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A health economist acknowledges how financing experiments failed our health system

Policy

August 16, 2022

I read a superb commentary in STAT, “Value-based payment has produced little value. It needs a time-out,” that reviews the failures of “value-based care” and the failure of its promoters to acknowledge those failures. Ideas conceived, tested and found lacking, and used as the basis for more of the same. Distracting from real health system reform.

So I thought, wouldn’t it be terrific if the originators of flawed health …

A medical student’s advocacy journey [PODCAST]

The Podcast by KevinMD

Podcast

August 15, 2022

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“As I looked across the boxes on my screen, I saw the gleaming faces of my peers. Just as it did then, and as it has for countless of my peers since, involvement in the Student Osteopathic …

How every doctor should address a patient’s pain

Ton La, Jr., MD, JD

Conditions

August 15, 2022

From medical school to residency, I’ve worked with colleagues who don’t prescribe pain medications for their patients who truly need them. Or they are just very hesitant about doing so. Some simply don’t believe in them. Others fear the legal implications like being named to a med mal or wrongful death lawsuit. And several avoid pain meds, specifically opioids, like the plague because of possible addiction risk even when their …

Academic medicine on life support: a letter to a newly appointed CEO of a leading academic medical institution

Anonymous

Physician

August 15, 2022

Congratulations on our leading academic medical institution (LAMI) yet again making it to the top ten list of the U.S. News & World Report!

You have taken the reins in perilous times (globally and domestically), and what you do and what you stand for will determine if this great hospital will not just survive but survive with its brand and reputation intact. Getting hired as a physician who grew up in …

Trauma and burnout among frontline health care workers

Naheed Ali, MD, PhD

Physician

August 15, 2022

Thinking back to 2020, concerning the emergence of COVID-19 and the first hard lockdowns all over the world. Individuals from all walks of life were frightened, locking themselves in their homes for fear of being infected. Yet, frontline providers and health care workers had to carry on with their daily jobs. Were they less scared than the nonmedical layman or immune to the virus? Unfortunately, they weren’t. They were just …

Are you ready to hear the truths about perfectionism? [PODCAST]

The Podcast by KevinMD

Podcast

August 14, 2022

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“Are you a perfectionist?

Did you know that perfectionists are actually some of the biggest procrastinators? Yes, really.

In theory, perfectionism sounds like a good thing. Who doesn’t want to do and be their best? It can even seem …

How doctors can regain control of their software

Drea Burbank, MD

Physician

August 14, 2022

I spent a year as a UCSF postdoc with the leaked tobacco documents. And this article is taken directly from the tobacco-control playbook. In the tobacco wars, we learned that: when a disease is caused by a for-profit industry, the only successful approach is regulation first, followed by treatment.

Here is exactly how and why doctors should regulate EHR and regain control of their cognitive …

I didn’t know her name until it was over

Sid Schwab, MD

Physician

August 14, 2022

I didn’t know her name until it was over, much too late. What I knew was she was thirteen and that on this winter day, someone in her family had been pulling her behind their car on a sled. No doubt laughing and looking in the rear-view mirror, the person driving had whipsawed around a corner, and the young girl — probably screaming (fear? delight?) — held onto the sled …

A pervasive culture of time constraints in health care

Hannah T. Todd, PT, DPT

Conditions

August 14, 2022

Picture this. A patient in a hospital or rehab facility has just finished exercising with therapy. He is thirsty, and he thinks he might as well ask for a snack now because he will be hungry in 30 minutes. His therapist sets him up in his wheelchair (brakes locked), tray table with all necessities positioned in front of him, with his call bell within reach. As she approaches the door …

Preserving humanity in the ICU [PODCAST]

The Podcast by KevinMD

Podcast

August 13, 2022

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“Five days before this story begins, where everything is upside down, and the end is the beginning.

Me, standing in my PICU, slowly approaching that cradle, then removing the medication, one by one, turning off the syringe pumps. …

Our Shakespearean love affair with BMI

Karla Lester, MD

Conditions

August 13, 2022

I’m standing outside the exam room, reviewing Marcus, my 16-year-old patient’s growth chart, specifically his BMI. It’s up again, and my heart sinks. I feel that all too common rush of frustration and disappointment and, “Why am I here and what is the point?”

“Am I just here to document weight gain in my patients?”

Marcus has been coming to my pediatric weight management clinic for over two years and has high …

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Our Shakespearean love affair with BMI

Breast implant illness: It’s not all in your head

Tara DeArmond

Conditions

August 13, 2022

“It’s just part of getting older.”

“Welcome to being a woman.”

“I hear this all the time from women. You just need to learn to deal with it.”

“Here’s a pill. See you in six months.”

“I have run all the labs I can think of. They are all normal. There’s nothing wrong. I’m sure it’s just stress.”

“It’s probably in your head.”

“There’s nothing I can do for you.”

Every doctor visit was the same. Each …

My high school was harder than my first year of medical school

Leonard Wang

Education

August 13, 2022

I am a second-year medical student at the University of Texas Medical Branch (UTMB) in Galveston, Texas. In 2018, I graduated from Westwood High School in Austin, Texas. My experience at Westwood was harder than my first year of medical school at UTMB. I wrote this piece to provide some context to students like myself who struggled or are struggling with public school in Texas.

When I was 17 years old, …

What a lifetime of gaslighting by other doctors feels like [PODCAST]

The Podcast by KevinMD

Podcast

August 12, 2022

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“Ehlers-Danlos syndrome patients take an average of 10 years to be diagnosed.

In that time, the pain from microtrauma and joint instability can become unbearable. “Just exercising more” can backfire, causing injury and disability and creating a cycle of added …

Misaligned expectations lead to conflict, burnout, and disillusioned physician leaders

Amanda Brisebois, MD

Physician

August 12, 2022

Would you expect the chef at a restaurant to be told that they are not only required to prepare the food in the kitchen but also deliver it to each of the tables and manage the billing? What about sorting out the restaurant’s finances or understanding the number of patrons that need to flow through per night to optimize income? If this sounds unreasonable, how did we end up asking …

When can physicians start spending money?

Andrew M. Ramsey, MD, MPH

Finance

August 12, 2022

You may never have created a budget. Not everyone does. For many of us in medicine, our saving so completely dwarfs our spending that we’ve never needed to use a budget. We just wing it. Why do some physicians spend so little?

Spending money is hard for many people, including physicians. After years of frugality in education and training, then funneling money into investments, planning for the future, building life for …

When a hospital unexpectedly closes

Marie Myung-Ok Lee

Conditions

August 12, 2022

An excerpt from The Evening Hero.

This was apparently not to be a Yungman-only meeting. It was in their conference room, same one where had their monthly morbidity and mortality conferences, and it was packed with doctors. In fact, there was just one chair open, and Yungmans best friend Ken the …

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When a hospital unexpectedly closes

A caregiver’s love story [PODCAST]

The Podcast by KevinMD

Podcast

August 11, 2022

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“Dying and introspection happening at the same time were a dual reality that I found impossible to ignore when Bill was not doing well. As Bill’s poor prognosis and impending death began to reflect on our life, …

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A caregiver’s love story [PODCAST]

5 things I would never do as an allergy and immune system expert

Kara Wada, MD

Conditions

August 11, 2022

Jumping on the recent TikTok trend of medical professionals sharing the things they would never do given their knowledge and expertise, I am sharing the five things I would never do as a board-certified allergist-immunologist.

1. I would never rely on a Primatene mist inhaler to treat my asthma or breathing symptoms alone. Primatene mist is a controversial over-the-counter epinephrine inhaler that can be used for mild intermittent asthma. This inhaler …

Breaking the vicious cycle of medical malpractice lawsuits

Howard Smith, MD

Physician

August 11, 2022

Lawsuits are conventional in medical practice.

An unhappy patient hires a malpractice attorney, who hires a medical expert, who interprets the standards of care and generalizes a departure from the standards of care and proximate cause. The preponderance of evidence is 50% certainty plus an ill-defined scintilla, which needs to be only 0.01% to be good enough.

The lawyer sues the doctor, who notifies the malpractice carrier, hires a defense counsel, and …