| KevinMD.com

November 10, 2016Nov 10, 2016

I dreaded Mr. L’s office visits. His mouth half vacant of teeth and his clothes reeking of hand-rolled cigarettes, he regularly demanded medicines he didn’t need. He was pushy and thankless. I frequently declined his requests. He stuck with me…

Over the years he grew in orneriness. Divorced, childless, and unemployed, he declared one day that he was tired of living. He was reasonably healthy. He disavowed depression. Would I …

Medical Education

A medical student rediscovers a love for writing

Anonymous

November 9, 2016Nov 9, 2016

Over the past month, I’ve slowly rediscovered my love for writing. Though I have never considered myself a strong writer, I have fond memories of it providing an outlet for my thoughts. The history essays that everyone dreaded writing in high school were some of my favorite assignments. I spent days wording and rewording my sentences while my classmates wrote them quickly the night before they were due. It felt …

Physician

Should patients fire their doctors if they suspect burnout?

Niran S. Al-Agba, MD

November 9, 2016Nov 9, 2016

In a recent PBS interview, Mayo Clinic CEO Dr. John Noseworthy suggested patients should “change physicians” when faced with non-empathetic doctors suffering from burnout. His cavalier resolution to our occupational struggle feels like a betrayal, to both his esteemed colleagues across the country and our profession. In my opinion, firing your physician is a risky proposition in light of the looming physician shortage.

Burnout is an overwhelming …

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Medical Education

3 reasons MDs should get MBAs

Akhilesh Pathipati, MD

November 9, 2016Nov 9, 2016

After finishing three years in medical school, I recently moved over to Stanford’s Graduate School of Business. I decided to pursue an MBA in addition to my MD and will graduate two years from now with both degrees. I’m not…

I’m not alone. There are 11 MD/MBA candidates in my business school class, including nine from Stanford. Our cohort is part of a small but growing trend towards doctors obtaining business training. The …

Read more…

3 reasons MDs should get MBAs

Medications

Codeine is a terrible choice for treating children’s pain and cough. Here’s why.

Roy Benaroch, MD

November 9, 2016Nov 9, 2016

Codeine is a terrible choice for treating children’s pain and cough, and we ought to just stop using it. It’s like an old yogurt container, way at the back of your fridge -- sure, it was once tasty, and then…

Codeine is a terrible choice for treating children’s pain and cough, and we ought to just stop using it. It’s like an old yogurt container, way at the back of your fridge — sure, it was once tasty, and then for a while, you held on to it for sentimental reasons. “Remember that yogurt?” you’d say to your spouse. But it’s well past time to throw that stinky stuff away.

For …

Health Policy

What does hugging have to do with physician pay?

Peter Ubel, MD

November 8, 2016Nov 8, 2016

According to recent research, a hug a day could keep the doctor away. According to another study, Twitter can predict the chance that people will experience heart attacks. A normal blogger would look at these two findings and tell a story about the relationship between stress and health. I’m not normal. I looked at these two studies and came to a different conclusion — that we …

Physician

The medical regrets in my life

Hans Duvefelt, MD

November 8, 2016Nov 8, 2016

“Listen, when I was your age, I did the same thing …” The words came out of my mouth too fast for my frontal cortex to weigh them or to monitor, let alone modulate, the intensity of my delivery. He…

“Listen, when I was your age, I did the same thing …”

The words came out of my mouth too fast for my frontal cortex to weigh them or to monitor, let alone modulate, the intensity of my delivery.

He was a relatively new patient, 17 years old, scheduled for a well-child exam. A tall, athletic young man, he was alone in the exam room. His right arm was in a sling.

“What …

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The medical regrets in my life

Physician

A doctor keeps a dead man’s secret from his mourning family

Gabriel Foster, MD

November 8, 2016Nov 8, 2016

"If my father dies, you're going down with him." The words pierced the air, and suddenly there was silence. I hadn't noticed Frank’s son at first. He'd been pacing in the back of the family group gathered in our ICU…

“If my father dies, you’re going down with him.”

The words pierced the air, and suddenly there was silence.

I hadn’t noticed Frank’s son at first. He’d been pacing in the back of the family group gathered in our ICU waiting room. Now, up close, I could appreciate how large and intimidating he was. And I’d just had the thankless job of telling him, along with the rest of his family, a …

Health Policy

The broken dreams of Obamacare

Richard Young, MD

November 8, 2016Nov 8, 2016

I have written before about predictions of the actual costs of Obamacare and the probable death spiral of increasing costs and decreasing participants. Several recent reports have brought more clarity to the cost realities. Recently regulators across the country approved…

Recently regulators across the country approved rate hike requests by Obamacare insurance companies even greater than they originally asked for. For example, Pennsylvania regulators approved rate hikes of 33 percent, which was …

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The broken dreams of Obamacare

Physician

A doctor thinks a patient is prepared for death. He’s wrong.

Don S. Dizon, MD

November 8, 2016Nov 8, 2016

Milly* was 82 years old and had been diagnosed with a recurrent ovarian stromal tumor — one that is typically seen in much younger women. Surgery was ruled out, and a colleague from outside of Boston sent Milly to me for an opinion about medical treatment. I reviewed her case before I met her: no significant medical problems, …

Physician

The stories that patients tell me are always a gift

Anne Katz, RN, PhD

November 8, 2016Nov 8, 2016

My background in nursing has given me a perspective that many physicians don’t have. From the beginning of my career, I have valued the information that patients have provided me about the context of their lives, family, work, and beliefs. I have never cared for a knee or a prostate, but rather I have cared for a person whose life experiences …

Physician

It is time to build a workforce of resilient physicians

Amy Locke, MD

November 7, 2016Nov 7, 2016

Burnout is a popular topic of discussion among health care professionals, but preventing it often eludes us. While burnout is common in many professions, it is particularly present in health care. It is estimated that about half of all physicians in the United States suffer from burnout with numbers rising rapidly. Burnout is associated with detachment from those around us and feelings of isolation. Burnout can lead physicians to lose …

Health Policy

Our health system is in dire straits with no good plans for reform

Linda Girgis, MD

November 7, 2016Nov 7, 2016

In her home country, everything is free. However, there is a catch -- certain services are only available to those who pay for private insurance. Those who are on the “free plan” sometimes must wait months for procedures. My patient…

In her home country, everything is free. However, there is a catch — certain services are only available to those who pay for private insurance. Those who are on the “free plan” sometimes must wait months for procedures. My patient said she knew many people who died on the list waiting for procedures. So, which is better: Free rationed care where people may suffer consequences waiting in line or overpriced care …

Physician

We give pets dignified deaths, why not our loved ones?

Jamie Coleman, MD

November 7, 2016Nov 7, 2016

Otis was our first baby. He was covered in a caramel-colored fur, weighed 150 pounds and was the best bullmastiff dog anyone could ask for. He protected me from my husband’s incessant tickle attacks and thought that my lap was…

Two years ago, I was walking Otis and he suddenly collapsed. After an extensive workup, including an EKG, blood work and an …

Physician

5 things physicians realize when they’re patients

Suneel Dhand, MD

November 7, 2016Nov 7, 2016

There are so many insightful stories out there about what happens when physicians experience life as a patient or family member. They always make sobering reading for everyone in health care. Over the years I’ve heard dozens of these stories from fellow physicians, describing experiences when they’ve unfortunately been sick themselves. It’s an inevitable fact of life for everyone that they will be the patient one day, but it’s often …

Physician

When we stop denying death we empower ourselves

James C. Salwitz, MD

November 7, 2016Nov 7, 2016

Man has been dying on a regular basis for millions of years — should we not be end-of-life experts by now? Why do I feel the need to devote pages and hours to this depressing topic? Is there a goal to my project, beyond venting the shared suffering which soaks my soul? What is my purpose?

For humans, denial of death and marginalizing its effect on our lives is a major …

Patient

A patient’s advice on how to improve the health care experience

Brian Boyle

November 7, 2016Nov 7, 2016

Every patient has a story and an experience, and my patient experience began on July 6, 2004. One month after graduating from high school, I was involved in a near-fatal car accident. My heart shifted across my chest, lungs collapsed,…

Every patient has a story and an experience, and my patient experience began on July 6, 2004.

One month after graduating from high school, I was involved in a near-fatal car accident. My heart shifted across my chest, lungs collapsed, major organs were either lacerated or failed completely, my pelvis was shattered, and I lost 60 percent of my blood. I was airlifted to shock trauma near death and underwent immediate …

Physician

Every day in the hospital, I walk through someone’s personal hell on earth

Anonymous

November 6, 2016Nov 6, 2016

We brought his family into a separate room with plenty of chairs. Sitting to the right of his father and mother, our attending uttered the first words in the room. “I think you know what I am about to say.”…

We brought his family into a separate room with plenty of chairs. Sitting to the right of his father and mother, our attending uttered the first words in the room.

“I think you know what I am about to say.”

His mother took in a deep sigh, her eyes already swollen from inconsolable tears.

“I think he is dead.”

The whole room sank. We were all punched in the gut by those words.

“Oh my …

Conditions and Diseases

A patient with extreme positivity despite going through difficult times

Neha Sharma, DO

November 6, 2016Nov 6, 2016

This is a story of a very special patient. A story that may change your outlook on life. When I first met her, there was an interesting aura that surrounded her. An aura of positivity and contentment. She was listening…

This is a story of a very special patient. A story that may change your outlook on life.

When I first met her, there was an interesting aura that surrounded her. An aura of positivity and contentment. She was listening to her favorite band on her iPhone and humming along. Her carefree countenance was perfectly paired with the jovial tunes.

I had admitted her to the hospital for an infected bedsore. She …

Medications

Should I take a statin to lower my risk of a heart attack?

Henry H. Ting, MD, MBA and Victor M. Montori, MD

November 6, 2016Nov 6, 2016

Most everyone has had the experience of sitting across from a doctor, being offered a prescription and walking out the door. Most patients will accept the instructions -- maybe ask a few questions -- and move on. For some of…

Most everyone has had the experience of sitting across from a doctor, being offered a prescription and walking out the door. Most patients will accept the instructions — maybe ask a few questions — and move on. For some of those patients, the medications are more than a one-off; they are intended to be taken indefinitely.

One of the most common of these medications is a statin. Imagine you exercise four …