| KevinMD.com

October 4, 2016Oct 4, 2016

These days, I work most of my shifts about 45 minutes from my "house on the hill." At one of those jobs, the day shift starts at 6:30 a.m. Which means I’m rising from my bed at 4:30 a.m. in…

These days, I work most of my shifts about 45 minutes from my “house on the hill.” At one of those jobs, the day shift starts at 6:30 a.m. Which means I’m rising from my bed at 4:30 a.m. in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world.

I lay out my clothes …

Conditions and Diseases

Stop with the unnecessary questions

Susan Turner, LICSW

October 3, 2016Oct 3, 2016

When I find a lump in my left breast, I am stunned. I probably shouldn't be surprised, but I'm immobilized. It takes me several days before I tell my partner, who has to push me into action. I get the…

When I find a lump in my left breast, I am stunned. I probably shouldn’t be surprised, but I’m immobilized. It takes me several days before I tell my partner, who has to push me into action. I get the referral from my doctor and schedule a mammogram. The radiology practice fits me into their schedule that same week, but I still have several days to sit with the unknown.

Finally, …

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Stop with the unnecessary questions

Health Policy

The interference in health care is mesmerizing

Rocky Bilhartz, MD

October 3, 2016Oct 3, 2016

“Beep,” went the machine. I left a message and hung up. My patient, Mr. G, had just been denied a medicine by his health insurer. It’s the same medication for the same condition that he had been taking last year.…

“Beep,” went the machine.

I left a message and hung up.

My patient, Mr. G, had just been denied a medicine by his health insurer. It’s the same medication for the same condition that he had been taking last year.

I was leaving a message on his behalf.

You can be assured that if you hand an insurance card to the front desk employee at your doctor’s office, your doctor deals with health insurers …

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Physician

We are not taking care of nurses. Who will heal the healers?

Michael Kirsch, MD

October 3, 2016Oct 3, 2016

On the day that I penned this post, I rounded at our community hospital. My first patient was in the step-down unit, which houses patients who are too ill for the regular hospital floor. I spoke to the nurse in order to be briefed on my patient’s status. I learned that this nurse was assigned six patients to care for — an absurd patient volume for a step-down unit.

“Why so …

Conditions and Diseases

5 cases where bedside ultrasound helped this doctor

Janice Boughton, MD

October 3, 2016Oct 3, 2016

After five years of doing bedside ultrasound, I'm still excited about it. Bedside, or point-of-care ultrasound is using an ultrasound machine during the physical examination of a patient in order to make a diagnosis. I use a pretty tiny machine…

After five years of doing bedside ultrasound, I’m still excited about it. Bedside, or point-of-care ultrasound is using an ultrasound machine during the physical examination of a patient in order to make a diagnosis. I use a pretty tiny machine that fits in my pocket. As an internist who works in the hospital and in rural clinic outpatient settings, I get to use my ultrasound all the time, and it’s …

Medications

What’s the best way to get rid of unused medications?

Roy Benaroch, MD

October 2, 2016Oct 2, 2016

A patient wrote in, asking what she ought to do with unused medications, including some psychiatric drugs and controlled substances. It’s good to get those out of the house, safely -- but how? Parents should make sure to keep their…

A patient wrote in, asking what she ought to do with unused medications, including some psychiatric drugs and controlled substances. It’s good to get those out of the house, safely — but how?

Parents should make sure to keep their homes free of unused medications. The misuse of prescription medications (usually narcotic painkillers) has surpassed motor vehicle accidents as the leading accidental cause of death in the U.S. A lot …

Physician

Practicing medicine in a place where the children have no name

Linda Girgis, MD

October 2, 2016Oct 2, 2016

I recently spent a week with the Floating Doctors in Bocas del Toro providing medical care to the Ngabe people in western Panama. In the jungle, there is little concern about prior authorizations or deductibles. There is also a critical lack of access to services that we have available in the U.S. The Ngabe people do not own much. In fact, some kids do not even have names.

In the Ngabe …

Physician

The lost art of asking questions

Hans Duvefelt, MD

October 2, 2016Oct 2, 2016

Most people know from experience or through intuition that there is a right time and a right way to ask important or sensitive questions. You don’t usually just blurt out requests for raises or marriage proposals, for example. In many…

In many areas of life, knowing when and how to ask difficult questions is viewed as an extremely valuable skill, for example in criminal investigations and in journalism.

In some cases, this kind of …

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The lost art of asking questions

Physician

We are all responsible for physician suicide

Dr. Eunice J. Minford

October 1, 2016Oct 1, 2016

As doctors, we love to think we are intelligent, rational, thoughtful and caring human beings, and we take pride in our profession and the privilege and status it accords. We like to hold our heads high, puff out our chests, speak with authority and convey our hard-earned knowledge acquired over many years of undergraduate and post-graduate study. We like to think we know; we have answers; we can cope; we …

Physician

Physician burnout challenges our assumptions

Anoop Kumar, MD

October 1, 2016Oct 1, 2016

I probably set a record for the earliest a physician ever burned out: less than a year after earning my MD. Some may not call it burnout; it could just as well be called “internship." I call it burnout because…

I probably set a record for the earliest a physician ever burned out: less than a year after earning my MD. Some may not call it burnout; it could just as well be called “internship.” I call it burnout because beyond the exhaustion and can’t-take-it-anymore, there was a gnawing sense that something fundamental was missing — something that no amount of time would fix.

Over the next year or so, the …

Health Policy

The Affordable Care Act presents challenges for college students

Aldebra Schroll, MD

October 1, 2016Oct 1, 2016

The school year is back in session, and our student health center is busy. As a college health doctor, I have been able to watch the rollout of the Affordable Care Act (ACA) among this population. Since its passage, more…

Young adults have historically demonstrated high rates of un-insurance. An estimated 30 percent of those 19 …

Conditions and Diseases

MKSAP: 51-year-old man with newly diagnosed hypertension and diabetes mellitus

mksap

October 1, 2016Oct 1, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 51-year-old man is evaluated during a follow-up visit for management of newly diagnosed hypertension and diabetes mellitus. He has started a program of…

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

A 51-year-old man is evaluated during a follow-up visit for management of newly diagnosed hypertension and diabetes mellitus. He has started a program of lifestyle modification for his diabetes but has not yet started antihypertensive therapy. He is currently taking no medications.

On physical examination, blood pressure is 148/92 mm Hg, and pulse rate …

Physician

I don’t apologize for being a fast doctor

Dina D. Strachan, MD

September 30, 2016Sep 30, 2016

When we think about the technology revolution, we often get excited at the thought of getting what we want instantly. We wait in line for new smartphones. We instant message. We love fast. Getting something done faster, with as good…

In these times of fast information, we find ourselves bombarded with surveys. Part of the downside of …

Medications

The statin wars expose 2 factions in medicine

Dr. Saurabh Jha

September 30, 2016Sep 30, 2016

It is the beauty of evidence-based medicine (EBM) that a scientist can at once be a Pope and a Galileo. His transmutation is as effortless as it is discretionary. If you think you’ve met Galileo — a rebel, a free thinker, a rocker of the establishment — the following week he is a Pope, castigating detractors, censoring critics, and celebrating uniformity. He changes by a roll of the dice. His …

Physician

Patients want to make their own informed choices. We need to let them.

Niran S. Al-Agba, MD

September 30, 2016Sep 30, 2016

Growing up during the 1970’s and 80’s, Little House on the Prairie was an iconic part of my childhood. Doc Baker was the physician and veterinarian for all of Walnut Grove, in spite of limited resources. Medical lessons were everywhere in the beloved television series: Mary experiencing onset of blindness (most recently attributed to viral meningoencephalitis, likely from measles), the death of Laura’s infant son by unknown cause, and Rose’s …

Physician

Physicians can lead from the bedside

Jean Robey, MD

September 30, 2016Sep 30, 2016

A recent movie series called Divergent depicted a dystopia that created five factions: Abnegation (selflessness), Dauntless (bravery), Erudite (intellectual), Amity (peaceful or charitable), and Candor (honest or just) or Divergent (a unique combination of traits that thinks for the whole…

I recently wrote a piece, “Physicians will take back the beside.” One …

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Physicians can lead from the bedside

Physician

How Captain Sully inspired this physician

Mike Sevilla, MD

September 29, 2016Sep 29, 2016

"I've had 40 years in the air, but in the end, I'm going to be judged by 208 seconds." This is a line spoken by Tom Hanks, who played the title role of Captain Chesley "Sully" Sullenberger. I remember being…

“I’ve had 40 years in the air, but in the end, I’m going to be judged by 208 seconds.”

This is a line spoken by Tom Hanks, who played the title role of Captain Chesley “Sully” Sullenberger.

I remember being on Twitter on Thursday, January 15, 2009, when I started seeing pictures of a plane in the water and people standing on the wings. I learned that it was US Airways Flight …

Physician

The Hamilton lyrics that resonate with this trauma surgeon

Heena P. Santry, MD

September 29, 2016Sep 29, 2016

Like much of America, my family is obsessed with everything Hamilton. We jammed to the soundtrack all summer. The season culminated with a late August trip to the show which I described on social media as the best day of my life. Seeing the show, the actors, the set, and choreography, come to life with lyrics we had all memorized was such an amazing experience.

I cried.

Part of that was pinching …

Physician

3 Dutchmen walked into an eye clinic and the rest is history

Hans Duvefelt, MD

September 29, 2016Sep 29, 2016

As a severe myopic, it is no wonder I have always had a certain interest in ophthalmology. And just the other day I had reason to ponder the peculiar Dutch dominance in the history of optics and ophthalmology. When I…

When I was a nearsighted young school boy in Sweden, my mother brought me on the bus into town every fall to see the eye doctor. He must have been in his eighties, …

Physician

6 unintended consequences of online doctor reviews

Chris Thiagarajah, MD

September 29, 2016Sep 29, 2016

Online reviews for doctors are here to stay. Letting patients review their doctor sounds great right? What could go wrong? That being said, there are several things that reviews do that is, in fact, damaging to the care of patients…

Online reviews for doctors are here to stay. Letting patients review their doctor sounds great right? What could go wrong?

That being said, there are several things that reviews do that is, in fact, damaging to the care of patients in medicine. Here are six things that many physicians now do in the world of online reviews.

Focus on showmanship not results. “Sometimes I spend extra time on the exam even when I …