| KevinMD.com

February 26, 2017Feb 26, 2017

An article from the Wall Street Journal caught my attention, and for all the wrong reasons. It was a review of two recent studies showing that medical trainees have difficulty diagnosing patients with complicated histories or confounding psychosocial features. At…

The WSJ, however, used much more pejorative language, referring to them as “difficult patients,” “a nuisance,” and “an annoyance.” …

Health Policy

The Obamacare generation of physicians is ready to fight for patients

Nuriel Moghavem

February 26, 2017Feb 26, 2017

I’m a member of the 25,000-strong medical school graduating class of Obamacare. We were pre-med college students during the debate over the Affordable Care Act (ACA) and began medical school during its implementation. We put ourselves into deep debt and…

I’m a member of the 25,000-strong medical school graduating class of Obamacare.

We were pre-med college students during the debate over the Affordable Care Act (ACA) and began medical school during its implementation. We put ourselves into deep debt and studied late into the night with the promise that we would practice medicine in a system that promoted insurance coverage, reduced medical bankruptcy, and incentivized high-quality care.

Increasingly, we see that promise …

Health Technology

Are you ready for a recording device in your exam room?

Matthew Anderson, MD, MBA

February 26, 2017Feb 26, 2017

During residency, one of my patients brought a tape recorder to his appointment. It was a big bulky old tape recorder, that was antique technology ten years ago. He was older and wanted to record his appointment so he could remember every detail. His children often called him and wanted an in-depth report of all of his medical visits. He decided he would audio-record his appointments and send the tape …

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Physician

Obese patients are among our most vulnerable

Helena Frischtak

February 26, 2017Feb 26, 2017

It was around 2 p.m. when a 380-pound woman came into the ED. She was in her late 30s. The physician went to see her and then ordered IV fluids, some basic blood tests, and a urine sample. At a…

It was around 2 p.m. when a 380-pound woman came into the ED. She was in her late 30s. The physician went to see her and then ordered IV fluids, some basic blood tests, and a urine sample.

At a hospital, everyone’s job is made harder when a patient is obese. Getting the patient on the bed requires more personnel. Inserting an IV — an intravenous catheter to infuse fluids or …

Physician

Physician coaching and retreats are innovative ways to fight burnout

Maiysha Clairborne, MD

February 25, 2017Feb 25, 2017

One of the most memorable times from my family medicine training days was the annual residency my intern year. It was the year of the World Cup, and a bonding experience that would later save my life. Being able to be with not only my residency class, but also the faculty in a relaxed and empowering environment brought a sense of safety that allowed me to reach out to one …

Medications

The exploding cost of prescription drugs

Homayoun L. Daneschvar, MD

February 25, 2017Feb 25, 2017

The amount of prescribed medications and the number of individuals taking them are increasing rapidly. The share of Americans taking one or more prescription drugs has risen among all age groups. According to the IMS Health Study, the total spending on prescription drugs in the U.S. reached $310 billion in 2015. This is almost three times more than total drug expenditures in the year 2000. It is forecasted that the …

Physician

Success is not congratulated as easily as failure is shamed

Judy Salz, MD

February 25, 2017Feb 25, 2017

“Bask in the glory, toots. You deserve it!” I received this text message from my very dear friend a few days ago after an extraordinary occurrence. I’m a retired internist, and recently my clinical acumen and intervention saved another friend’s…

“Bask in the glory, toots. You deserve it!”

I received this text message from my very dear friend a few days ago after an extraordinary occurrence.

I’m a retired internist, and recently my clinical acumen and intervention saved another friend’s life. That is a statement of fact, not a boast. And that’s why I’m writing about it.

The patient, a retired surgeon, hosted our circle of friends’ New Year’s Eve party a little …

Conditions and Diseases

MKSAP: 55-year-old man with gout

mksap

February 25, 2017Feb 25, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity…

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

A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including the ankles …

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MKSAP: 55-year-old man with gout

Physician

Tips for physicians thinking about working part-time

Warren Holleman, PhD and Marsha C. Holleman, MD, MPH

February 24, 2017Feb 24, 2017

Sure, it’s nice to think about cutting back on the work hours and spending more time at home with the kids. Or out on the running trails getting fit and enjoying nature. Or singing in a chorus. But how do you really make that decision? And if you do decide to work part-time, how do you make the most of it?

After struggling to juggle two full-time health care careers with …

Health Technology

Retooling the future physician

Kiran Raj Pandey, MD

February 24, 2017Feb 24, 2017

A computer algorithm learning how to play StarCraft like a champ may raise some eyebrows, but when algorithms start to give the skills of a trained physician a run, job security becomes a futile construct. An algorithm now diagnoses melanoma as well as a dermatologist: A consolation for the dermatologists, though: Folks across the hallway — the radiologists and the pathologists — are feeling the heat as well. …

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Retooling the future physician

Medications

The EpiPen debacle may be the shot heard around the world

Niran S. Al-Agba, MD

February 24, 2017Feb 24, 2017

The Mylan EpiPen debacle may have inadvertently weakened the grip of big pharma on U.S. lawmakers. Recently, a bill proposed by Senator Bernie Sanders was narrowly rejected by a vote of 52 to 46. Unexpectedly, 12 Republicans and 1 Independent voted with Senator Sanders in favor of allowing pharmacists and distributors to import cheaper prescription drugs from foreign countries. The winds of change may finally blow in a bipartisan direction. …

Physician

The importance of being present

Ronald Epstein, MD

February 24, 2017Feb 24, 2017

An excerpt from Attending: Medicine, Mindfulness and Humanity. Sometimes a simple gesture and a few well-placed words can signal presence. One day on rounds in the hospital, as we walked into the room, Laura Hogan, a nurse-practitioner on our palliative…

An excerpt from Attending: Medicine, Mindfulness and Humanity.

Sometimes a simple gesture and a few well-placed words can signal presence. One day on rounds in the hospital, as we walked into the room, Laura Hogan, a nurse-practitioner on our palliative care team, said three words to the patient: “What beautiful flowers.” The patient looked at the flowers and smiled. The previous day the patient had had a biopsy …

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The importance of being present

Physician

How journaling can help physician wellness

Amanda S. Cuda, MD, MPH

February 23, 2017Feb 23, 2017

Health behavior was my emphasis in my MPH. Add a faculty development fellowship, time as residency faculty, work in a private practice, and increasing interaction with medical students now as faculty at a medical school; the outcome is not just an emphasis, but a mindset. A mindset of health behavior that is not just for patients, but for physicians, as well.

I must have company in this concept as ten invitations …

Patient

How to ease your transition home from the hospital

Raissa Hacohen

February 23, 2017Feb 23, 2017

A hospital stay is a right of passage for any patient, but the road to health is often a marathon and not a sprint. Discharge is an essential step in the patient journey, but it can be as exciting for a family as it is daunting. Families can prepare ahead and put all the right pieces in place in order for a “soft landing” home. Here are some of our …

Health Policy

12 steps to make America’s health care great again

Michael F. Weisberg, MD

February 23, 2017Feb 23, 2017

America’s health care system is broken and no longer works. Many practicing physicians are unhappy with the way insurance companies control medicine. Most patients are unsatisfied with the benefits they receive from the health insurance companies and with the lack of choice they have in who cares for them. Patients are frustrated with the exorbitant cost of prescription medicine. They wonder why this system often doesn’t allow them to receive …

Conditions and Diseases

Perioperative brain health: The need to better understand this public health problem

Lee A. Fleisher, MD and Roderic G. Eckenhoff, MD

February 23, 2017Feb 23, 2017

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. During the course of our careers as physicians, we have cared for or are aware of an elderly patient in the intensive care unit or ward who has…

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

During the course of our careers as physicians, we have cared for or are aware of an elderly patient in the intensive care unit or ward who has exhibited delirium, or an acute confused state. This is particularly common after surgery and anesthesia. While simply being …

Medical Education

Having a baby during medical school wasn’t such a bad idea

Allison Lyle

February 22, 2017Feb 22, 2017

My stomach had been in knots that morning. “Are you pregnant?” my classmate laughed after I returned to the gross anatomy lab for the second time after leaving for fresh air. “No,” I spat, dissection through fat and fascia, teasing…

My stomach had been in knots that morning.

“Are you pregnant?” my classmate laughed after I returned to the gross anatomy lab for the second time after leaving for fresh air.

“No,” I spat, dissection through fat and fascia, teasing out muscles from nerves.

But, I wondered.

After lab, I bought a pregnancy test. I began medical school in my late 20s, already having discussed with my husband appropriate times to start a family during …

Physician

How to publish as a medical trainee

James E. Siegler, MD

February 22, 2017Feb 22, 2017

With all this talk about medical student, resident, and fellow burnout, I thought we might take a break to discuss the small delights that sprinkle throughout medical training. This is not a “You should publish as a trainee” manifesto. It’s more of a DIY guide for those who are interested but can’t find the time or the mentor. And after a decade of rejected manuscripts, unfortunately, I’ve …

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How to publish as a medical trainee

Medications

We need to pay better attention to medication side effects

Marlene Beggelman, MD

February 22, 2017Feb 22, 2017

Years ago, after I suffered a deep personal loss, my doctor prescribed Prozac, and I joined the millions of Americans who have taken an antidepressant. A few weeks later, I had my first panic attack — heart racing, sweating profusely, gasping for breath — sensations of terror normally reserved for life-threatening events. Attacks continued every half-hour and were so incapacitating that I could not even leave my house. My doctors …

Physician

Every doctor needs a moment like this

Andrea Eisenberg, MD

February 22, 2017Feb 22, 2017

My car says it’s 2:10 a.m., 17 degrees. I just left my warm bed — and snoring husband — threw on scrubs and my contact lenses and quickly brushed my teeth and hair. I’m shivering as the car warms up and I hear the crunch of the snow as the car rolls out of the driveway. I’m the first one out on the fresh snow, and it glistens in the …

Read more…

Every doctor needs a moment like this