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What’s the best way to evaluate surgery residents?

Physician
March 12, 2016

It comes as no shock to me, and probably many other current and former program directors, that a recent study showed faculty overall performance evaluations of residents do not correlate with their scores on the yearly American Board of Surgery in Training Examination.

According to the JAMA Surgery paper, faculty evaluations encompassed technical skill and the six core competencies — medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning …

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What’s the best way to evaluate surgery residents?

Women may experience more pain than men, but receive less treatment for it

Physician
March 12, 2016

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

That men and women are different has been discussed since Adam and Eve. That they experience and cope with pain differently has been consistently described in research studies.

It is concerning, however, to learn that women may experience more pain than men, but receive …

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Women may experience more pain than men, but receive less treatment for it

How to do a no hands-on physical in 3 minutes (or less)

Physician
March 12, 2016

Pamela-Wible-Big-Box-Medicine2

Step 1: Greet patient.

Step 2: While chatting, check all boxes in electronic medical record for a complete review of systems and physical exam. Copy and paste parts of previous chart note while looking at patient every once in a while. Smile if possible.

Step 3: Tell patient to do yoga.

Step 4: Bill insurance company for complete physical exam.

Welcome to big box assembly line medicine.

Ever wonder what …

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How to do a no hands-on physical in 3 minutes (or less)

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MKSAP: 55-year-old man with hepatitis C virus (HCV)

Conditions and Diseases
March 12, 2016

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

A 55-year-old man is evaluated in follow-up after a recent routine screening for antibody to hepatitis C virus (HCV) was positive. His medical history is unremarkable; he has not used illicit drugs or had any history of blood transfusions. He currently feels well and takes no medications.

Vital signs and physical examination are normal.

Laboratory studies reveal …

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MKSAP: 55-year-old man with hepatitis C virus (HCV)

Wait lists at the VA may be a sign of things to come

Health Policy
March 11, 2016

Last year, several scandals unfolded involving the Veterans Health Administration. Close to home, the Fort Collins VA hospital falsified its wait times for clinic appointments. To meet the VA goal of clinic appointments within 14 days, the hospital instructed its clerks to “cook the books,” falsifying appointment records to give the illusion that the vets were being seen in a timely manner.

Farther away in Phoenix, the local VA hospital had …

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Wait lists at the VA may be a sign of things to come

Two powerful words that more doctors should use

Physician
March 11, 2016

Sticks and stones may break my bones but two words — thank you — will not hurt you but will certainly help you.

We, myself included, are often so busy and always in a hurry rushing from one task to another that we often forget common courtesies.  I believe that we can accomplish so much more with our patients, our staff, and even in our personal lives by not forgetting to …

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Two powerful words that more doctors should use

This doctor quit medicine. It saved her life.

Physician
March 11, 2016

I quit medicine. I was five months out of residency, and I was leaving medicine. I had dedicated my heart, soul, several years of my life along with weekends, holidays, special events, and my children’s first words to this honorable profession. Medicine was never suppose to “just be” my job. It was suppose to be my calling, and it had betrayed me.

I was finally a full fledged physician, and I …

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This doctor quit medicine. It saved her life.

From burnout to balance: How this medical student did it

Medical Education
March 11, 2016

I burned out for the first time in my life about three months after starting medical school. The surprising thing was that nothing out of the ordinary happened, I was doing exactly what they told me to do, pre-reading from lecture notes and recommended textbooks, going to lectures and labs, and trying to study and review what I learned that day in the library.

The problem was, that after a 45-minute …

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From burnout to balance: How this medical student did it

EMRs displaces medicine’s art. Here’s why that matters.

Health Technology
March 10, 2016

I know a wise old forester. Ask him any question and he’ll answer, “Well, now, it depends on what you want.”

“Should we clear this underbrush or just leave it?” It depends on what you want.

I realize this can explain any choice we’ve made: that is, we have what we have because, at some level, that’s what we want. In that light, let me discuss electronic medical records.

EMRs can be wonderfully …

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EMRs displaces medicine’s art. Here’s why that matters.

A gastroenterologist shares practical advice on probiotics

Medications
March 10, 2016

The microbiome is among the hottest topics in medical and scientific research. The National Institutes of Health and private foundations have invested hundreds of millions of dollars in research to define and characterize the human microbiome. In the next decade, billions more will be devoted to deciphering how microbes influence human health in a positive manner. The White House even issued a national call to action for …

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A gastroenterologist shares practical advice on probiotics

Why I joined the battle as a physician

Medical Education
March 10, 2016

“… slipped the surly bonds of earth to touch the face of God.”

This quote, borrowed in part from poet and pilot John Gillespie McGee, Jr., was used by President Ronald Reagan to honor the seven astronauts killed in the Challenger shuttle explosion. I was in the 6th grade when I first heard this phrase. In a tiny schoolroom in remote West Texas, President Reagan’s speech was broadcast and replayed over the …

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Why I joined the battle as a physician

What you don’t know about anal sex. A gastroenterologist explains.

Conditions and Diseases
March 10, 2016

Although it is still early, 2016 is already shaping up to be a year to remember in science: Long-postulated gravitational waves were finally discovered, the CDC scrambles to battle Zika virus on multiple continents, and long-awaited clinical testing begins for a new HIV vaccine.

Editor’s note (2026): The HIV vaccine regimen tested in the HIV Vaccine Trials Network’s HVTN 100 study moved on to a larger …

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What you don’t know about anal sex. A gastroenterologist explains.

Should the USPSTF include specialists?

Conditions and Diseases
March 9, 2016

The United States Preventive Services Task Force (USPSTF) was created by the federal government in 1984 to provide recommendations to primary care practitioners on the scientific efficacy of screening. In 2010, the federal government linked USPSTF recommendations with national healthcare policy when the Affordable Care Act mandated free coverage by Medicare and private insurance for all screening exams that receive a USPSTF recommendation of A or B.  …

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Should the USPSTF include specialists?

I’m an emergency doctor and I’ve become human

Physician
March 9, 2016

We walk down the halls, time and time again, each encounter a new discovery, mystery, or typical presentation.  As ED providers, we see new faces, entwined with “frequent flyers” that have become in a weird way part of the family.  Our job is often loosely entangled with our identity and existence.  It becomes hard to have dinner conversations without discussing therapies, changes in health care, Obamacare, or “unusual cases.”  We …

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I’m an emergency doctor and I’ve become human

How palm reading helps this physician today

Physician
March 9, 2016

I grew up in a house of spirituality, homeopathy, palmistry, astrology, art, and science alike. My father, with a masters degree in statistics, is a computer systems architect. He also fancies himself an amateur palm reader. The irritation with which I reluctantly used to give my hands over to my father, before the SATs, college decisions, medical school admissions, and my residency match results was real, but I was always …

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How palm reading helps this physician today

Should doctors marry doctors? Here are the challenges they face.

Physician
March 9, 2016

Fifty years ago, it was very uncommon to find doctors married to other doctors. Why? To answer that question, we need to explore the sociology of the time. Fewer women went to college, which meant fewer female doctors. Many couples married early, right out of high school or right after college. If the wife had career aspirations herself, these were often put aside in order to help her husband get …

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Should doctors marry doctors? Here are the challenges they face.

The heartbreak of dating an exhausted medical resident

Physician
March 8, 2016

When I was finishing my fifth year of studies as clinical psychology doctoral student, I fell in love with a second-year medical resident; a wanderer at heart with the softest smile and a way of listening that made me feel like the whole world stopped when I spoke. Whenever possible, we found ourselves in the forest exploring the world on foot or, if the weather was bad, on long drives …

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The heartbreak of dating an exhausted medical resident

Time macho: Why I’m part of the problem

Medical Education
March 8, 2016

It was a concept intimately familiar to me long before anyone gave it a name. From my earliest days in college, I felt surrounded by people who packed their days with meetings, activities, sports practices or competitions; classes, study groups, and research; for whom every moment had been spoken for and each day didn’t so much end as spill over into the next. The standard was clear: to do any …

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Time macho: Why I’m part of the problem

The problem with cultural competency in medical education

Medical Education
March 8, 2016

“Let’s say a Chinese patient comes into labor and delivery … simply logs onto the CultureVision website. Next, click on the Chinese section and finally click ‘Labor, Birth and Aftercare.’ Just that quickly you have the information you are looking for.”

CultureVision boasts that it is the “first comprehensive, user-friendly database that gives health care professionals access to culturally competent care.” The website’s automatic slideshow, entitled “Did you Know?” shifts between messages such as: …

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The problem with cultural competency in medical education

How a young doctor treats young patients

Physician
March 8, 2016

On a typical day in a major hospital, patients pass through the emergency room with different ailments. Some of them are coming in to check out minor aches and pains, and others are coming in barely responsive with a life-threatening condition. Outside of the pediatric ward, all of the patients coming in are adults, and the majority of them are advanced in years, showing signs of chronic conditions taking effect …

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How a young doctor treats young patients

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