| KevinMD.com

The best defense against the influence of crappy science

Physician

March 30, 2016

Science, to use the term correctly, isn’t a body of knowledge or a bunch of facts written up on a whiteboard by a crazy-haired professor. It’s a method, or way of figuring out things. Thinking and reading and learning from experts are all important, sure. But real science relies on experimentation.

First, make an educated guess about how something works. Then design an experiment to test your guess. (I’m oversimplifying here. …

Medical school has killed my soul. What can I do?

Pamela Wible, MD

Medical Education

March 30, 2016

DearPamela-900x607

Hi Pamela,

I’m a medical student in the UK. Though I’ve only been in med school since September, it has already taken its toll on me. Before I started, I was so in touch with my emotions, spirituality, and nature. Now I feel so empty and desensitized. I hate that when faced with the horrible circumstances of another person, I just don’t feel …

How safe are home births? A pediatrician explains.

Christopher Johnson, MD

Conditions and Diseases

March 30, 2016

The debate over the safety of giving birth at home, both for the mother and for the infant, has been debated for years. I’ve written about the issue myself. From time immemorial until about 75 years ago or so most babies were born at home. Now it’s around 1 percent in the U.S., although it’s much higher than that in many Western European countries.

The shift to hospital births …

Real physician voices, twice a week

Join 100,000+ subscribers. Free, and one click to unsubscribe.

The “go to the ER” mentality of American medicine

Edwin Leap, MD

Health Policy

March 29, 2016

Currently, in American health care, experts are wringing their hands in confusion. I mean, people have insurance, right? And yet, health care is still expensive and dang it, people just keep going to the ER. Visits are climbing everywhere, and I can speak from personal experience when I say that we’re tasked with more and more complex and multi-varied duties in the emergency departments of the 21st century.

I’m not a …

Are today’s surgical residents poorly trained?

Skeptical Scalpel, MD

Medical Education

March 29, 2016

A surgical resident writes:

I’m sure you have read several recent studies suggesting that current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency.

My questions for you:

1. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?

2. What should we do differently? I personally don’t feel that “more simulation activities,” which …

Read more…

Are today’s surgical residents poorly trained?

Why the best administrators are doctors and nurses

Suneel Dhand, MD

Physician

March 29, 2016

Over the last several years since I graduated from residency, I’ve worked in many different hospitals up and down the east coast. These have ranged from large urban medical centers to rural community outposts. In all of these places I’ve felt the inevitable conflict that exists between physicians and administrators — to varying degrees.

It almost seems like a rite of passage that the world of clinical medicine and administration are …

The importance of palliative care in surgery

Adrienne Bruce

Medical Education

March 29, 2016

Even as a child, I noticed that many people, especially my Depression-era grandmother, feared aging and the imminence of death. Death was no stranger to me growing up; I lost my then best friend, my Nano, and my uncle as a child, both traumatically. Yet, death was sad, but natural.

Because of this, I never understood our society’s stigma against dying, something that I’ve struggled with even in medical school. In …

Make sure you know who signs your doctor’s paycheck

Gene Uzawa Dorio, MD

Physician

March 28, 2016

You have a persistent cough and poor appetite, but for six months your doctor has prescribed an assortment of antibiotics after an initial chest x-ray showed a small pneumonia. Finally, short of breath, you go to the emergency room where a CT scan reveals untreatable lung cancer. Later you find your doctor has received a bonus from your HMO insurer for not ordering a CT scan earlier.

Physicians count on experience …

Doctors are more than just skilled workers. Here’s why.

Hans Duvefelt, MD

Physician

March 28, 2016

Physicians today are increasingly viewed and treated as skilled workers instead of professionals. The difference is fundamental and lies at the root of today’s epidemic of physician burnout.

Historically, there have been three learned professions: law, medicine, and theology. These were occupations associated with extensive learning, regulation by associations of their peers, and adherence to strong ethical principles, providing objective counsel and service for others.

Learned professionals have, over many centuries, worked …

Why we need hope in health care

Val Jones, MD

Physician

March 28, 2016

Hope is a tricky thing. On the one hand, false hope can lead patients to opt for painful, futile treatments at the end of life. On the other, unnecessarily bleak outlooks can lead to depression and inaction. When health is at stake, presenting information with the right amount of hope can guide patients away from both suffering needlessly and/or succumbing to treatable disease.

I was reading a sad story about a …

Read more…

Why we need hope in health care

What is wrong with medical students today?

Ahmad Yousaf, MD

Medical Education

March 28, 2016

This question has been circulating in the academic medical world for years. As an intern and resident, I would hear complaints about how “unready” they seemed. The grievances often include adjectives like ill-prepared, lazy, or uninterested. The complaints have burgeoned over time, and the examples are numerous in my institution: Students show up late to rounds with coffee in their hands; one med student had the gall to go directly to the attending and …

We could use more nudges in health care. Can you think of any?

Marjorie Stiegler, MD

Physician

March 27, 2016

A nudge is a form of social engineering to make better choices. In the world of patient safety and medical decisions, it shares some of the concepts of human factors engineering.

Richard Thaler and Cass Sustein may be the world’s authority on the nudge concept, and have a great book by the same name.

Nudges help people to choose their own best decisions by making the easiest, laziest choices — the defaults — …

This doctor quit medicine. But she really tried to make it work.

Rebecca Reyes, MD, JD

Physician

March 27, 2016

It is exactly 49 steps from my bedroom to my garage. It is a 23-mile drive to the hospital and 75 steps to the unit. It takes 10 seconds to walk to the nursing station. I can measure what it takes to get me to work each morning with absolute certainty. I know because I have measured it a million times hoping something will prevent me from reaching my destination. …

This doctor orders pregnancy tests on men. You’re probably doing it too.

Dennis Bethel, MD

Health Technology

March 27, 2016

I order pregnancy tests on men. In fact, I do it pretty frequently.

Now before you go and question my professional competency, let me assure you that I went to a good medical school. I also completed a four-year residency in emergency medicine at a top-notch residency program. I was board-certified less than one year after finishing and have maintained that status ever since.

Despite this, I still order pregnancy tests on men.

Perhaps …

From volunteer to family physician: A medical student’s journey

Farrah Fong

Medical Education

March 27, 2016

Sometimes, it’s difficult to recall that single defining moment or person that sends you on the path you’re meant to take in life. I was fortunate in that I found that experience halfway through my undergraduate career at the University of California, Davis. I had recently lost my grandmother; although I’d wanted to help, all I’d been able to do at the hospital was translate for her. That overwhelming sense …

When debating inpatient vs. observation, remember this history lesson

Suneel Dhand, MD

Health Policy

March 26, 2016

The observation versus inpatient distinction is rightly getting more media and public attention with each passing month. In a nutshell, for anyone reading who is not familiar with what this is all about, it’s essentially a way of categorizing people when they get admitted to hospital.

You are either deemed an inpatient (basically a more complex case) or an observation (a less serious case). The individual reasons and checkboxes that have …

No, doctors aren’t to blame for burnout

Starla Fitch, MD

Physician

March 26, 2016

It makes me crazy when I hear things like, “Doctors are to blame for burnout. They need to just be tougher.”

Are people really serious?

This is like comparing us to people who are eating super-sized fast food meals daily, while complaining about their jeans being too tight. Not the same.

Some will say that burnout is a given and just goes with the territory.

Many debate whether this is something that needs to …

Read more…

No, doctors aren’t to blame for burnout

Teaching students should be the primary focus of medical schools

Robert Centor, MD

Medical Education

March 26, 2016

An anonymous medical student has this post on KevinMD — A star medical student feels like he made a terrible decision:

And so, medical students learn quickly how to play this game. We enter noble. We leave jaded. We leave seeing that the smart move is to get out of it. And so the smartest of the smartest, the ones lucky enough to have a choice, go into fields where …

Read more…

Teaching students should be the primary focus of medical schools

MKSAP: 48-year-old woman with type 1 diabetes mellitus

mksap

Conditions and Diseases

March 26, 2016

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

A 48-year-old woman returns for a follow-up visit for management of type 1 diabetes mellitus. She reports doing well since the last visit. Overall, she believes that most of her blood glucose levels are at goal, but is concerned about occasional episodes of hyperglycemia occurring in the morning before breakfast. She eats a bedtime snack …

Confused by food labels? You’re not alone.

Roy Benaroch, MD

Conditions and Diseases

March 25, 2016

There’s been a push lately for more explicit labeling of foods — to make sure that consumers know that what they’re buying is organic, or free-range, or natural, or GMO-free, etc. But these labels don’t tell the whole story. Sometimes, they’re outright lies.

For instance, “organic” veggies still contain plenty of pesticides. There are the natural pesticides that ordinarily occur in food, plus the organic-OK chemical pesticides that …

Real physician voices, twice a week

The Podcast

Latest episodes

The Podcast

Latest episodes