| KevinMD.com

December 1, 2016Dec 1, 2016

As a clinical student, I’ve been a part of dozens of outpatient clinic visits, but several days ago, I witnessed a clinic visit much unlike the others. For one, our patient arrived not for a 20-minute appointment, but for a…

As a clinical student, I’ve been a part of dozens of outpatient clinic visits, but several days ago, I witnessed a clinic visit much unlike the others.

For one, our patient arrived not for a 20-minute appointment, but for a three-hour one. As a hemophiliac, this patient came to Stanford once a year, for a comprehensive, coordinated patient care visit, where she saw not only her hematologist but also her social …

Physician

Get disruptive: 8 ways doctors create change at work

Thomas D. Guastavino, MD

November 30, 2016Nov 30, 2016

"If you do not cooperate, doctor, we will have no choice but to label you as being 'disruptive' and take whatever steps are necessary to remedy the situation." What physician does not dread hearing these words? Over the past several…

“If you do not cooperate, doctor, we will have no choice but to label you as being ‘disruptive’ and take whatever steps are necessary to remedy the situation.”

What physician does not dread hearing these words? Over the past several years, the term “disruptive” has been increasingly used to characterize and intimidate a physician who is perceived as not being a “team player.” With hospitals increasing the difficulty in navigating a …

Physician

Doctors are teachers too

Hans Duvefelt, MD

November 30, 2016Nov 30, 2016

Madame Theriault refused a rectal exam but agreed to get me some stool cards, the first one the next morning, Saturday. Sadie, the lab tech, had enough blood to send off a B-12, folate and iron studies. We agreed to…

The man who felt bad all over had a bilirubin twice the upper …

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Doctors are teachers too

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Medical Education

What this medical student learned after being diagnosed with cancer

Ramez Kouzy

November 30, 2016Nov 30, 2016

We as humans start learning new things since we are born and continue learning until the last breath we take on this earth. We learn lessons that are essential to our lives such as walking and talking, all the way to life lessons that we learn when we face death. I learned a lot through my lifetime; as a child, as a student, as a citizen, and I continue to …

Physician

Dying holds as much meaning as living

James C. Salwitz, MD

November 30, 2016Nov 30, 2016

When patients and their families seek hospice care, they are thinking about how they will die. They want to be without pain, shortness of breath, loneliness and, above all, fear. They want to end their lives with those they love, in a place they know, with respect and support. They want control. They want dignity. We all know this, and try to provide it as friends, family and caregivers. Nonetheless, …

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Dying holds as much meaning as living

Physician

This is one of the most difficult tasks that physicians perform

Bruce Campbell, MD

November 30, 2016Nov 30, 2016

"It's strange how the worst day of your life often starts just like any other." - Joanna Cannon I prepare for each clinic by reviewing the tests and scans of the patients who will be seen that day. Today, I…

“It’s strange how the worst day of your life often starts just like any other.”
– Joanna Cannon

I prepare for each clinic by reviewing the tests and scans of the patients who will be seen that day. Today, I am dismayed as I read a report for a longstanding patient. The news is not good; his scan shows that his cancer has returned.

Twenty years ago on a day like today, I …

Physician

Time is fleeting and doctors must focus on what’s important

Edwin Leap, MD

November 30, 2016Nov 30, 2016

It’s August. I’m looking out the windows of our log house and across the immense variety of green leaves, on oak and birch, mountain laurel and sycamore, magnolia and honeysuckle. It’s a rain forest here. Indeed, after a long dry spell, we’ve had days and days of soaking rain, with breaks in the clouds so that the sun raises steam from the earth like water coming up in the garden …

Physician

How to provide individualized care in an era of standardized office processes and procedures

Yul Ejnes, MD

November 29, 2016Nov 29, 2016

A guest column by the American College of Physicians, exclusive to KevinMD.com. It’s been several years since we transformed our practice into a patient-centered medical home and started to truly work as a team. As I’ve written before, working as…

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

It’s been several years since we transformed our practice into a patient-centered medical home and started to truly work as a team. As I’ve written before, working as a team is one of the biggest reasons for my practice satisfaction increasing …

Physician

A physician-mother’s call to action at a medical meeting

Miriam A. Knoll, MD

November 29, 2016Nov 29, 2016

As a physician and mom, I hate the work culture that generates the glass ceiling for women. Like many professional environments, Medicine is a hierarchical culture dominated by men. The leadership positions are mostly filled by men- including the hospital…

As a physician and mom, I hate the work culture that generates the glass ceiling for women.

Like many professional environments, Medicine is a hierarchical culture dominated by men. The leadership positions are mostly filled by men- including the hospital CEOs, department chairpersons, and medical school deans. This reality begs the question: if nearly half of medical school graduates are women, why don’t we see more female …

Health Policy

How this physical therapist left her insurance nightmare behind

Kristi Anderson, PT

November 29, 2016Nov 29, 2016

It is time for me to dig out from under the frustrating quagmire of paperwork imposed on me by my insurance contracts so I can reclaim my sanity and love of my work. I am terminating all of my in-network contracts, firing my billing service, and focusing my clinic time and energy entirely on patient care. Removing my practice from the control and limitations of health care insurance companies allows …

Physician

This holiday season, pass the family history

Cedrek L. McFadden, MD

November 29, 2016Nov 29, 2016

This morning, I diagnosed a 49-year-old female with stage 4 colon cancer. She will probably not be alive in 5 years. She could have possibly prevented this diagnosis if she had known her family history. Many people don’t know the health history of their family. This holiday season is a perfect time and opportunity to delve into this history and prevent more senseless deaths.

The apple really doesn’t fall too far …

Medications

Drug names need to be simplified for our patients’ safety

Rahul Banerjee, MD

November 29, 2016Nov 29, 2016

The patient’s heart was beating dangerously slowly, and his EKG showed third-degree AV block: His heart’s electrical system had completely shut down in the middle. If this were TV, the doctors would have started shouting “Epi!” and “Get the pads!” immediately. This was real life, though, so his team decided to briefly sit down with him to try to determine why his heartbeat had slowed so dramatically. Was it something …

Physician

Why you should care about medical student debt

Nisha Mehta, MD

November 29, 2016Nov 29, 2016

In a time of rising health care costs, it’s hard to talk about the financial strife of physicians, who as a whole over time do very well financially. We see the bills from our doctor’s office, and it’s hard to imagine why anybody would complain about the upfront investment of a medical education, when the payoff seems so good.

Many recent articles make the case for why becoming a physician is …

Physician

The decision a family can’t make

Shawn C. Jones, MD

November 28, 2016Nov 28, 2016

Just a minute before, I had been in surgery checking on the status of a patient who was undergoing an exploratory laparotomy. She had been doing OK, but deteriorated relatively quickly that afternoon while still in the hospital recuperating from an unrelated operation. The anesthesiologist popped out of the room to tell me what the initial findings looked like. It was not good. That’s when I went to speak to …

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The decision a family can’t make

Health Policy

Why repealing Obamacare won’t be as bad as many people think

Brian C. Joondeph, MD

November 28, 2016Nov 28, 2016

With Donald Trump’s promise to repeal and replace Obamacare on many Americans’ minds, there are numerous questions about how the health care system will work in the very near future. There are equally as many, if not more, outlandish speculations.…

Donald Trump was elected a week ago and doesn’t assume office for two more months. Much of what will get changed and how is yet unknown. Yet the mainstream media has been quick …

Conditions and Diseases

A startling end to nurse turf wars

Debbie Moore-Black, RN

November 28, 2016Nov 28, 2016

We fought. And we fought hard. We were smarter and quicker and we could multi-task, and critically think beyond any MD or NP or PA or beyond any cardiovascular ICU (CVICU) nurse. We always thought we had the higher acuities.…

We fought. And we fought hard. We were smarter and quicker and we could multi-task, and critically think beyond any MD or NP or PA or beyond any cardiovascular ICU (CVICU) nurse.

We always thought we had the higher acuities. We had the critical patients. The multi-system failure patients. The hemodynamically unstable patients.

We had to figure out the lungs, the heart, the kidneys, the brain, the pancreas, the gallbladder, the liver.

And …

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A startling end to nurse turf wars

Conditions and Diseases

What’s the real reason women remove their pubic hair?

Jennifer Gunter, MD

November 28, 2016Nov 28, 2016

A study published in JAMA Dermatology regarding women’s pubic hair grooming practices has people abuzz. This cosmetic act needs a formal medical name because “clamscaping” just doesn’t work on grant applications. Although why the authors couldn’t go with hair removal, I don’t know. The study wasn’t about styling, it was about removal. The study even made it into the New York Times. And yes, my first …

Physician

Makeup and the female physician

Christine Ngaruiya, MD

November 28, 2016Nov 28, 2016

Every day, millions of women across the United States find themselves in predicaments confronting the quality of their appearance. And their makeup. While this may seem a non-issue in the emergency medicine world, it is something that you, as a female professional, or that your female colleagues, have no doubt encountered. Before walking out the door, you have to consider not just what means of transport to take to …

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Makeup and the female physician

Health Policy

Donald Trump keeping the pre-existing conditions protections isn’t new

Robert Laszewski

November 28, 2016Nov 28, 2016

The Wall Street Journal, The Washington Post, CBS News and other news outlets have led with headlines touting the big news that Donald Trump is willing to keep parts of the Affordable Care Act -- notably the pre-existing condition protections…

The Wall Street Journal, The Washington Post, CBS News and other news outlets have led with headlines touting the big news that Donald Trump is willing to keep parts of the Affordable Care Act — notably the pre-existing condition protections and the ability for children up to the age of 26 to stay on their parents policies.

Except this isn’t news.

In May, Trump’s policy advisor told Healthline that …

Physician

4 ways to deal with post-election disappointment

Manoj Jain, MD, MPH and Mark W. Muesse, PhD

November 27, 2016Nov 27, 2016

The pain is silent, subtle and gnawing, like that of being overlooked for a promotion, or being rejected by your dream college. Over 60 million Americans who voted for Hillary Clinton may be groping for a way to overcome such…

For thousands of years, sages have guided us on how to find comfort in a time of …