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MKSAP: 56-year-old woman with type 2 diabetes mellitus

mksap

Conditions and Diseases

June 17, 2017

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

A 56-year-old woman presents to the office to discuss management of her type 2 diabetes mellitus. She is unhappy with her recent HbA1c value. She adheres to the maximum dose metformin monotherapy, which she has been taking for 1 year. Additionally, she has been working toward weight reduction without success; however, weight …

The future of EHR: Here are 5 predictions

John Halamka, MD

Health Technology

June 16, 2017

With the Department of Justice announcement of the $155 million dollar eClinicalWorks settlement (including personal liability for the CEO, CMO and COO), many stakeholders are wondering what’s next for EHRs.

Clearly, the industry is in a state of transition. eCW will be distracted by its 5-year corporate integrity agreement. AthenaHealth will have to focus on the activist investors at Elliott …

Interested in being a locum tenens physician? Read this first.

Val Jones, MD

Physician

June 16, 2017

I receive a significant amount of email in response to my blog posts about locum tenens work. Curious colleagues (from surgeons to internists and emergency medicine physicians) ask for insider insight into this “mysterious business” of being a part-time or traveling physician. I am always happy to respond individually, but suddenly realized that I should probably post these conversations on my blog so that all can benefit.

The most common question …

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Caught between the ideal of breastfeeding and the reality of doing it

Andrea Eisenberg, MD

Physician

June 16, 2017

On a recent vacation in St. Lucia, I came across this mama nursing her babies. “Public breastfeeding. How great!” I thought. But, after posting this picture on Facebook, these were some of the responses: “Yikes! They need to be weaned!” and “they are pretty big to be still nursing.” This, of course, got my head whirling about people’s attitudes toward breastfeeding.

On the surface, …

Many places in America are essentially devoid of doctors

Kenneth Lin, MD

Physician

June 16, 2017

I recently attended a conference in Savannah, Georgia sponsored by the Association for Prevention Teaching and Research.

Since I haven’t spent much time in Georgia outside of Savannah and Atlanta, the welcoming plenary on improving health outcomes for the state’s rural and underserved populations was eye-opening. According to Dr. Keisha Callins, Chair of the Department of Community Medicine at Mercer University, Georgia ranked 39th out of 50 states in primary care physician …

Why can’t doctors be depressed?

Michael Grzeskowiak, MD

Physician

June 15, 2017

Why can’t doctors be depressed? They encounter challenging and emotional situations every day, and they are robbed of the emotional intelligence training necessary to handle them properly.

The 32-year-old single mother of two who was recently diagnosed with metastatic breast cancer and given a prognosis of four months to live. The 13-year-old daughter who suffered her first seizure while swimming alone in her home pool and now lies paralyzed in the …

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Why can’t doctors be depressed?

Burned out? Just say no and teach others to as well

N. Bande Virgil, MD

Physician

June 15, 2017

Without question, the interconnectivity created by social media is a plus when it comes to talking about physician burnout, suicide and policies affecting our practice of medicine. We are no longer in independent silos with the surgeons suffering in one corner and pediatricians elsewhere. Physicians are no longer isolated contemplating if what they are experiencing is just unique to them. We are developing collective voices. It is incredible to believe …

3 points on dialysis John Oliver forgot to make

Katherine Kwon, MD

Physician

June 15, 2017

Dear John Oliver,

First of all, thank you for your recent segment on dialysis. Kidney disease deserves much more attention and discussion than it currently receives. Thank you also for your full-throated support of transplantation and the need for more kidney donors. As a practicing nephrologist, there is nothing better than hearing that one of my patients has been given a transplant. Finally, thank you for pointing out that end-stage renal …

Even if you can’t see sexism immediately, it’s still there

Shannon Tapia, MD

Physician

June 15, 2017

For the most part, the sexism in medicine is not subliminal at all — it’s quite overt. Unless you’re a female physician, you probably are unaware that it’s still an ever-present reality for us. I want to note that there are very good men out there who are trying their best to be advocates for equality in our field even though they cannot fully appreciate the female physician plight. My …

Observing Ramadan as a medical student

Eman Sahloul

Medical Education

June 14, 2017

3 a.m. The alarm blares. Get up, make food, study. Maximize caffeine intake, maximize studying efficiency.

4:12 am. Take the last sip of water, pray. Maximize studying with residual caffeine power.

7 a.m. Get dressed, go to work. Stay awake, stay alert, see patients, present well, regurgitate answers, retain information. Produce saliva, clear dry throat. Study during lunch break. Stay awake, stay alert, see patients, present well, regurgitate answers, retain information.

6 p.m. …

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Observing Ramadan as a medical student

Why Medicaid block grants won’t work

Megan Douglas, JD

Health Policy

June 14, 2017

Medicaid is the largest single health insurance program in the nation, spending more than $500 billion to serve the most vulnerable people with some of the highest need, including children, pregnant mothers, people with disabilities, the poor and the elderly living in nursing homes. Recent proposals to repeal and replace Obamacare – such as the American Health Care Act (AHCA) – would fundamentally change the Medicaid program. …

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Why Medicaid block grants won’t work

Physicians are not fundamentally different from their patients

Colleen Farrell, MD

Medical Education

June 14, 2017

Delivered at the Harvard Medical School Class Day Ceremony, May 25, 2017.

Distinguished faculty, dedicated staff, and most importantly, loving parents and family members:

Thank you for all you’ve done to support us and transform us into doctors. Harvard Medical School Class of 2017, congratulations. It is an enormous honor to address you all today.

When I was a third-year medical student, I scrubbed in on the surgery of a woman …

The golden era of medicine is never coming back

Matthew Hahn, MD

Health Policy

June 14, 2017

An excerpt from Distracted: How Regulations Are Destroying the Practice of Medicine and Preventing True Health-Care Reform.

If you want to learn what is wrong with the American health care system, just follow any doctor for just a short time. It will soon become obvious. The following common scenario should make things clear.

The …

The last patient of the day gets the least care

Anonymous

Physician

June 13, 2017

He entered the hospital on Monday morning with a list of patients running through his mind. From the time he received a sign out of 22 patients from his colleague on Sunday evening, he was planning his workday. It was a ritual of his to pray and sleep early on Sunday night to prepare him for what lie ahead. What lied ahead was a busy week of inpatient medicine — …

Caring for employees is the right thing to do

Tracy Asamoah, MD

Physician

June 13, 2017

I am not an employee. Maybe I should have said this four years ago when I was an employee. When I opened my private practice in 2014, I was running away from something as much as I was running to something new. I’ve been out of training for over a decade. Early in my career, I envisioned myself as an employee of either a non-profit organization working with underserved communities …

Medical school is miserable. Here’s the secret to surviving it.

Tristan Brooks

Medical Education

June 13, 2017

Dear future medical student:

It’s graduation week. I’m running into people I haven’t seen in a long time. There are a few things on my mind currently, and in four years, you’ll have the same conversations.

“Did you have so much fun in med school? Did you love it?”

“No.”

“Wow! Those four just FLEW by, didn’t they?”

“No. They absolutely did not.”

“Well just WAIT ‘til you get to residency. THAT was hard. What you …

The slow death of private practices

Emily Dalton, MD

Physician

June 13, 2017

Doctors have been bemoaning changes in the practice of medicine for years and with good reason. It’s harder and harder to make a go of it in private practice. In recent years our area has lost several small practices — Hal Grotke’s Redwood Family Practice closed, Dr. Garcia retired, Teresa Marshall’s solo office shut its doors, Eureka Internal Medicine transitioned to Humboldt Medical Specialists (which then became St. Joseph Hospital …

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The slow death of private practices

Stop asking doctors for free advice

Anonymous

Physician

June 12, 2017

My husband is a doctor. Similar to any other career, this is what he spends most of his time doing. It’s also our family’s livelihood — how we pay our mortgage, our bills and send our daughter to preschool.

He went to through seven years of training after college, often working all night or even 24-plus hour calls. He’s had to miss family dinners, birthday parties, nights of putting our daughter …

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Stop asking doctors for free advice

Doctors: You have a PR problem

Kaci Durbin, MD

Physician

June 12, 2017

Over the last few decades, public perception of physicians has been on the decline. Many issues are to blame, but a largely overlooked contributing factor is the media. Physicians are often portrayed negatively, with stories of narcotic abuse, greed and medical mistakes dominating the news. Rather than fight back, physician organizations have stood silently and allowed their reputations to be tarnished. On the other hand, nursing organizations have been busy …

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Doctors: You have a PR problem

Medical school didn’t teach me how to fix a patient’s broken heart

Nicholas Koen

Medical Education

June 12, 2017

It was the first warm day of spring as I walked into the assisted-living facility for what would be the last time. I was on my way to Larry’s room, the resident of the facility that I had been paired with, when I was stopped by my group leader. “I have some terrible news,” he said. “Larry’s wife was moved to another facility — her dementia has worsened since our …

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