| KevinMD.com

November 22, 2016Nov 22, 2016

Thanksgiving is this week, and I have a lot to be thankful for, both inside and out of medicine. Life isn't always easy as a resident, and to quote the lyrics of Journey, "And lovin' a man, ain't always what…

Thanksgiving is this week, and I have a lot to be thankful for, both inside and out of medicine. Life isn’t always easy as a resident, and to quote the lyrics of Journey, “And lovin’ a [medicine] man, ain’t always what it’s supposed to be.”

What’s a life in medicine mean to me? It’s certainly not the glamorous. I’m on the back half of 30 years old. I’ve been a doctor for little over …

Physician

Handheld electronic devices are the thieves of our meaningful moments

Keith Pochick, MD

November 22, 2016Nov 22, 2016

A few weeks ago, my employer sent me to a three-day out of town conference. I had mixed emotions. It would put a burden on me to work more than usual both before and after it, but I couldn’t help but look forward to the blissful, uninterrupted sleep I would get in a cozy, quiet hotel room. There was guilt when I realized that my wife would shoulder the full …

Patient

Here’s what we want you to know about being our doctor

Catherine Richardson

November 21, 2016Nov 21, 2016

Dear doctors, Are you looking through our charts and wondering what you’ve gotten yourself into? Are you maybe wishing we were someone else’s problem? Yeah, we know. It’s OK. We know we aren’t the type of patient most doctors like…

Dear doctors,

Are you looking through our charts and wondering what you’ve gotten yourself into? Are you maybe wishing we were someone else’s problem? Yeah, we know. It’s OK. We know we aren’t the type of patient most doctors like to take on. There are a lot of strings attached to us, and there’s a lot of paperwork waiting to join that already insurmountable mountain of paperwork on your desk.

We can’t …

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Physician

Pretending the world is homogeneous is a dangerous path

James Nichols, MD

November 21, 2016Nov 21, 2016

I was at work a few nights ago. We had had a patient death early in the morning before I got there, and the body was still in the room awaiting the JP’s arrival. The family was en route back…

I was at work a few nights ago. We had had a patient death early in the morning before I got there, and the body was still in the room awaiting the JP’s arrival. The family was en route back with the children (he was only 57) and the body was not presentable. Blood, saliva, a gaping mouth and lividity with rigor were a bad combination for the kids to see. …

Physician

Dr. Mommy: When will you put yourself first?

Maiysha Clairborne, MD

November 21, 2016Nov 21, 2016

Beyonce wasn’t kidding when she wrote the song “Girls Run the World.” We as women wear as many hats as some of us have shoes. However, the cost of that can be grave if we never learn to create balance in our lives. When I say balance I don’t mean the balancing act, I mean the act of giving back to ourselves. Imagine that you have an energy bank account. …

Patient

Patients without partners, and the doctors who stereotype us

Joan DelFattore, PhD

November 21, 2016Nov 21, 2016

"You have no husband?" asked an oncologist at an Ivy League cancer center, his voice full of concern. "No," I replied. "No sons?" "No." "No daughters?" "No." "No sisters or brothers?" "No." "Your parents -- are they living?" "No." When…

“You have no husband?” asked an oncologist at an Ivy League cancer center, his voice full of concern.

“No,” I replied.

“No sons?”

“No.”

“No daughters?”

“No.”

“No sisters or brothers?”

“No.”

“Your parents — are they living?”

“No.”

When I mentioned friends and extended family, he talked right over me. Without a nuclear family, he seemed to think, I had no one.

I’d been diagnosed with stage four gallbladder cancer, usually fatal within months. The surgeon who’d removed three-quarters of …

Physician

The story of how a stranger helped a physician

Caroline Wellbery, MD

November 20, 2016Nov 20, 2016

In the middle of a five-way thoroughfare intersection, with the early-morning sun's glare on my windshield, I hit the curb of the median and blew out my left front tire. Amid stopped traffic, I ran to collect my escaped hubcap,…

In the middle of a five-way thoroughfare intersection, with the early-morning sun’s glare on my windshield, I hit the curb of the median and blew out my left front tire. Amid stopped traffic, I ran to collect my escaped hubcap, whose silver eye stared helplessly from among the automotive debris of previous accidents.

A policeman blocked the lanes until I could pilot my car into the gas station on the other …

Conditions and Diseases

It’s time to phase out the word “psychosomatic”

Jeff Kane, MD

November 20, 2016Nov 20, 2016

Psychosomatic. I learned not to use that word forty years ago, after I'd told a patient her malady might be psychosomatic in origin. She turned red, jumped up, and on her way out said, “I hope you fall into an…

Psychosomatic. I learned not to use that word forty years ago, after I’d told a patient her malady might be psychosomatic in origin. She turned red, jumped up, and on her way out said, “I hope you fall into an open manhole and die!”

Well, maybe I should’ve been more circumspect. I hadn’t realized until then that people can understand “psychosomatic” in a different way than I do. I’d meant what …

Physician

The disappointment of mothers in medicine

Anonymous

November 20, 2016Nov 20, 2016

It is 6:08 p.m. on a Monday night, and I am sitting in an unlocked patient exam room, my uneaten lunch opened in front of me, clicking through a patient’s chart, all to the constant whir of my breast pump. I last breastfed my infant at 6 a.m. this morning, and the discomfort in my chest has only amplified as the 12th hour has gone by without time to express …

Physician

The exam room post-election

Megan S. Lemay, MD

November 20, 2016Nov 20, 2016

It’s Wednesday, the day after the election. I spent the previous night clicking from one website to another, trying to find someone who was refuting what the others said was true. And when it became inevitable, I held my infant…

Now I’m in front of my exam room, walking in to see Mr. Bundy. I open the door to find him wearing a red hat embroidered with …

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The exam room post-election

Health Policy

Why physicians need to organize

Andres Barkil-Oteo, MD

November 19, 2016Nov 19, 2016

In my previous post, "Have physicians finally joined the working class," I discussed the changes in the health care system regarding physicians roles in these systems. In this post, I propose two strategies that could help physicians regain some influence…

In my previous post, “Have physicians finally joined the working class,” I discussed the changes in the health care system regarding physicians roles in these systems. In this post, I propose two strategies that could help physicians regain some influence over their work and to participate fully not just in the execution of strategy from management but also have an input in creating it.

Building unions

There has …

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Why physicians need to organize

Physician

Patients are not fast food. Stop treating them that way.

Gene Uzawa Dorio, MD

November 19, 2016Nov 19, 2016

I had never heard the term “throughput” before a meeting at our hospital two years ago. It was used to discuss how the emergency department (ED) could yield greater profits by faster patient turnover. Coordinating various duties (including intake, admitting, and cleaning staff; lab and radiology; nurses and doctors) patients could be shuttled into and out of the ED earning the hospital $2 million more per year.

This strategy was implemented …

Health Technology

A revolution is needed to fix what’s wrong with EMRs

Diane W. Shannon, MD, MPH

November 19, 2016Nov 19, 2016

During the Q&A period after a presentation I gave recently on understanding and preventing physician burnout, a physician in the audience voiced her vehement objections to the current electronic health record (EHR) with a simple statement: “We need a revolution.”…

In a few words, she described her frustrations with the EHR. “It is meaningless — full of fields that we cut and paste from other fields. There are an ever-growing number …

Conditions and Diseases

MKSAP: 34-year-old man with progressive left knee pain

mksap

November 19, 2016Nov 19, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 34-year-old man is evaluated for progressive left knee pain. The pain causes difficulty with his work as a mail carrier, particularly when walking.…

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

A 34-year-old man is evaluated for progressive left knee pain. The pain causes difficulty with his work as a mail carrier, particularly when walking. His occupation does not require repetitive bending. He played football in college and experienced left knee trauma during sports participation; he underwent left meniscectomy and stopped playing sports. His …

Physician

All patient lives matter

Greg Smith, MD

November 18, 2016Nov 18, 2016

She is tall, thin and wears torn jeans like a mannequin. A silky top flows around her, masking the thin torso, the exposed ribs. Her hair is long, fine and the ends are perfect. Her face is smooth, drawn, a bit careworn, but that is why she is here. She carries herself with an aristocratic bearing that is not learned but genetically endowed over generations. She is rich, entitled and …

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All patient lives matter

Medications

Are doctors the new drug dealers?

Michael Kirsch, MD

November 18, 2016Nov 18, 2016

I have written about pain medicine, previously on this blog, and it generated some spirited responses. Let me be clear that I am completely against all forms of pain, whether foreign or domestic, physical, spiritual, psychic or even phantom. The medical profession has superb tools to combat and relieve pain, and physicians should utilize them, within the boundaries of appropriate use. We now have an actual specialty — …

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Are doctors the new drug dealers?

Medical Education

The moment my passion for clinical care was reaffirmed

Joseph Cooper, MD

November 18, 2016Nov 18, 2016

“Medicine Purple is now rounding at Room 202.” The announcement rang throughout the hallways on the lower pavilion. It was an announcement I had heard many times before, but this time it was quite different. As I glanced in the upper right-hand corner of the electronic medical record of my first patient, the following glared back at me in all capital letters: “ATTENDING: COOPER, JOSEPH DAVID.” I had imagined the …

Medical Education

Why I’m a doctor: Life-changing stories from med students

David Power, MD

November 18, 2016Nov 18, 2016

I am a professor of family medicine at the University of Minnesota Medical School. During their third and fourth years, students must complete a four-week clerkship in family medicine. The clerkship includes a "significant-event reflection" project, in which students discuss…

I am a professor of family medicine at the University of Minnesota Medical School. During their third and fourth years, students must complete a four-week clerkship in family medicine. The clerkship includes a “significant-event reflection” project, in which students discuss patient encounters that they’ve found especially meaningful.

Over nearly a decade as a facilitator for these groups, I have heard many powerful and emotional stories. I’ve often felt deeply moved–and admiring …

Medications

People who aren’t “pill people”: What do they mean?

Frederick Gandolfo, MD

November 17, 2016Nov 17, 2016

“I’m not really a pill person.” “I was never one for all those pills.” “I don’t really like taking those pills.” “I’m not really into taking pills.” As a doctor, I hear some version of this phrase every day. It’s…

“I’m not really a pill person.”

“I was never one for all those pills.”

“I don’t really like taking those pills.”

“I’m not really into taking pills.”

As a doctor, I hear some version of this phrase every day. It’s almost accusatory, like “Hey, Doc — don’t even think about pushing all those pills on me!”

Luckily, since I am a gastroenterologist, I don’t dispense nearly as many medications as doctors in some other fields …

Health Technology

Leave my patients’ health data alone!

Linda Girgis, MD

November 17, 2016Nov 17, 2016

The patient looked angry and I felt his frustration. His voice was rising, “Why is the chart 54 pages long? My son has only been here five times!” In the olden, pre-electronic health record days, chances are the chart would most likely have been less than 10 pages. However, since the government takeover of medical records, this is no longer the case. When the government rolled out its meaningful use …

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Leave my patients’ health data alone!