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Please don’t take gynecological advice from Khloe Kardashian

Conditions and Diseases

August 18, 2016

The latest celebrity to use the internet like a public speculum is Khloe Kardashian. I know this because my phone blew up recently with reporters texting, e-mailing and sending direct messages on Twitter asking about vaginal vitamin E. So I gave some quotes and thought it would all die down.

But no. Kardashian vagina ranks up there in national significance with the first woman running for the highest office …

When should physicians lie for patients?

Michael Kirsch, MD

Physician

August 17, 2016

Even the most honest among us do not tell the truth all of the time. We are flawed human beings. We covet, we gossip, we steal, we lie, and we stand idly by. You don’t think you steal? Have you ever “borrowed” someone else’s idea and represented it as your own?

A few weeks before I penned this, I was presented with two opportunities to lie in order to save a …

The evolution of a hospital admission

John Schumann, MD

Physician

August 17, 2016

Once upon a time, a hospital was a place you went if you were sick. Doctors would (ideally) figure out what was wrong, offer treatment, and you would convalesce.

The longer you stayed in a hospital, the more the hospital could charge you (your insurance, really — if you had it).

This all changed in 1983, with the advent of the DRG system (it stands for diagnosis-related group). Almost overnight, the incentives for …

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The evolution of a hospital admission

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Can chiropractors be saved? Only they can decide.

Roy Benaroch, MD

Physician

August 17, 2016

Can the chiropractic profession evolve and renew itself as a legitimate part of the health care system? Prominent Australian chiropractor Bruce Walker, who is also the editor-in-chief of the Journal Chiropractic and Manual Therapies, has proposed a 10 point plan to ensure that chiropractors create a profession based on science, knowledge, and genuine healing. He makes a strong case that chiropractors need to embrace research, shun “nonsensical elements,” …

The vaccine crisis we’re facing isn’t the one that you think

Peter Ubel, MD

Medications

August 16, 2016

We have a vaccine crisis in the this country. Not just the one caused by anti-vaxxers like Jenny McCarthy, scaring Americans away from life-saving childhood vaccines with pseudo-scientific claims about autism. Instead, I’m talking about a bigger crisis, one caused by a dangerously thin supply of vaccines. Wise parents who ignore the blatherings of people like McCarthy may soon arrive at their pediatricians’ offices prepared to vaccinate their children, only …

Getting him a new pair of pants was the least that we could do

Heena P. Santry, MD

Physician

August 16, 2016

“Please don’t cut off my pants,” he pleaded. “I am homeless, and they are my only pants. Please.”

He could say these words as we were conducting our initial assessment in the trauma bay so at least he was hemodynamically stable with an intact airway at that moment in time. However, he had arrived seconds earlier with potentially life-threatening injuries as a level 1 trauma activation. Based on the location of …

How can we find the patient within?

Linda Girgis, MD

Physician

August 16, 2016

My medical student found it difficult to get any information from a patient. When she presented the patient’s medical history to me, she was quite flustered and did not know what to say. I went with here to talk to the patient and met the same wall. It is not always an easy task finding the patient within.

Often, when what a patient is saying doesn’t make sense, or it is …

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How can we find the patient within?

The spectacular incompetence of third-party payers

Dr. Saurabh Jha

Physician

August 16, 2016

To paraphrase Tolstoy, all competence is alike, but every incompetence is incompetence in its own way. Every time I think I’ve seen the horizon of incompetence, I’m dealt a surprise. The sun never sets on incompetence. In health care, incompetence can be found in odd places, such as three recent examples I encountered with third-party payers.

Case 1: Downgrading caviar to boiled salmon

A patient was referred for a CT angiogram run …

I am very much a student of the Zen of call

Michael P. Jones, MD

Physician

August 15, 2016

I can’t believe I’m writing something with this title. Anyone who knows me and sees my name next to that title will probably spit their coffee all over the kitchen counter. And to all the people who have dealt with me on call, let me begin by saying, I’m truly sorry for anything I might have said, done, thrown or broken. Mostly. Kinda mostly.

Those who know me will likely think …

Emergency physicians: You are not alone

Edwin Leap, MD

Physician

August 15, 2016

Dear emergency medicine physicians: You aren’t alone. This is very important for you to realize. I mean, I know you aren’t ‘alone.’ You have spouses and children, parents, siblings, neighbors, dogs and cats. That’s all good. You need them. Also, every shift is chock-full of people and their maladies, which you heroically manage day in, day out. Patients are everywhere. Some are sick, and some are injured, and many are …

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Emergency physicians: You are not alone

Hospital fires doctor for having cancer

Pamela Wible, MD & Stephanie Waggel, MD

Physician

August 15, 2016

StephanieFired

Dear Pamela,

You’ll never guess what happened to me today. Hours after the National Day of Solidarity to Prevent Physician Suicide volunteer web page went live, I received an email stating that I am officially terminated from my psychiatry residency program.

On this web page, I spoke about the fact that I had become interested in this event during my …

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Hospital fires doctor for having cancer

6 actions new medical students should take

Robert Pearl, MD

Medical Education

August 15, 2016

Dear Class of 2020,

You’ve worked hard to earn the privilege of becoming a physician. I hope you took some time before starting medical school to enjoy yourself and embrace your passions, be they travel, music or art, or simply spending time with family and friends. Becoming a doctor is a long, bumpy and often lonely road. Resiliency is essential. My first and most important piece of advice is to be …

The kind of family medicine I knew I needed to practice

Hugh Silk, MD

Physician

August 15, 2016

“Why do you want to go into family medicine?” my internal medicine preceptor asked.

It was an innocent enough question. I’d known from day one of medical school what I wanted to do, so I answered with confidence, and perhaps a bit of a chip on my shoulder.

“I love being with people and getting to know them,” I said. “I’ve always been this way, so it makes sense that’s what I …

The quiet leadership of the surgeon general

Maria Yang, MD

Physician

August 14, 2016

Somehow people knew he was about to enter the room. The thirty or so people in the room were seated, though people began to stand up.

“Are we supposed to stand up for the surgeon general?” I asked the person sitting next to me.

She shrugged. If we remained seated, everyone would have noticed. So we stood up.

“I’ve been in this position for a year and a half,” Dr. Murthy …

When medical students and residents are distracted by technology

Kashif Shaikh, MD

Medical Education

August 14, 2016

“Please don’t spoil the movie with your own soundtrack.” Remember hearing this message before the beginning of a movie in a theater and how most people turn their devices on silent to watch the movie? The cost of the movie ticket is considerably less than the cost of medical education, but I wonder if learners consider this phenomenon when they walk into their classrooms. Is the habit of smartphones in …

The part of your day that will be most remembered by patients

Suneel Dhand, MD

Physician

August 14, 2016

Being a doctor is often more about talking to people and communicating than it is about the scientific practice of medicine. This is something that is unfortunately not taught in medical school, and it’s left to newly qualified doctors to realize very quickly as they start their careers.

Throughout the busy and hectic day of any hospital-based physician — no matter what their specialty — one of the most common requests …

After a medical error: Here’s what clinicians should do

Betsy M. Cohen

Patient

August 14, 2016

I have been a rehabilitation specialist and case manager working with patients who have neurological and neuropsychiatric impairments for thirty years. About three years ago, my life took an unanticipated detour when I was perforated during a baseline colonoscopy. All of my experience as a case manger and patient advocate could not prevent this error or the others that followed.

Although my health, body, and life were forever altered by the …

How the book “When Breath Becomes Air” changed my practice

Kim A. Reiss, MD

Conditions and Diseases

August 13, 2016

Behind every door in my clinic, is human suffering. It hangs like a mist; I can see the living ghosts of my patients through it.

As an oncologist who treats primarily pancreatic cancer, many of my patients will be dead within a year of our first meeting. I knew this would be the case when I chose my specialty. Pancreas cancer is one of the last frontiers in cancer therapeutics: a …

Dear Hippocrates: I want a divorce

Lara Salyer, DO

Physician

August 13, 2016

Dear Hippocrates,

I want a divorce.

Let’s face it, you and I were young, idealistic, and naive when we met. Everyone said we were perfect for each other: valedictorian and humanitarian. We thought we could change the world, one sacrifice at a time. Sleep deprivation, grueling academic hurdles, delayed gratification. We proudly wore those badges as a testament to our commitment together when we started our board certified family medicine profession in …

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Dear Hippocrates: I want a divorce

Exciting implications of the neuro-immune link no one is talking about

Keith Pochick, MD

Conditions and Diseases

August 13, 2016

A recent research paper from the University of Virginia may pound the final nail into the coffin of the long-standing medical dogma which rigidly labels diseases as “organic” or “psychiatric.” UVA researchers have discovered a complex network of lymphatic vessels which service the brain, prompting a serious update of the concept of a highly selective “blood-brain barrier.”

When asked about methods to study the immune response of the brain and …

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