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Forget the PC police and telemedicine: Give your patient a hug

Neil Baum, MD

Physician

January 23, 2018

Today, the public has criticized health care as too high in technology and too low in touching. Computers take patients’ histories, provide a differential diagnosis, supply educational materials and even submit a bill for the services that we render. A new specialty — telemedicine — offers health care service to rural areas that were previously underserved or couldn’t afford the latest diagnostic technology. Telemedicine, a technology in its infancy, offers …

A lesson from Hurricane Harvey: Compassion has meaning

Neeti Reddy, MD and Praveen Vijhani, MD

Physician

January 23, 2018

On September 1, 2017, four children and their grandparents drowned while their uncle was trying to drive them to safety. Their van was swept off the road by rushing floodwaters. The uncle was able to escape through a half-open window as the van sank headfirst into the bayou. As the van sank, he could hear the four children screaming and crying. Two days later, the van was found, with all …

If you are a practicing physician, you need rest

Physician on FIRE, MD

Physician

January 23, 2018

“It is neither wealth nor splendor, but tranquility and occupation, which gives happiness.”
– Thomas Jefferson

If you are a practicing physician, you need rest.

Why do I say this? Because you have gone through an enculturation process which focuses on hyperactivity and super high-level achievement. In training programs and in practice, admitting that you are tired or needing a rest break is a sign of weakness and is discouraged, to say the …

A physician suicide: covered up with a tarp and silence

Pamela Wible, MD

Physician

January 22, 2018

Another young doctor recently jumped to her death in New York City. She landed at the entrance of the building where she lived.

Within less than an hour, I received the following emails about her. All published with permission.

Hello Pamela, I am not a doctor, but a mother of 3 and a wife of a resident physician. Tonight I watched AGAIN the police …

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A physician suicide: covered up with a tarp and silence

You can’t separate mind and body in medicine

Peggy A. Rothbaum, PhD

Physician

January 22, 2018

According to the American Psychological Association and the American Academy of Family Physicians, well over half of patient visits to primary care physicians are for mental health issues. So, as part of my book, I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship, I asked about mental health.

None of the doctor interviewees disagreed with the important role that …

Should the SOAP note be changed?

Jennifer Middleton, MD

Physician

January 22, 2018

Our hospital system’s IT department has recently encouraged us all to change our default encounter note template from the traditional “SOAP” format to the “APSO” format.

For those not familiar with those acronyms:

S: subjective — the patient’s story
O: objective — physical exam, labs, other data
A: assessment — the identified issues/diagnoses
P: plan — details of how to address issues/diagnoses in the assessment

The argument in favor of APSO, putting the assessment and plan …

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Should the SOAP note be changed?

Obstruction of medical justice: How health care fails patients with cancer

Miriam A. Knoll, MD

Health Policy

January 22, 2018

Isn’t getting cancer bad enough?

That’s the frustrated thought that goes through my mind when I see patients with cancer suffering — not from their cancer, but from the failure of the health care system.

Take Nancy,* a 60-year-old woman with hormone-positive breast cancer. When she came to the emergency room with a fungating breast mass, we knew …

When should physicians retire?

Wall Street Physician, MD

Physician Finance

January 22, 2018

The decision to retire is a difficult one for anyone, including physicians.

However, with everyone’s investment accounts so flush with money because of the bull market, a lot of physicians younger than the traditional retirement age of 65 have enough money to retire early. Some have chosen to do so; others have chosen to continue to work even though they are financially ready for retirement.

So what are the factors that …

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When should physicians retire?

Opioid addiction is an epidemic. Let’s treat it like one.

Heath McAnally, MD

Conditions and Diseases

January 21, 2018

If we want to talk about the opioid epidemic as an actual epidemic, let’s use the same terms we use for communicable disease: agent, vector/environment, host. Virulence. Transmission. Immunity.

The media has done a great job of providing descriptive statistics of the epidemic. And recent oversight, both legislative and advisory, have attempted to focus on altering vector (prescriber) behavior in the wake of apparent failed attempts to reduce agent virulence. What …

13 things every doctor wants their patients to know

Joanne Jarrett, MD

Physician

January 21, 2018

1. We worry. We lie awake worried sick about you more often than you’d think. The stakes are so high, and we know it.

2. We wonder. I ran into a friend who’d met a patient I’d had sixteen years earlier. She gave me some follow-up, and it made my day — maybe my month. It was a year ago, and I’m still thinking about it. She’d had blood cancer. I referred her …

A near-death experience taught this medical student a lesson

Johnathan Yao, MD, MPH

Medical Education

January 21, 2018

I had just taken my final anatomy exam and finished a long two-month ordeal dissecting through and memorizing every component of the human body. At the beginning of the course, I had been excited, energized, honored to commence such a foundational experience in medical training. By the end, I was exhausted, wanting nothing more than just to sleep.

The very next day, we began physiology with two weeks of cardiology separating …

Physicians: Beware lifestyle inflation

Live Free MD

Physician Finance

January 21, 2018

At some point in our lives, most of us have learned to live on very little. For example, if you’ve ever been a college student, you’ve mastered the art of living in the same house with a dozen other people, finding free meals, and using public transportation.

Back in the early 2000’s, when I was a college student, I estimate that I spent about $15,000 per year on living expenses (aside …

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Physicians: Beware lifestyle inflation

10 ways this primary care physician will work smarter in 2018

Hans Duvefelt, MD

Physician

January 20, 2018

I don’t regularly make any New Year’s resolutions, but this year I am tossing around a couple of ideas. One reason is that I have so many things going on that I need to be clever about how I use my time.

I work four days a week at my regular clinic, and I also work two long days at a clinic in far northern Maine. In addition, there are many …

What a toddler can teach physicians about the stock market

Dads Dollars Debts, MD

Physician Finance

January 20, 2018

We are now almost 2 1/2 years into this parenting thing. It is a pretty amazing thing, raising a toddler. There are a lot of awesome days, watching him learn and explore his surroundings. The sentences that are coming out of his mouth now are pretty wild. He is funny, has a good amount of potty humor, and is all around a cool kid (at least I think so).

That is …

If politicians really want to address the problems in health care, this is what they should do

Linda Girgis, MD

Health Policy

January 20, 2018

Americans witnessed the many failed attempts of our elected officials to reform our broken health care system over the past year. Some call for repealing and replacing the Affordable Care Act (ACA) while others think it is the cure-all for what ails our system. The simple fact that politicians fail to consider is the fact that having health care coverage does equate to actually receiving health care services.

In fact, the …

MKSAP: 55-year-old woman after bariatric surgery

mksap

Conditions and Diseases

January 20, 2018

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

A 55-year-old woman is evaluated during a routine examination. She underwent biliopancreatic diversion with duodenal switch 8 years ago for treatment of obesity-related complications and lost 68.0 kg (150.0 lb) in the first year following surgery. Her weight has been relatively stable for the last year. She has had chronic nonbloody diarrhea since her bariatric …

Young surgeons are learning robotic surgery in the shadows

Matt Beane, PhD

Physician

January 19, 2018

Artificial intelligence and robotics spell massive changes to the world of work. These technologies can automate new tasks, and we are making more of them, faster, better and cheaper than ever before.

Surgery was early to the robotics party: Over a third of U.S. hospitals have at least one surgical robot. Such robots have been in widespread use by a growing variety of surgical disciplines, including urology and …

5 ways poorly thought out health IT can worsen patient safety

Suneel Dhand, MD

Physician

January 19, 2018

The frontlines of health care have been transformed over the last decade as electronic medical records have been rolled out across America. Unfortunately, information technology has yet to live up to its immense promise in health care — a topic that I frequently write about. As somebody who has worked with every single major EHR on my travels, I am being brutally honest when I say not a single one …

A 16-page note with little information to help physicians

Niran S. Al-Agba, MD

Physician

January 19, 2018

My pediatric practice is one which harkens back to days long ago when physicians knew their patients and pertinent medical histories by heart. My 81-year-old father and I were in practice together for the past 16 years; he still used the very sophisticated “hunt and peck” to compose emails. The task of transitioning to an electronic record system seemed insurmountable, so we remain on paper. Our medical record system has …

Women in medicine: Getting to this point came at a cost

Diane Birnbaumer, MD

Physician

January 19, 2018

Sometimes life just walks right up and slaps you in the face. It happened to me while attending the dynamic FIX17 conference in NYC, and it led to an epiphany: At the ripe old age of 59, I am officially a dinosaur.

I was giving a talk on the history of women in medicine. Passionate about the topic, I spent months planning and organizing the lecture, weaving what I hoped was an intriguing tale …

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