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Guidelines are wonderful. Guidelines are dangerous.

Conditions and Diseases

July 31, 2017

Over the past decade, I have thought often about the benefits and the problems of clinical guidelines.

The first concept that attracted my attention was reading about conflicting guidelines. Given the same data, different guideline committees would have significantly different recommendations. At the least, this problem raises questions about guideline validity. It makes clear that committee perspective could influence recommendations. Guideline recommendations sometimes are clear and demonstrably evidence based, but too …

Does the high-risk psychiatric patient pose a risk for the patient or the doctor?

Steven Reidbord, MD

Conditions and Diseases

July 30, 2017

A woman recently requested a medication evaluation at the suggestion of her psychotherapist. The caller told me her diagnosis was borderline personality disorder. She hoped medication might ease her anxiety. She also admitted that two other psychiatrists refused to see her because she was too “high risk.” I asked if she was suicidal. Yes, thoughts crossed her mind. However, she never acted on them, and was not suicidal currently. I …

Health reform should simplify our health system. Here are some ideas.

Matthew Hahn, MD

Health Policy

July 30, 2017

We are a nation divided. Our two major political parties agree on essentially nothing. Republicans cannot agree even amongst themselves how to proceed on health care reform. It is demoralizing that even though U.S. health care has sunken to last among developed nations, our elected leaders are unable to envision or agree upon any effective solutions. We could all use a win. When it comes to health care reform, administrative …

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Here’s what it’s really like when your spouse is a doctor

Emily Loeb

Physician

July 30, 2017

June 30 is a date that those in the medical world know well; it’s the official end of the medical training calendar year. July 1 represents new beginnings: beginning of the academic year, an internship, a residency, or a fellowship. This year was our tenth and final passing through the medical new year. Looking back, I realize that we never would have predicted what we were going to learn and …

Forget what you’ve heard. Direct primary care is here to stay.

Trevin Cardon

Health Policy

July 30, 2017

Much has been written in recent weeks about the failure of direct primary care giant and pioneer Qliance. Much of the conversation has examined the reasons for their closing and the negative impact it will have on the direct primary care movement. Questions have been raised about the longevity of the movement, with many exclaiming that “If they can’t sustain it, no one can.”

While I don’t pretend to know all …

5 ways to transition to residency

Stephanie Wellington, MD

Medical Education

July 29, 2017

Every July, recently graduated doctors from medical school transition into hospitals, clinics, and surgical rotations. Doctors completing their internship year welcome the second year with additional leadership roles. This period of transition is coupled with the pressure of doing well, the stress of proving your competency on attending rounds, and the desire to receive respect from your team.

It is easy to become confused and frustrated as you learn to navigate …

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5 ways to transition to residency

Is there an EMR checkbox for a renewed spirit?

Jennifer Lycette, MD

Health Technology

July 29, 2017

Mr. X. is a man in his 80s who was cured of his cancer. The question remains: at what cost?

The biologic therapy and radiation which eradicated the cancer left him with the inability to swallow and need for permanent PEG tube. Due to overall frailty and multiple comorbidities, he never graduated from the SNF and continues to reside there today.

I inherited his care after he completed his definitive treatment in …

MKSAP: 34-year-old man with episodic palpitations

mksap

Conditions and Diseases

July 29, 2017

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

A 34-year-old man is evaluated for episodic palpitations of 8 months’ duration. The palpitations last 5 to 10 minutes and then resolve spontaneously. They are usually associated with sweating and anxiety. Medical history is significant for thyroidectomy for medullary thyroid carcinoma diagnosed at 12 years of age. His father has also undergone thyroidectomy …

Cancer patients can’t afford care

Syed M. Ahmed, MD, PhD

Physician

July 28, 2017

Lost in the debate on “Trumpcare” versus “Obamacare” is the proper consideration of the factors driving increasing health care costs. In cancer, the pharmaceutical industry plays a major role setting drug prices that exceed reasonable returns on research and development. The economics of treatment were again apparent during the plenary session of the American Society of Clinical Oncology Annual Meeting in June, aka the cancer community’s Super Bowl. Two years …

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Cancer patients can’t afford care

Waiting on a significant other to finish medical school? Here are some tips.

Lauren Checketts-Warne

Medical Education

July 28, 2017

My husband and I met during my graduate studies and while he was earning his bachelor’s degree. Two years after getting married, we packed our belongings and moved to a new state where he began medical school. We started our own little family a year later and welcomed an amazing daughter into our lives. After she was born, I made the personal decision to leave my job and stay at …

Lost in America: Reflections on homelessness and societal marginalization

David Zacharias, MD, MPH

Physician

July 28, 2017

Humanity often exists as a bell curve which cuts off and marginalizes its own tail. We judge individuals at the end of a spectrum rather than recognizing them as products of deeply rooted systemic failures within a society. In all cultures, both ancient and modern, humans have created scapegoats — individuals designated to “take on the sins” of a people, to represent and be held responsible for the shortcomings of …

Why are doctors leaving private practice?

Linda Girgis, MD

Physician

July 28, 2017

In the U.S., approximately 30 percent of physicians work in practices that they own. This number has been dwindling down over recent years. Perhaps more surprising, the number of women doctors who are self-employed are a mere 18 percent.

Many hospitals and other corporate entities are actively looking to purchase the remaining practices. It is not just to make money from that practice; it’s to make money from services that are …

Being Latina, a physician, a mother and a runner: by the numbers

Monica Verduzco-Gutierrez, MD

Physician

July 28, 2017

To a runner, numbers are everything. It’s data. It’s workouts. It’s goals. It’s pace. It’s winning or losing. To a physician, numbers are everything as well. Before you get into medical school, numbers are your schedule, your GPA and your MCAT. In medical school, numbers are your grades, your board scores and your rank in the class. It goes on and on. …

We need to talk about mental illness in the medical field

Lisa Jacobs, MD, MBA

Physician

July 28, 2017

It wasn’t until I was six months into my second depressive episode that I discovered depression existed. I didn’t know it was a real disease. I didn’t know that my grandmother got electroconvulsive “shock” therapy in the 1950s. I only knew something was terribly wrong when I sat crying for 20 minutes in front of a pile of laundry one morning because the thought of choosing clothes and going through …

The oral contraceptive’s PR problem

Shikha Jain, MD

Medications

July 27, 2017

Recently in Missouri, a bill was proposed that would ban women on oral contraceptives (OCP) from working. In the world of politics, the use of contraceptives has been discussed ad nauseam, often without medical consideration. As physicians, in order to continue to uphold our Hippocratic Oath: “First do no harm,” it is imperative that we continue to challenge any law that goes against scientific evidence, and our voices must be …

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The oral contraceptive’s PR problem

Who is alive: man or machine?

Debbie Moore-Black, RN

Conditions and Diseases

July 27, 2017

He had cardiomyopathy and CHF for over 20 years. At the time, doctors told him he could die at any time. That was 20 years ago. His EF was 10 percent — barely livable.

Two decades later, this admit kept him on a see-saw with respiratory distress, a bad heart, bad lungs, atrial fibrillation with RVR and heart rate in the 140s all day long. He progressed from nasal cannula to …

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Who is alive: man or machine?

5 reasons why medical students drop out

Dr. Daniel

Medical Education

July 27, 2017

I write this blog in order to prepare premedical students for the road ahead. I want you to understand common obstacles facing medical students so you can be better prepared to overcome them. Medical training is akin to a roller coaster pulling you through the highest of highs and the lowest of lows. On the one hand, medical school is extremely challenging but rest assured, it is very tough to …

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5 reasons why medical students drop out

The stupidity epidemic is far more lethal than the opioid epidemic

Jay Joshi, MD

Physician

July 27, 2017

Substance abuse and overdose deaths are nothing new. People who use opioids are dying and will keep dying until we learn how to fix our bigger problem: the “stupidity epidemic.” We see and hear about the opioid epidemic every single day in the media, but no one is talking about the epidemic of stupidity, both in the medical and non-medical communities. We have thrown time, money and even tears at …

2 stories of how physicians dealt with burnout

Mani Saint-Victor, MD and C. Nicole Swiner, MD

Physician

July 27, 2017

We’ve been talking to doctors all around the world, and the mood is consistent. Physicians are frustrated and suffering from burn out because the old model of practicing medicine is no longer meeting their needs. From decreased compensation to desire to spend more time with our families to the combination of loss of autonomy and an increasingly impersonal and inefficient system, a career in medicine is not meeting its end …

Doctors: Don’t lose your humanity

Dr. Sonia Henry

Physician

July 27, 2017

There has been much publicity recently surrounding the issue of doctor mental health after a spat of doctor suicides, and sadly not a new thing in the history of medical training. I think the crux of this issue is the idea that doctors are somehow above the concept of humanity. We are held to standards above human abilities, yet we bleed the same blood, cry the same tears and feel …

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Doctors: Don’t lose your humanity

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