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Today’s divisive political climate and our ability to treat our patients without bias

Medical Education

November 26, 2017

Politics are divisive. That should not be a shock to anyone. However, the political climate in the USA at the moment is more than just divisive. Lately, I have noticed that there is an underlying disdain for those we disagree with in a way that even my grandparents say they have never seen in this country. The current political climate pervades nearly every aspect of our society, from pop culture …

Attending physicians should not pass down their impressions of trainees

Cherilyn Cecchini, MD

Medical Education

November 26, 2017

In 1968, Rosenthal and Jacobsen introduced the concept that expectations in the classroom can positively or negatively affect students. This phenomenon was dubbed, “The Pygmalion Effect.” Since then, there has been controversy surrounding the topic. Other authors have argued that the data was insignificant or inconclusive. From my own personal experience, having been in school for over ten years, I believe that the concept carries validity. Furthermore, I believe that …

Doctors can buy happiness by buying time

Ryan Bayley, MD

Physician

November 25, 2017

While enjoying good incomes, physicians and other health care providers chronically suffer from a lack of time. Between scheduled clinical work and being on call, it is not uncommon to have only one full day off in seven. Not surprisingly, it is far too easy to spend that entire day just trying to keep your life afloat, catching up on mundane tasks for yourself and your family that fell by …

Navigating the minefield of medical speak in your relationship

Sarah Epstein

Medical Education

November 25, 2017

An excerpt from Love in the time of medical school: Build a happy, healthy relationship with a medical student.

My dad is the oldest of four boys and my grandfather was an anesthesiologist for many years. Apparently, the women who wanted to marry into the family all had to pass the “test” of listening to my grandfather tell gory surgery stories over dinner. My mother tells me about one …

Picking up the pieces of a broken medical dream

Marteney Jacobs

Medical Education

November 25, 2017

I was in the midst of my family medicine clinical rotation when my world came crashing down. I had failed my Step 1 boards. I would never be a doctor. It was a nightmare that unfolded over three failed attempts, from which I awoke in a new reality where I was no longer a medical student — and there was absolutely nothing I could do to change that.

I poured everything …

MKSAP: 40-year-old woman with amenorrhea

mksap

Conditions and Diseases

November 25, 2017

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

A 40-year-old woman is evaluated for amenorrhea of 4 months’ duration. She has had weight gain, facial hair, alopecia, and debilitating fatigue. Her medical history is significant for psoriasis. She seems to be gaining weight in her face, abdomen, and neck. She also bruises easily. Her only medication is clobetasol for psoriasis.

On …

The lessons of Harry Potter and the Deathly Hallows

Divya Yerramilli, MD

Physician

November 24, 2017

Harry understood at last that he was not supposed to survive. His job was to walk calmly into Death’s welcoming arms … All those times he had thought that it was about to happen and escaped, he had never really thought of the thing itself: His will to live had always been so much stronger than his fear of death … It was over, he knew it, and all that …

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The lessons of Harry Potter and the Deathly Hallows

The worst-case scenario question you must ask patients: even healthy ones

Sarah Fraser, MD

Physician

November 24, 2017

The last few passengers filter in and buckle themselves up before takeoff. The emergency exit row is occupied by an elderly couple, and I am seated behind them. The flight attendant asks whether they are comfortable in those seats, given that they’d have to respond in the case of an emergency.

“Not that I expect anything bad to happen,” the flight attendant adds with a smile.

I, too, am familiar with discussing …

4 problems with the Joint Commission

Anonymous

Physician

November 24, 2017

I’m passionate about patient safety. In no small part because I was raised to be. My mom has a lot of letters behind her name (RN, BSN, MSN), and she’s dedicated her career to the field.

Before I was accepted into medical school, I knew about “six sigma,” the “Swiss cheese model” and root-cause analysis. I’d been taught about creating a culture of safety and the example of the airline industry. …

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4 problems with the Joint Commission

3 reasons why health care costs are rising

Samuel Falkson

Health Policy

November 24, 2017

Following a relatively routine doctor appointment, I received my bill for over $1,000. I rubbed my eyes, hoping to find an overlooked decimal point. I didn’t.

My experience is not unique. We have a problem in the U.S. We pay over $3 trillion annually for health care — about 18 percent of our GDP. No other developed nation spends more than Read more…

3 reasons why health care costs are rising

I’ll never forget the eyes of a 6-year-old sexual assault victim

Debbie Moore-Black, RN

Conditions and Diseases

November 23, 2017

Patsy loved playing bingo every Wednesday night. Her boyfriend of three years loved watching her daughter Jenna who was a tiny and pretty six-year-old her momma called “princess.”

Even though they weren’t related, Jenna called Patsy’s boyfriend “Uncle Billy” at her mother’s behest.

And Uncle Billy made Jenna shyer and quieter than she usually was. He’d walk in on those Wednesday nights and demand a big hug and kiss on the cheek …

A new approach to shared decision making

Dennis Deruelle, MD

Physician

November 23, 2017

If patient-centered care is the current winning game plan for health care, then shared decision making (SDM) is the secret weapon. But we physicians need a new way to approach it.

SDM, as defined by the Society for Medical Decision Making, is “a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patients values …

Prioritize primary care this open enrollment season

Glen R. Stream, MD

Physician

November 23, 2017

This open enrollment season, patients will be considering their health care coverage for the coming year. To ensure they are fully utilizing their primary care benefits and building relationships with health care teams that will keep them healthy, we need to encourage them to connect with a primary care practice or medical home.

A medical home is a place where a patient can seek treatment from primary care physicians and other …

The scourge of electronic health records

Faith A. Coleman, MD

Health Technology

November 23, 2017

Scourge:

An instrument of punishment or criticism
A cause of wide or great suffering
Whip or lash — especially for torture

Introduction

They say you never forget your first time. I remember mine, vividly. If only I could erase the memory. I had high expectations and higher hopes, but what I got was disillusionment. I felt violated and humiliated. I’m talking about my first time using a system for electronic health records …

The doctor-patient relationship is everything

Peggy A. Rothbaum, PhD

Physician

November 22, 2017

While doing my doctoral dissertation research at a clinic for kids with diabetes, I observed the attachment that some of them had to the physician faculty member who directed the clinic. I particularly remember one teenager who complained that this doctor “did not care” about her, as he sent “fake doctors” (residents) to take care of her, not coming himself. She was refusing to cooperate. When I suggested to the …

The case of a fish hook in the eye

Raj Waghmare, MD

Conditions and Diseases

November 22, 2017

Triage Note: Fish hook in eye. No bleeding. Tetanus up to date.

It’s a sunny weekend during cottage season. A young woman is rushed into the ER as she cups both hands over her left eye. She’s in shorts, and flip-flops, and she’s hyperventilating. Her friends follow, hands similarly cupped over their mouths. I read the triage note. I’ve never seen this before. I’ve removed dozens of fish hooks — it’s …

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The case of a fish hook in the eye

The most frustrating things about being chronically ill

Toni Bernhard, JD

Patient

November 22, 2017

Healthy or not, everybody has his or her share of frustrations in life. The chronically ill don’t have a corner on that market! This piece focuses on frustrations that are unique to those with ongoing health issues. I’ve experienced all of them as a result of being chronically ill with a debilitating illness that settled in after I contracted what appeared to be an acute viral infection in 2001.

Here are …

Physicians share same mission across cultures and countries

Philip A. Masters, MD

Physician

November 22, 2017

A guest column by the American College of Physicians, exclusive to KevinMD.com.

As part of my role in International Programs at the American College of Physicians (ACP), I have a unique opportunity to travel frequently and engage with internists around the world. In fact, I am writing this while almost 7,000 miles away from home, …

Why are you in medicine?

Marc N. Katz, MD

Physician

November 22, 2017

I was recently interviewed on a podcast and was asked the simple question, “Why are you in medicine?” In retrospect, that’s the exact question I silently ask myself in frustration and exhaustion a little bit too often while I’m in the hospital. In those moments I recognize that I feel burnt out. In those moments if someone told me that I had to repeat intern year in order to finish …

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Why are you in medicine?

These are the biggest medical issues of 2017

Robert Centor, MD

Physician

November 21, 2017

Periodically we should reflect on what challenges face patients and physicians. Over the past few days, I have worked on a list of the issues that concern me the most. I welcome suggestions for expanding the list.

1. Diagnostic errors. All patient care requires that we make the proper diagnosis. Too often we make errors. A recent paper estimated that 30 percent of cellulitis admissions did not have cellulitis. A similar …

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