Physician

Should the SOAP note be changed?

Physician

January 22, 2018

Our hospital system’s IT department has recently encouraged us all to change our default encounter note template from the traditional “SOAP” format to the “APSO” format.

For those not familiar with those acronyms:

S: subjective — the patient’s story
O: objective — physical exam, labs, other data
A: assessment — the identified issues/diagnoses
P: plan — details of how to address issues/diagnoses in the assessment

The argument in favor of APSO, putting the assessment and plan …

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Should the SOAP note be changed?

13 things every doctor wants their patients to know

Joanne Jarrett, MD

Physician

January 21, 2018

1. We worry. We lie awake worried sick about you more often than you’d think. The stakes are so high, and we know it.

2. We wonder. I ran into a friend who’d met a patient I’d had sixteen years earlier. She gave me some follow-up, and it made my day — maybe my month. It was a year ago, and I’m still thinking about it. She’d had blood cancer. I referred her …

Young surgeons are learning robotic surgery in the shadows

Matt Beane, PhD

Physician

January 19, 2018

Artificial intelligence and robotics spell massive changes to the world of work. These technologies can automate new tasks, and we are making more of them, faster, better and cheaper than ever before.

Surgery was early to the robotics party: Over a third of U.S. hospitals have at least one surgical robot. Such robots have been in widespread use by a growing variety of surgical disciplines, including urology and …

The practice of emergency medicine is a team sport

Sandra Scott Simons, MD

Physician

January 18, 2018

“Same team!” bellowed all the frustrated parents from the sideline of a lacrosse game as we watched two teammates clash sticks while fighting to catch the same pass. Both players missed the ball, and the other team scooped it up and scored, perfectly illustrating to our kids what happens when they battle among themselves.

It’s easy to remind our kids that teammates shouldn’t fight, but it’s harder to remind each other …

A patient accused this doctor of sexual harassment

Thomas D. Guastavino, MD

Physician

January 17, 2018

It was a typical weekend on call. The usual number of surgeries, ER calls and consults. I was called to consult on 47-year-old female who had been admitted with four days of left shoulder pain. She had gone through a cardiac workup and was cleared by her internist. So now, a consult was called to see if there was an orthopedic cause for the patient’s pain — not an uncommon …

Top 10 lies doctors tell themselves

Pamela Wible, MD

Physician

January 16, 2018

Pamela Wible: Today I’m sitting here with Sydney Ashland, an expert in physician mental health, who has worked with doctors for decades helping them overcome negative thinking patterns. And we’re going to dive into the top 10 lies that physician’s tell themselves. The number one thing that I hear over and over again from doctors is, “I’m stuck in assembly line medicine.”

Sydney Ashland: Yes. I …

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Top 10 lies doctors tell themselves

A physician lurked on Facebook mom groups. Here’s what she found.

Audrey Nath, MD, PhD

Physician

January 9, 2018

In my off time, as a mom and a physician, I spend a decent amount of time lurking in a rather strange environment, even for the internet. A place so filled with anxiety, stories of ill-chosen spouses and little glimpses of unbridled joy, that you’d think you were somehow inside a taping of the Real Housewives of This-crying-baby-makes-me-hope-that-I-end-up-having-a-dissociative-fugue. You know, *that* place.

Online mommy groups on Facebook.

And, there I am, lurking …

15 minutes aren’t enough for a primary care visit

DrizzleMD

Physician

January 9, 2018

Have you bought a new memory foam mattress recently? Many come vacuumed in shrink bags. Once air gets in the bag, the mattress expands to its normal size. It is fascinating to watch how they expand.

It is not so fascinating to watch a patient expand to their actual size, when they are forcefully squeezed into an enclosed time space like an office …

Do physicians make the best politicians?

Anonymous

Physician

January 4, 2018

Even though we have probably 20 years of work remaining as physicians, like a lot of you, I like to think about how we will spend our retirement years. After all, in twenty years we will still only be in our early fifties, hopefully with no dependents and a lot of financial security. Of course, my wife and I are interested in traveling, spending time with grandchildren (hopefully), gardening and …

Plastic surgeon quits and couldn’t get a job at Chick-fil-A

Pamela Wible, MD

Physician

January 4, 2018

I just got off the phone with Paul, a highly-sought-after plastic surgeon in New York.

“I don’t want to be a doctor anymore,” Paul says. “What else can I do? I have lots of restaurant experience. I’ve worked in 15 restaurants during my life. It’s not easy, but I could do it. I did research on chains and franchises, and I chose Chick-fil-A. …

Why the social history is important

Maria Yang, MD

Physician

January 3, 2018

From the notes I read, it seems that other medical specialties limit “social history” to whether or not someone uses tobacco, drinks alcohol, or uses drugs.

“Social history” is meant to get a sense of the context in which people live. Where do they live? Who do they live with? How did they come to live there? Where did they grow up? What sort of work do they do? How much …

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Why the social history is important

Surgeon suicide-homicide: What happened to Dr. Chris Dawson?

Pamela Wible, MD

Physician

January 1, 2018

Sometimes there are no words. Not even a eulogy.

Then one courageous family writes this obituary. (This obituary was written by Rachel Dawson, his wife, with the blessing of his parents.) In it, they share how their son lost his battle with severe depression. How he adored his children. How he sacrificed fun, free time, and relaxation to receive his medical …

Safe pediatric dental anesthesia is the right of every child

Karen S. Sibert, MD

Physician

December 29, 2017

When you tell anyone in health care that “sedation” to the point of coma is given in dentists’ and oral surgeons’ offices every day, without a separate anesthesia professional present to give the medications and monitor the patient, the response often is disbelief.

“But they can’t do that,” I’ve been told more than once.

Yes, they can. Physicians are not allowed to do a procedure and provide sedation or general anesthesia at the …

The physician’s relationship with the beeper

Ben Gold, MD

Physician

December 29, 2017

If you’re thinking about a career in medicine, there’s a piece of technology you’ll come to know intimately. It’s small and sleek, with excellent battery life and remarkable durability. It’s not an iPhone; it’s not a Pixel. It’s a beeper. You will come to know, and to respect, this tiny black rectangular prism. It will govern your life. You will be at its mercy, yes, but it also offers you a chance at salvation. …

End the resident physician abuse now

Anonymous

Physician

December 21, 2017

Let’s talk about the cycle of abuse. No, I am not referring to the very serious issue of domestic violence. Instead, I am talking about the graduate medical education system. No one is a resident forever: the duration of each residency is predetermined with a wide range of three to nine years. The self-limited nature of this experience decreases the incentive for participants to advocate for changes. And the attitude …

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End the resident physician abuse now

Are post-apocalyptic disaster films inspiration for doctors?

Seiji Yamada, MD, MPH

Physician

December 20, 2017

What would medical education that is relevant for the here and now — for America in the early 21st century — address? It is impossible to teach the content relevant for an entire career. It is important to educate practitioners able to adapt to the changing landscape of medicine. We must consider what the future might hold.

Watching science fiction may serve to prompt future physicians to practice preventive medicine for …

A doctor saved a patient’s life. Twice.

Rob Lamberts, MD

Physician

December 18, 2017

I have good days and bad. Some days I am content, connected, focused, and motivated. On those days I enjoy my job, I enjoy the people I’m with, I am willing to be inconvenienced by interruptions.

On other days, not so much. I wake up as grumpy Rob and (despite multiple cups of coffee) the old codger doesn’t leave me alone. I keep score of all the ways in which life …

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A doctor saved a patient’s life. Twice.

The Good Doctor shows us the value of time

Suzanne Fiscella, PA-C

Physician

December 17, 2017

In a recent episode of the television series, The Good Doctor, a patient played as Robbie Ato does not tell his doctors he has a history of cancer. You can see his surgeons stare in disbelief as one consulting surgeon recognizes the patient’s name and then alerts the team leader that she treated him three years ago for cancer.

This is one of the very most troubling and dangerous acts of …

Getting it right: the challenge and reward of clinical diagnosis

Philip A. Masters, MD

Physician

December 17, 2017

A guest column by the American College of Physicians, exclusive to KevinMD.com.

It was actually a great diagnosis that led me to become an internist.

I distinctly recall a patient admitted to my service during my third-year internal medicine clerkship inpatient rotation. He was extremely sick and what was wrong with him had eluded multiple other …

The myth of multitasking in primary care

Hans Duvefelt, MD

Physician

December 15, 2017

Primary care doctors don’t usually have scheduled blocks of time to read incoming reports, refill prescriptions, answer messages or, what we are told the future will entail, manage their chronic disease populations. Instead, we are generally expected to do all those things “between patients.”

This involves doing a little bit of all those things in the invisible space between each fifteen-minute visit, provided we can complete those visits, their documentation and …

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