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I want to quit medicine, and it has nothing to do with patients

Physician

May 5, 2017

I think a lot about quitting medicine lately. A lot.

Then I have a morning like yesterday morning:

I see a patient I’ve known for more than twenty years, caring for him through an adrenal tumor, a major gastrointestinal surgery and now renal failure, for which he needs a kidney transplant. As we review his last set of labs (stable, thank goodness), he is sanguine, hopeful. He may have found a donor, …

This gynecological issue is misdiagnosed over 50 percent of the time

Roger Reichert, MD, PhD

Conditions and Diseases

May 4, 2017

As a consultant in gynecologic pathology, I receive requests for second opinions from patients who have been diagnosed with endometrial hyperplasia. My opinion is based upon correlating the relevant clinical history with a review of the patient’s pathology slides and report. In my experience, there is a difference of opinion that leads to a change in treatment in about half of the cases. 75 percent of cases with changed diagnoses …

Should we standardize clerkship grades?

Anonymous

Medical Education

May 4, 2017

I’ll be honest, when I first matriculated into medical school, I didn’t even know what a USMLE Step exam or clinical clerkship was. In fact, the first time I ever heard of them was from another applicant on the interview trail. I have always been a take-it-one-step-at-a-time type of person, but eventually, I would have to succumb to the pressure and ask upperclassmen about the exam. And what did they …

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Should we standardize clerkship grades?

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There she was, hanging in our closet

Jacqueline Cory Russo

Conditions and Diseases

May 4, 2017

No matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it’s some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight.

That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali …

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There she was, hanging in our closet

More young people are getting colorectal cancer. What do we do?

J. Leonard Lichtenfeld, MD

Conditions and Diseases

May 4, 2017

After years of declining rates of colorectal cancer (CRC), a study from the American Cancer Society raises the specter that not all is going as well as we would have hoped, especially among younger folks born since 1990. And that raises the question of what the future holds for this frequently preventable form of cancer, …

Doctors aren’t cops: We need to change gunshot reporting

Shane Collins

Medical Education

May 4, 2017

On my first trauma shift as a fourth-year medical student, a young, disheveled man with blood-soaked pants hobbled into the emergency department. Wincing in pain, he offered me a bizarre history of being shot in the leg by a nail gun that went off after he dropped it on some stairs while helping a friend move. He lifted his right pant leg and removed the bloody, tattered bandana wrapped around …

What Netflix can teach us about treating cancer

Elana Fertig, PhD

Conditions and Diseases

May 4, 2017

Two years ago, former President Barack Obama announced the Precision Medicine initiative in his State of the Union Address. The initiative aspired to a “new era of medicine” where disease treatments could be specifically tailored to each patient’s genetic code.

This resonated soundly in cancer medicine. Patients can already manage their cancer with therapies that target the specific genes that are altered in their particular tumor. For …

Widespread hype gives false hope to many cancer patients

Liz Szabo

Conditions and Diseases

May 3, 2017

After Michael Uvanni’s older brother, James, was diagnosed with a deadly form of skin cancer, it seemed as if everyone told the family what they wanted to hear: Have hope. You can beat this, and we are here to help.

The brothers met with doctors at a half-dozen of the country’s best hospitals, all with impressive credentials that inspired confidence.

Michael Uvanni was in awe when he visited the University of Texas …

Obamacare isn’t a disaster. Failing to improve upon it would be.

Cedric Dark, MD, MPH

Health Policy

May 3, 2017

Congress has returned to DC in the wake of the defeat of Paul Ryan’s American Health Care Act. And while shouting “repeal and replace” might win elections, this debacle proves that the American people will not tolerate their families, friends, and neighbors losing healthcare coverage just so rich people can get tax cuts.

Yet, Congress will certainly revisit health reform again. With the Republican caucus fractured, Paul Ryan should seek out …

Other jobs have strict rules on hours worked. So should doctors.

Cory Fawcett, MD

Physician Finance

May 3, 2017

There has been much talk over the years about resident work hours. How long is a safe shift? With safety being considered for both the patient and the resident. But no one ever discusses attending work hours. If putting in a 24-hour shift is bad for a resident, isn’t it bad for an attending as well? When I was working in critical access hospitals, I usually was on call for …

We need to kick our harmful and ineffective addiction to punishment

Marc Krupanski

Conditions and Diseases

May 3, 2017

As New Jersey Governor Chris Christie takes the lead in crafting the Trump administration’s response to the opioid crisis, he and his colleagues need to understand that we can’t fix the problem until we kick our long-term addiction to the war on drugs and accept overdoses for what they are: a health …

An extraordinary day in the life of a physician

Jeremy Topin, MD

Physician

May 3, 2017

Walk with me, why don’t you? It’s time, don’t you think? We have been avoiding this for quite a while. But it’s best to bring this out from the shadows and into the light. Let’s take a walk through part of my day.

Be careful.

You won’t like what you see. I don’t like this much, but I just keep moving forward, one foot in front of the other. Don’t stop. Can’t …

Your on-call doctor probably didn’t receive training in telephone medicine

Michael Kirsch, MD

Physician

May 3, 2017

Physicians spend a lot of time counseling patients on the phone. Often, these conversations occur at night with patients we have never met before. When I am on-call in the evenings or on the weekends, these are some typical phone calls I receive from patients I have never met.

I have a very bad stomach ache for the last hour.
I started having rectal bleeding an hour ago.
My wife tells …
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Your on-call doctor probably didn’t receive training in telephone medicine

No, pregnancy did not help Serena Williams win the Australian Open

Jennifer Gunter, MD

Physician

May 2, 2017

The New Scientist wonders if Serena Williams pregnancy is making her a better athlete?|This is a new low in “pregnancy angles.”

I often get asked to comment on celebrity/athlete pregnancies, and I always decline. Why? Partly because I don’t want my name in articles like this, but also I don’t care what anyone does in their pregnancy and neither should you. If a celebrity or athlete is offering …

What is the right way to deliver bad news?

Andrea Eisenberg, MD

Physician

May 2, 2017

Recently, someone close to me was diagnosed with cancer. Due to a series of missed phone calls on both sides, he had not heard the results of his biopsy prior to his follow up appointment. When his young doctor walked in, he started with, “So you know you have cancer, right?” I just wanted to scream, “What the f*ck!” It is never easy to give someone bad news, but this …

Here’s how your commute can help you

John Merrill-Steskal, MD

Physician

May 2, 2017

This is an open letter to everyone everywhere, especially people who live in small communities such as mine:

If you drive to work, you are missing out. If someone offered you an opportunity to improve your health, enhance your happiness and creativity, boost your self-esteem and even make you richer, what would you say? Many might think it would be an offer that was too good to be true — a …

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Here’s how your commute can help you

In their obsession with numbers, doctors sometimes forget who patients are

Rob Lamberts, MD

Physician

May 2, 2017

The consultant note read:

Weight 250 lbs. BMI 40.3. Patient is morbidly obese. Counseled on the dangers of excess weight. Counseled to increase exercise and decrease calories.

I walked into her room. She smiled at me as I walked in, a lovely smile that reached her eyes. I scanned her record. She was in my office for an ankle injury. Blood pressure normal. Weight 248 lbs., BMI 40.

When I looked back at …

My first mistake could have been fatal

Rogue Dad, MD

Physician

May 2, 2017

Recently, our three-year-old wandered into our bedroom around 4 a.m. waking me up, saying he was scared. As I did the previous few nights when he did this, I muttered a curse word to myself and picked him up to carry him back to his room. Upon lifting him, a wrinkle in the routine emerged — he was naked below the waist. At some point, before he entered our room, …

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My first mistake could have been fatal

Patient-dictated vs. patient-centered care. What can physicians do?

Kyle Bradford Jones, MD

Physician

May 2, 2017

Patient-centered care (PCC) seems to be a popular buzzword among policymakers and administrators in recent years. Indeed, many physicians see our health care system as payer-centric, many patients see it as physician-centric, and no one seems to see it as patient-centric. While putting the patient at the center of what we do as physicians is critical to improving the triple aim of better care, better health, and lower costs, it …

Stop the slut-shaming: HPV vaccines prevent cancer

Cory Michael, MD

Conditions and Diseases

May 1, 2017

I met “Samantha” during my first rotation as an intern. She was a strong-willed and optimistic lady who weighed about 100 pounds. She was dependent on a tube in her stomach for nutrition, and she appeared 10 or 15 years older than her age of 44 years. Pictures of her children were next to her bed. I asked her how we could help her. She cried.

Her husband of 20 years …

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