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Are family physicians the best weapon against opioid crisis?

Physician

December 30, 2017

As the national opioid crisis takes center stage, I want to make a case for the authority of the family physician in managing and treating this problem.

I am a family physician and have been treating patients with opioid dependence and addiction for 12 years. These patients comprise about half of my practice. The other half is representative of a typical primary care practice. I have patients who have been treated …

Doctors and patients are drowning in data. What can be done about it?

Fred N. Pelzman, MD

Physician

December 30, 2017

Too much data, big and small.

Every morning when I log onto our electronic health record, one group of messages are from patients with their self-recorded health information data that they’ve sent to me for review.

Here’s my home blood pressure over the past 24 hours. Here are my fingerstick glucose readings over the past 24 hours. Here’s my weight over the past 24 hours. Here is my depression score over the …

If you don’t teach IMGs, maybe you should start

Denelle Mohammed

Medical Education

December 30, 2017

“I don’t teach IMGs.”

It was such a simple and concise statement. Four words. But it felt like a bullet that was heated in the depths of hell had pierced through my heart when I heard those words. My ears burned and I felt physically ill. I wondered to myself, “Am I really that bad at medicine? Am I even going to make it? Should I just quit?” I felt lesser …

Learn pulmonary hypertension with a Medcomic

Jorge Muniz, PA-C

Conditions and Diseases

December 30, 2017

Pulmonary hypertension (PH) refers to increased pressure in the pulmonary circulation. It develops when pulmonary vessels become constricted and/or obstructed, which can occur in a wide variety of conditions. The increase in pressure is measured by right catheterization, and is defined as a mean pulmonary arterial pressure ≥ 25 mm Hg at rest.

PH leads to right ventricular hypertrophy and enlargement as the …

MKSAP: 64-year-old man with diabetes

mksap

Conditions and Diseases

December 30, 2017

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

A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history is notable for type …

Read more…

MKSAP: 64-year-old man with diabetes

Safe pediatric dental anesthesia is the right of every child

Karen S. Sibert, MD

Physician

December 29, 2017

When you tell anyone in health care that “sedation” to the point of coma is given in dentists’ and oral surgeons’ offices every day, without a separate anesthesia professional present to give the medications and monitor the patient, the response often is disbelief.

“But they can’t do that,” I’ve been told more than once.

Yes, they can. Physicians are not allowed to do a procedure and provide sedation or general anesthesia at the …

The physician’s relationship with the beeper

Ben Gold, MD

Physician

December 29, 2017

If you’re thinking about a career in medicine, there’s a piece of technology you’ll come to know intimately. It’s small and sleek, with excellent battery life and remarkable durability. It’s not an iPhone; it’s not a Pixel. It’s a beeper. You will come to know, and to respect, this tiny black rectangular prism. It will govern your life. You will be at its mercy, yes, but it also offers you a chance at salvation. …

Lessons from 38 years of being an internal medicine ward attending

Robert Centor, MD

Physician

December 29, 2017

Finishing my 38th year of internal medicine ward attending, I wish I knew then what I know now. I estimate the equivalence of at least ten full years of ward attending; I think this meets the magic 10,000-hour number. Hopefully, these notes to myself will help some newly minted ward attendings. The job is quite difficult and multifaceted.

Understand the various responsibilities of the ward attending
- Help your learners grow

Lessons from 38 years of being an internal medicine ward attending

This retired physician is truly free

Cory Fawcett, MD

Physician Finance

December 29, 2017

An unusual thing happened to me today; I was awakened by my phone alarm. Ever since I stopped practicing medicine ten months ago, I have rarely needed to set an alarm to get up. Today when my alarm sounded, Carolyn commented that when she woke up, she thought we were in Spain.

Last Spring, we were traveling through Spain on a two-week bus tour. Each day we had to have our …

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This retired physician is truly free

It’s a shame so many doctors want to leave medicine

Hans Duvefelt, MD

Physician

December 28, 2017

It’s just after six o’clock on a Sunday morning in December. The barn animals have fresh hay and warm water. My wife and the dogs are asleep. The cats are gathered around me as I sit down to write. One of them has jumped up in my lap and is pawing and clawing my jeans.

The fire is roaring in the wood stove, but the 1790 room is still cold. I …

How value-based pay can worsen patient outcomes

Matthew Hahn, MD

Health Policy

December 28, 2017

Results of a study released JAMA Cardiology demonstrated that lower readmission rates among hospitalized heart failure patients, a key focus of recent Medicare value-based payment efforts, were associated with increased patient mortality. In other words, patients admitted to the hospital for heart failure are being re-admitted less frequently, but dying at higher numbers. Value-based pay, as it turns out, where monetary incentives and penalties are tied …

Can we implement the Canadian health system in America?

Shefali Luthra

Health Policy

December 28, 2017

For Dr. Peter Cram, an American internist who spent most of his career practicing in Iowa City, Iowa, moving here about four years ago was almost a no-brainer.

He’s part of a small cohort of American doctors who, for personal or professional reasons, have moved north to practice in Canada’s single-payer system. Now when he sees patients, he doesn’t worry about whether they can afford treatment. He knows “everyone gets a …

How to make your taxable accounts a winning situation

Another Second Opinion, MD

Physician Finance

December 28, 2017

Hopefully, you’ve realized when all of your accounts are taxed; if not, here is a quick refresher.

On the surface, the taxable account looks like a bad deal compared to the others:

You use after-tax money to contribute to these accounts
You pay taxes on any dividends you receive each year
You pay taxes on any capital gains when you take money out

So basically it’s a lose-lose-lose scenario when it comes …

A nurse’s reaction to MACRA haters

Carrie J. Whitaker, RN

Health Policy

December 27, 2017

Like it or not, the Medicare Access and CHIP Reauthorization Act (MACRA) legislation will affect virtually all health care providers practicing in the U.S. Although I sympathize with Dr. Hahn’s sentiment in his article “If Medicare wants value, it should cancel MACRA,” lamenting this legislation feels like “another layer of senseless rules, data collection and more rules.”

MACRA ushers in a long-overdue value-based payment system designed to foster …

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A nurse’s reaction to MACRA haters

7 reasons why being in pain is a pain

Franklin Warsh, MD, MPH

Physician

December 27, 2017

I’m now walking the second mile in another man’s moccasins, and it’s no more enjoyable than my first mile.

Many doctors cringe when they see a chronic pain patient on their day’s schedule or at least certain chronic pain patients. Some of that dread isn’t directly caused by the patient but rather the deluge of third-party administrative demands: workman’s compensation updates, disability applications, insurance forms, lawyers’ letters, etc.

Still, even when the …

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7 reasons why being in pain is a pain

Here’s what it’s like to be a student on a health care team

Rachel Bigley

Medical Education

December 27, 2017

As a first-year medical student, I have the privilege of observing medical practice from two perspectives: as a patient and as a student learning how to think like a doctor. I interview patients with deliberation and overthink every part of the physical exam and every detail of the patient’s history. I attempt to convey the patient’s condition, feelings, and pain as I present to my attending. I also marvel at …

For some happy doctors, medicine is a hobby

Passive Income, MD

Physician Finance

December 27, 2017

“A hobby is an activity, interest, enthusiasm, or pastime that is undertaken for pleasure or relaxation, typically done during one’s own time.”
– Wikipedia

“A job is often defined as a regular activity pastime performed in exchange for payment.”
– Wikipedia

If you search “hobby” on Wikipedia, you’ll be presented with a lengthy list of the most common ones: everything from magic to beekeeping to vehicle restoration. But if you look at these “hobbies” …

Pass-fail in medical school. But the stress remains.

Orly Farber

Medical Education

December 26, 2017

Greetings from the library. I’m writing to you through caffeine jitters, wrapped in a scarf that doubles as a blanket. I’ve marked my territory with my things: several Apple products, remnants of oatmeal in a mason jar, a sketchbook exhibiting my best attempt drawing the inside of a skull, and the most-essential item: my planner, detailing all the tasks I now avoid.

I’m in the midst of my first round of …

Why do people hate Obamacare?

Julie Rovner

Health Policy

December 26, 2017

The Affordable Care Act, a.k.a. “Obamacare,” has roiled America since the day it was signed into law in 2010. From the start, the public was almost evenly divided between those who supported it and those who opposed it.

They still are. The November monthly tracking poll from the Kaiser Family Foundation found that 50 percent of those polled had a favorable view of the health law, while 46 …

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Why do people hate Obamacare?

Can a bear market take away your financial independence?

Physician on FIRE, MD

Physician Finance

December 26, 2017

You did it! You worked, you saved, you conquered.

Your investments add up to 25 times your expenses, or 30 times, or whatever your magic number is. You have achieved financial independence (FI), however you have chosen to define it.

What’s that low rumbling sound I hear?

Is that a bear coming out of hibernation?

I won’t pretend to know when it’s coming, but I promise you I haven’t seen my last bear market. It could start …