve prosthesis visits to discuss anticoagulation management during pregnancy. Her last menstrual period was 6 weeks ago and her pregnancy was confirmed by laboratory testing in the office. Her mitral valve was replaced 5 years ago. Her medications are low-dose aspirin, metoprolol, and warfarin (4 mg/d).

On …

A medical student’s first day in anatomy lab

Joseph Azar

Medical Education

February 23, 2018

During the first week of medical school classes, we visited the anatomy lab. As far as I can remember, I had extremely mixed feelings on that day. I felt the thrill of taking my first baby steps towards my medical journey blending with a certain feeling of fear. Was I afraid of the pure existence of cadavers in that gloomy, long and hall-like room? Or was it the fear of embarking …

How this physician started his consulting business

Sylvan Waller, MD

Physician

February 23, 2018

I do some of my best thinking while exercising.

A few years ago, I was swimming laps in the still-dark early morning.

Swimming is one of my favorite activities. But in a pool, it gets boring staring at the bottom, so my mind often wanders off to tackle difficult problems.

That morning, like many of you, I was wrestling with the question of how to turn my passion into a successful side gig …

The problem with patients bringing in their own CDs

Douglas Matulewic

Health Technology

February 23, 2018

As someone who has been in IT health care supporting hospitals, radiologists, and specialty surgeons, I’ve seen the struggle from just about every angle when it comes to the problems with health care technology. One of these struggles that continue to be a problem for myself, our patients, and our physicians are the imaging CDs that patients bring in.

Sometimes the patient brings in a disc that is found to be …

In tragedy, practicing medicine both an honor and a privilege

Molly M. Murray, PA-C

Physician

February 23, 2018

For the past four years, this is James Beck’s routine: After a morning spent guzzling $5 vodka, he stumbles into a Dunkin’ Donuts parking lot, lying on the cement with his dusty oversized coat splayed open to reveal a cachectic chest. A concerned patron (cigarette and coffee in hand) will call 911 and, in accordance with protocol, an ambulance will deliver him to our emergency room.

Upon his arrival, we unpredictably …

3 steps doctors can take to stop living paycheck to paycheck

Cory Fawcett, MD

Physician Finance

February 23, 2018

Many doctors today find themselves living paycheck to paycheck. They make a good income but just never seem to get caught up. Non-doctors see us as rich. But many of us are just broke on a larger salary. The whole reason I wrote my book stemmed from a conversation with a doctor who was struggling to make ends meet on a $450,000 a year income. That should never happen.

The national …

What #MeToo must learn from the science of sexual harassment

Shaili Jain, MD

Physician

February 23, 2018

As a psychiatrist, I’ve spent almost two decades caring for patients who have survived sexual trauma, be it childhood sexual abuse, rape or repeated and threatening forms of sexual harassment.

I’ve witnessed how when the assailant was known to the victim, especially someone from whom they expected comradery or even just professionalism, it can be devastating. The fact that the assailant came from within a trusted circle often delivers the toughest …

The irony of me observing death on a day celebrating my birth

Johnathan Yao, MD, MPH

Medical Education

February 22, 2018

As part of my medical school’s inter-professional learning, I shadowed a hospital chaplain this afternoon. While physicians principally attend to the physical healing of patients, chaplains also fulfill an important role in health care: meeting the spiritual needs of patients. When faced with disease, patients often grapple with deeper questions about their illness beyond just what the diagnosis and treatment plans are.

Immediately upon arriving at the hospital, there was a …

A physician sees end-of-life care through a religious lens

Chiduzie Madubata, MD

Physician

February 22, 2018

In my second year of residency, I was on the hematology/oncology service where we were taking care of a pleasant lady in her 80s who was admitted with pancreatic cancer. It was apparent that the disease had spread rapidly, and when we discussed her at rounds, we knew that she likely had a few months to live, at best. We also knew, however, that there were life-extending treatment options we …

You’ve prescribed an opioid: Now what? 5 key strategies to prevent addiction

Caroline Carney, MD

Physician

February 22, 2018

After being prescribed opioids for just one day, individuals can face significant challenges with addiction, with six percent continuing to use opioids a year later, according to the Centers for Disease Control and Prevention (CDC). The likelihood of long-term use increases sharply after five days of use.

While much of the discussion around the opioid epidemic has centered on the challenges of opioid use and recovery, to get …

What if we treated physicians in training the way we want to be treated?

Stephanie Wellington, MD

Physician

February 22, 2018

What if each doctor who interacts with medical students and residents acknowledges that they are a diverse group with their own inherent strengths and weaknesses?

Some residents will have mastered the knowledge within the pages of the textbook and can easily recite it during attending rounds. Others will have a natural bedside manner, making patients feel comfortable so that the admission history and physical exams are more complete. Others will be …

The CVS-Aetna merger is still the one to watch in 2018

Leah Binder

Health Policy

February 22, 2018

Lots of mergers have been announced lately, but there’s still one transformative merger that will define and reshape the U.S. health care market in 2018: the CVS/Aetna $69 billion deal announced last December.

CVS is best known for its 9700 retail pharmacies and 1100 walk-in clinics, but its most significant profit driver is its pharmacy benefits manager (PBM) enterprise — a middleman between pharmaceutical manufacturers and dispensers like drugstores. The company …

We are a product of our upbringing: a tale of 2 cities

DocG, MD

Physician Finance

February 22, 2018

We are a product of our upbringing. For many of us, this means we develop values and beliefs about money and work from our parents. Our communities, however, also play a role. It is in these communities that we learn a joint value system, a blueprint for how to approach and interact with the world. It’s easy to underestimate the profundity of this effect.

I grew up in vastly different cities. One …

Influencing your resident evaluations for success

Todd Rice, MD, MBA

Medical Education

February 21, 2018

Performance appraisals are an integral part of an organization’s assessment of employee and trainee standing. Management and human resource literature is full of analysis and debate regarding how to best rate subordinates. Regardless of evaluation system utilized, some of the common goals of individual appraisals are to monitor progress, identify areas for growth, set goals, guide development, provide and elicit feedback through open communication, and document issues that may require …

A doctor to a patient: Please call me when you get home

Aalap Shah, MD

Physician

February 21, 2018

It is 3:30 p.m. on a Wednesday, and I am bringing my last patient out of the operating room. Everyone is in great spirits: a smooth case and an early finish at our surgical center. The patient has already awakened, stretching his arms, and clearly comfortable.

“Everything went alright, doc?”

I smile, knowing that I will be repeating what I am about to say a few more times as the anesthesia wears …

There’s no easy way out of the opioid epidemic

Jeff Kane, MD

Physician

February 21, 2018

Across the United States at least forty people die each day from overdosing on opioids like Vicodin, codeine, heroin, and oxycontin. Seven percent of drivers who died in car crashes last year were found to have prescription opioids in their systems — seven times more than in 1995.

Considering these alarming rates of overdosing and DUIs, this is serious business. Authorities view it in their traditional way: the problem is drugs. …

Medicine needs its soul back

Robert Baker, MD

Physician

February 21, 2018

In a recent issue of the Annals of Internal Medicine, Terwiesch and colleagues propose “reimagining provider visits as the new tertiary care.” Initially, their arguments seem sound, even reasonable. Then, they conclude with this:

The conceptual change is to see every engagement with a clinician not as something to be celebrated but as a kind of failure — an inability to accommodate patient needs by any of …

Read more…

Medicine needs its soul back

The biggest innovation in health is here. And you’re probably using it.

Eunice Zhang, MD

Health Technology

February 21, 2018

Health care is obsessed with new technology. Every week, a new article comes out promising disruption of medical care as we know it through personalized genetic therapy, app extensions that transform smartphones into ultrasounds or autonomous surgical robots. Yet, one of the best examples of health care technologies is also one of its oldest — instant messaging.

Though the original messaging platform AOL Instant Messenger was sadly discontinued at the end …

A physician’s life as an FBI informant

Claire Grove, MD

Physician

February 21, 2018

“Where is Saipan?” I typed into Google to search for this little U.S. territory island in the Western Pacific when I was told about a need for an OB/GYN in 2016.

Next, I inquired to the private physician looking to expand his practice, “Do you really have a significant volume to support another doctor?” My vision of island medicine was that there were a smaller number of births due to a …

Read more…

A physician’s life as an FBI informant

Inaction and playing it safe has costs

Passive Income, MD

Physician Finance

February 21, 2018

Every day, we’re presented with choices. Some are larger than others, and though some make little difference in the grand scheme of things, some choices can be life-altering. In life and in business, when we have a big decision to make, it’s all too easy to err on the side of caution — sometimes to our personal or financial detriment. It’s human nature.

But what is it that keeps us from …

Read more…

Inaction and playing it safe has costs