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Why this is an exciting time to work in psychiatry

Physician

July 27, 2014

Today, I celebrated mental health care. And this was after a morning of battling with insurance companies, patching together community care plans, trying to create an inpatient bed for a suicidal patient where none exist, and arguing with agencies for better patient support.

I work on a busy inpatient psychiatric unit that provides a daily reminder of the beauty, heartache, and pain that define living with mental illness. The diverse stories of …

Better care is mindfully listening to patients

Davis Liu, MD

Physician

July 27, 2014

“Dr. Liu, I don’t think he has diverticulitis.”

So said the second-year medical student. She had just completed her first year of anatomy, biochemistry, pathology, and introduction to doctoring at the local medical school. One of the sharpest medical students I’ve proctored.

Like many summers, I’ve been fortunate to spend time with the next generation of doctors. These future doctors were brimmed with enthusiasm and energy. Instead of taking time off to …

Choose your career: Should I be a nurse or a doctor?

Shirie Leng, MD

Medical Education

July 26, 2014

doctor v nurse

Having been both a nurse and a doctor, most of the questions I get from readers have to do with making the decision between nursing and medicine. Let’s lay aside for a moment the reality that the fields are totally different and that direct comparisons are useless.

But people ask me all the time, so, as a little experiment, I …

Suicide Med: A medical school thriller

Freida McFadden, MD

Medical Education

July 26, 2014

An excerpt from Suicide Med.

“I wish I had become a ballet dancer instead.”

I use the back of my forearm to swipe at strands of dark hair that have come loose from the tight bun at the back of my head. The attempt fails and the escaped locks fall back into my field of vision just as my glasses slide down the bridge of my nose. This …

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Suicide Med: A medical school thriller

Is higher cost health care perceived as being higher quality?

Brad Wright, PhD

Health Policy

July 26, 2014

Luxury goods are items that people purchase in disproportionately greater amounts as their income increases. That’s how economists think of them anyway. But for the average American, a luxury good means something else. We tend to think of luxury goods being things like designer clothing, luxury cars, and high-end restaurants. Our minds fill with images of Gucci, Burberry, and Luis Vuitton, or Mercedes-Benz, Porsche, and Ferrari.

One thing is clear to …

Can medical students lean in to psychiatry?

Jennifer Adaeze Anyaegbunam

Medical Education

July 26, 2014

I recently read an interesting article in Glamour about why Zosia Mamet, an actress on HBO’s Girls, refuses to “lean in.” While the column focuses on the influence of modern-day feminism on notions of professional success, her words resonated with me as a medical student and an aspiring psychiatrist.

“I have been incredibly blessed with success in my chosen career. I’ve worked my a** off and had the support and encouragement …

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Can medical students lean in to psychiatry?

Doctors still work while on vacation

Afshine Ash Emrani, MD

Physician

July 26, 2014

shutterstock_53296837

Last week, I took a 6-day vacation. Two days before and two days after, I put in a total of 32 unpaid hours of work which was cut short by a call from my daughter asking me why I am working during my time off. While away with my family, I ran into people of different walks of life and noted …

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Doctors still work while on vacation

MKSAP: 68-year-old woman with exertional leg discomfort

mksap

Conditions and Diseases

July 26, 2014

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

A 68-year-old woman is assessed for a 6-month history of progressive exertional leg discomfort, described as a “heaviness” involving both calves. The symptoms are relieved within 5 to 10 minutes of rest. She has noted the same limiting heaviness with bicycling. Medical history is significant for hypertension, type 2 diabetes mellitus, and …

America’s need for a diverse generation of family physicians

Kenneth Lin, MD

Medical Education

July 25, 2014

Since joining my current practice two years ago, I’ve noticed that I care for a disproportionate number of immigrants of Chinese and other Asian descent compared to my colleagues. Although both of my parents were born in Taiwan, I don’t speak Mandarin or have special expertise on medical conditions common in Asian Americans. Nonetheless, Asian patients seem more comfortable with me anyway. Similarly, U.S. health workforce analyses show that underrepresented …

The secret lives of doctors

Starla Fitch, MD

Physician

July 25, 2014

Recently, when my parents came for a visit, our conversations led me to realize something important: I have been a doctor for more than 20 years, and yet my parents have no idea what my daily life is like. It then occurred to me that if they have no idea, then surely my patients have no idea either.

So, if you’re a …

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The secret lives of doctors

Dear patient: Your 5-minute appointment is awaiting you.

Susan Hecker, MD

Physician

July 25, 2014

Dear patient:

I am writing to inform you of some recent changes to my practice. These changes have been implemented to improve the quality of your care.

I will no longer be able to see you for a 20-minute or 40-minute appointment. These will instead be shortened to a 10-minute or 20 minute-appointment based on your stated needs. For example, if you just …

Do patients choose Medicare Advantage for convenience?

David Mokotoff, MD

Health Policy

July 25, 2014

Having just retired on July 1st, my medical group’s commercial health insurance policy is no longer available to me. However, being past 65, I started a year ago applying for Medicare benefits. Despite my knowledge in this field, I had assumed this would be a snap.

I also had assumed that my Medicare patients who enrolled in a Medicare HMO (Medicare Advantage) did so for purely economic reasons. My experience has …

Incorporate empathy in patient interactions

Edward Leigh

Patient

July 25, 2014

A popular television commercial shows a group of older women playing cards. One woman talks about her friend who is struggling financially since her husband died (the husband only had a small life insurance policy). Another lady said that she doesn’t have to worry about that happening since her husband has an XYZ insurance policy. The other ladies immediately ask about the policy. Then a TV pitchman describes the policy …

Sometimes there is no substitute for a face to face visit with a doctor

Michael Kirsch, MD

Physician

July 24, 2014

A 32-year-old woman recently came to see me for an opinion on stomach pain. Why would I refuse to see her again? Abdominal pain is an everyday occurrence for a gastroenterologist. She was accompanied by her mother. I had never met this woman previously.

She had suffered abdominal pains for as long as she could remember. She recalled frequent visits with the school nurse when she was a young girl.

She has abdominal distress …

Don’t turn primary care into General Motors

Hans Duvefelt, MD

Health Policy

July 24, 2014

When Uncle Will needed a hip replacement, he chose an orthopedic surgeon, Jason Brockman, and Mountain Memorial Hospital because of their excellent reputations for low complication rates and satisfied patients. The process reminded him of when he bought his first brand new truck.

Norm and Clara Anderson chose Dr. Wheeler as their family doctor once they had made the decision to relocate to Maine and raise their family away from the …

Wildly differing prices for the exact same medical service

Jay Warner

Patient

July 24, 2014

Before losing my health insurance in 2009, it never occurred to me to be concerned about a little thing like a blood test. Since 1986 I’d been having three vials of blood drawn each year during my physical. My doctor would authorize it, the nurse would draw the blood in the office and send it to the lab for processing.

A few days later she would call me with the results …

3 ways to master the art of teaming in medicine

Della M. Lin, MD

Physician

July 24, 2014

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

As a physician anesthesiologist in a community hospital setting for more than 25 years, the quest for mastery keeps my practice from getting stale or boring. I relish the technological innovations in the past decade: the video laryngoscopes and ultrasound-guided nerve blocks that allow …

Moving annual visits into the 21st century

Yul Ejnes, MD

Physician

July 24, 2014

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

The recent uproar over the American College of Physicians’ recommendation against routine pelvic examinations made me think about the status of the annual visit (a.k.a. yearly physical, annual exam) on average risk, asymptomatic adults that most internal medicine specialists perform. Some would say that …

Balancing activity and restfulness in retirement

John Schumann, MD

Physician

July 23, 2014

As a doctor, I’m trained to do many things: I listen. I ask. I examine, order, and test. And then I assess. I certainly try to treat. All too often, this includes prescribing.

What frequently gets obscured in this paradigm is that, on many occasions, the listening part is enough.

Take Gene, for instance. He’s a retired biochemist. When I met him for the first time as a patient, I took a …