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The humiliation a nursing physician faced during her board exam

Physician

July 2, 2016

To the American Board of Pediatrics:

I took and passed my recertification exam in Washington State last fall and would like to express my sincere gratitude to your organization for setting up more hoops for pediatricians to jump through under the guise of helping us stay up-to-date. The first hurdle was the exam application and the second was the testing day experience, which was one of the most humiliating of my …

MKSAP: 86-year-old woman with pain

mksap

Conditions and Diseases

July 2, 2016

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

An 86-year-old woman is evaluated in her assisted-living facility for pain. Four weeks ago, she developed herpetic lesions on her right posterior thorax in a T7 distribution. She was treated with acyclovir, and the lesions healed; however, she has persistent severe burning pain. The pain is so severe that she is unable to …

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MKSAP: 86-year-old woman with pain

What does quality mean in the eyes of a patient?

Kerri Vincenti, MD

Physician

July 1, 2016

One hot topic that has recently gained a relatively large amount of attention over almost all areas of medicine is quality improvement. Hospitals have created dedicated senior-level positions to oversee it, interdisciplinary councils have been formed to research and address it, and employees are reminded daily, if not more often, of their role in implementing it in the form of various quality benchmarks they are held accountable for (such as …

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For hospitals to thrive, they need to value nurses

Anonymous

Health Policy

July 1, 2016

Three weeks ago, I changed jobs. I left a high-tech, high-volume teaching hospital in one of the largest medical centers in the U.S. for the greener pastures of a small, private community hospital. Why? I needed a less stressful position, lower acuity patients and to be rid of the madness of commuting.

I am a registered nurse with experience in emergency and trauma nursing, critical care, electrophysiology and cardiovascular surgery. I …

New doctors may be more unprepared than ever

Chris Tedeschi, MD

Medical Education

July 1, 2016

July is back, and clinical faculty at teaching hospitals have again braced for the annual deluge of new residents just beginning their specialty training. Unfortunately, our new doctors may be more unprepared than ever.

The gap between medical school (the four years leading to the MD degree) and residency (advanced training in a particular field) has widened over the past several years. Changes in the health care system, shifting patient expectations, …

It’s time for doctors to tell insurance companies how they really feel

David Wild, MD

Physician

July 1, 2016

The time has come. The time has come for patients to know how dangerous the state of health care has become and to finally do something about it. I’m ticked off. So ticked off that I’m writing this in between office patients, and I really try very hard to prevent my patients from waiting. Apparently insurance companies feel practicing medicine is as easy as checking off boxes, like hanging chads …

The story of a doctor who destroyed his EMR

David Mann, MD

Physician

June 30, 2016

“I love you,” she said as she was leaving the room.

“I, I um …”

“Not you. Your computer.” She cast my computer, still warm and glowing with its brilliantly colored logout screen, a glance of longing and desire, and left the exam room.

“Oh, I thought …”

The slamming of the exam room door clipped off whatever the end of that sentence might have been.

I sat down and rolled my chair over to …

Did Prince die because he had bad doctors?

Peter Ubel, MD

Medications

June 30, 2016

Prince died of an opioid overdose. A tragic and avoidable fate but, even more tragically, one that is becoming increasingly common in the United States. Some people who overdose live on the edge of society–homeless and with no access to good medical care. Prince, by contrast, had several mansions and a number of physicians actively involved in his care, physicians aware of his problem with opiates. …

The widespread use of fentanyl escalates the risk of overdose

Karen S. Sibert, MD

Physician

June 30, 2016

A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009.

For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, …

On June 30th, I hope we remember the intern within us

Fatima Z. Syed, MD

Medical Education

June 30, 2016

Much is made of the date July 1st in the medical profession. Freshly graduated physicians begin their training career in medicine as interns. Although technically physicians, these interns are new to the clinical practice of medicine and all that comes with that. Much has been made of the experience of the new intern. Samuel Shem’s House of God is a renowned novel about medical training. Countless television series, chronicle the …

It’s time for physicians to demand a national medical license

David M. Mitchell, MD, PhD

Physician

June 30, 2016

The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice.

Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any …

Why new doctors should think beyond the stethoscope

Shantanu Gaur, MD

Health Technology

June 29, 2016

This spring, thousands of medical graduates will cross the stage and become doctors. Yet practicing medicine isn’t the only career for these young professionals; the path to becoming a doctor also provides ample skills for entering the innovation economy.

Today’s medical students are perfectly poised to change the gridlock of the U.S. health care system — and medical schools should empower them with the support and business exposure necessary to tackle …

The opioid disaster: Stop criminalizing doctors

Cindy Perlin, LCSW

Medications

June 29, 2016

It’s an unmitigated disaster. One hundred million pain patients. Millions addicted to opioids, hundreds of thousands dead. Pain patients abruptly cut off medication they’ve depended on, sometimes for decades, and offered nothing to replace it. Doctors, fearful of prosecution for overprescribing, dropping pain patients like hot potatoes. Pain patients unable to find any doctor that will treat them. Patients turning to heroin when they can’t get their prescription painkillers. Articles …

People are going broke because they can’t afford care. It needs to end.

Michael P. Jones, MD

Health Policy

June 29, 2016

“I need help with my colitis.”

“Really? I thought we had things pretty well controlled.”

I hadn’t seen her in the better part of a year. I remembered how hard it had been to get her ulcerative colitis into remission. How sick she had been, how miserable her life was. There was a bit of trial and error in the office, followed by a hospitalization for intravenous steroids, then a tapering dose …

We need to show empathy for patients who miss their appointments

Jessica M. Yeatermeyer, MD

Physician

June 29, 2016

I have a love-hate relationship with the no-show patient. Like most doctors, I’m a reasonably good multitasker, adept enough at charting while emailing while waiting on hold with insurance companies and planning what to prepare for dinner when I get home. But there are days, more than I’d like to admit, when I feel like I need just a little bit more time, and I find myself compulsively refreshing my …

Do hospitals need a formal appearance policy?

Richard Plotzker, MD

Physician

June 28, 2016

One day into our medical center’s newly announced colleague appearance policy, nobody has yet approached my office with a steel wool soap pad to make any of the docs or medical assistants shine. My active white coat went into the laundry bin the day before, having inserted my left sleeve into a puddle of spilled coffee. The other two lab coats with hospital logo remain in their plastic protective coating, …

A culture of misogyny at a VA hospital

Mary Branch, MD

Physician

June 28, 2016

This is a very controversial essay, but I am going to express how some women physicians, like myself, feel at the VA hospital.

I came home one day after my clinic and was perturbed. I called my significant other and the emotion of the day unraveled. I was reporting an uncomfortable interaction I had with an older male patient. During this patient encounter, his tone and comments became sexually charged and …

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A culture of misogyny at a VA hospital

Some doctors do it for the money. Here are some reasons why.

Future Proof, MD

Physician Finance

June 28, 2016

If you stay in medicine long enough, you will encounter physicians who seem to care more about the paycheck than the patient in front of them: think Dr. Farid Fata. You may find those colleagues revolting; I know I did. I despised these physicians and felt nauseated even to be in the same room as them. But as time went on, I realized that almost nobody starts a career …

Patient satisfaction must start with nursing satisfaction

Alberto Hazan, MD

Physician

June 28, 2016

Ever since the U.S. government decided to link Medicare reimbursement dollars to patient satisfaction scores, hospital administrators have been obsessed with improving the quality of care for patients visiting their emergency departments. While the motivation may be partly financial, the goal of improving the patient experience during emergency department and hospital visits is an admirable one.

Unfortunately, many of the tactics used by administrators have done little to achieve that goal. …

Why not make antibiotics over the counter?

Dana Corriel, MD

Medications

June 27, 2016

Bacteria are rapidly becoming resistant in our antibiotic-loving society. This statement is a fact. We are facing a threat not only to our country, but to the world.

I have a proposal to make: over-the-counter antibiotics.

(Insert tongue-in-cheek here.)

Will this help us deal with the falsely popular notion that antibiotics are a cure-all? I don’t know, but here’s something I do. I’ve had patients storm out because I’ve said no, and I …

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