MKSAP: 25-year-old woman with chest pain after a motor vehicle accident

Conditions
August 17, 2019

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

A 25-year-old woman is evaluated in the emergency department for chest pain after a belted motor vehicle accident. She is pregnant at approximately 23 weeks’ gestation. She reports no additional symptoms and is otherwise well. Her only medication is a prenatal vitamin.

On physical examination, the patient is afebrile, blood …

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I’m a jail physician. Here’s what likely happened to Jeffrey Epstein.

Physician
August 16, 2019

Jeffrey Epstein’s apparent suicide while in custody at a Manhattan detention facility has focused intense media scrutiny into jail suicide prevention procedures. Suicide is the biggest cause of death in jails in the U.S. — by far. Because of this, all jails (including the facility where Epstein was housed) have a suicide prevention policy. Since the process was an epic …

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Clinical performance data: a physician’s friend or foe?

Physician
August 16, 2019

According to a recent Harvard report, physician burnout is “a public health crisis that urgently demands action.”

Half of all doctors report troubling symptoms: depression, exhaustion, dissatisfaction, and a sense of failure. These physicians are twice as likely to commit a serious medical error, research finds. Experts predict that if left unaddressed, burnout will further erode the mental health of doctors and radically undermine …

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New doctors are prioritizing the wrong things

Physician
August 16, 2019

Every year, there’s this rite of passage, the passing of the baton, as our graduating senior residents move on to fellowships, or into spots as hospitalists, or to practice jobs here in New York City or other cities, and a fresh new group of newly-minted physicians arrives ready to take up the gauntlet of training as Internal Medicine doctors under our …

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The deadly silence of physician depression and suicide

Physician
August 15, 2019

“It is high time for us to recognize that the physicians who spend so much of their lives caring for us are often suffering in silence, and effective interventions would be good medicine for all of us.”
– Joan M. Anzia, MD

On February 4, 2007, I attempted to take my own life.

It was Super Bowl Sunday, and the Colts were playing the Bears. My wife Charlene and I were home, and …

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ER staff deserve a safe place to do their jobs

Physician
August 14, 2019

Many years ago, it was called the emergency room. Now we call it the emergency department. However, unlike so many departments in the world, the emergency department has almost too many purposes, duties, and mandates to number.

However, in the process of being the under-funded safety net for American health care, it has also become a place of remarkable danger where medical and nursing staff, support personnel and even patients face …

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Should USMLE Step 1 be pass-fail?

Education
August 14, 2019

On March 11th and 12th, representatives from the NBME, AMA, AAMC, Federation of State Medical Boards and the Educational Commission for Foreign Medical Graduates gathered in Philadelphia for InCUS — the Invitational Conference on USMLE Scoring — to discuss potential changes regarding how Step 1 is scored. InCUS came about as a result of a wave of student frustrations over the pressure from the increasing importance of this exam in …

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The questions surgeons need to ask their seniors before surgery

Conditions
August 13, 2019

The decision seemed straightforward. Bob McHenry’s heart was failing, and doctors recommended two high-risk surgeries to restore blood flow. Without the procedures, McHenry, 82, would die.

The surgeon at a Boston teaching hospital ticked off the possible complications. Karen McHenry, the patient’s daughter, remembers feeling there was no choice but to say “go ahead.”

It’s a scene she’s replayed in her mind hundreds of times since, with regret.

On the operating table, Bob …

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How to save money when moving for residency

Finance
August 13, 2019

Here are some specific ways for medical trainees to save on their move.

Timing is everything

When is the exact timing of your move? Are you flexible? Think about your situation: you graduate medical school, pack up, and then move for residency. Right?

Most moving companies are busiest (read: most expensive) between May and September when they know you are likely to move. With Match Day in mid-to-late March, getting an early start …

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The doctor trap: What it is and how to escape it

Physician
August 12, 2019

There is a trap used to capture monkeys that uses a tree with a hollowed-out trunk. The opening is just large enough for the monkey to put its hand inside. While the monkey can easily pull its empty hand out at any time, inside the hole is a larger space containing delicious nuts that the monkey craves. When the monkey grabs a large handful of nuts, it is unable to …

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Becoming a doctor in India can be life-threatening

Education
August 12, 2019

Recently, my niece gingerly confided that she was going to study engineering rather than medicine. I was certain she’d become a doctor – so deep was her love for biology and her deference to our family tradition. But she calculated, as would anyone with common sense, that with an engineering degree and an MBA, she’d be working for a multinational company making a comfortable income by twenty-eight. If she stuck …

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Doctors: Step boldly into your calling

Physician
August 12, 2019

We often associate our calling with our career. That’s what I did from the very moment I decided to become a doctor. That’s all I focused on. I studied for it. I invested time and money into it. Like many doctors, my identity was intimately woven into what it means to be a doctor. It’s who I became to the exclusion of everything else.

From the outside looking in, I was …

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Stop nickel and diming doctors

Physician
August 11, 2019

So, who doesn’t want a better health care system?

We are barraged with stories in the medical literature and in the public press about the terrible state of our health care system, what poor outcomes we have, the inefficiencies in care, complaints about the electronic medical record, inflated costs, lives ruined by medical bankruptcy, and massive social inequities in terms of access …

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A doctor survived a day without a computer. Here’s how he did it.

Physician
August 9, 2019

It wasn’t even nine o’clock when the screen on my laptop suddenly froze. From that moment until my last patient left the building, my clinic had no internet.

For my part, the day went pretty smoothly, mostly because of some of my own work habits. It also helped that it was a warm, sunny day, and my schedule was on the light side. Others have frowned at my old-fashioned work habits, …

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Why doctors make bad patients

Physician
August 8, 2019

I’m a doctor. And, like most medical professionals, I’m a bad patient.

Two years after my last appointment, I got a CTJ, “Come to Jesus” from my doctor.

I called his office for a form. I needed proof that I don’t have tertiary syphilis. For my Thai visa.

Why tertiary syphilis, as opposed to HIV, cholera, lepers or bubonic plague? I don’t know. That’s the power of bureaucracies. They don’t have to make sense. …

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Elon Musk’s girlfriend had eye surgery for depression. Is there science behind that?

Conditions
August 7, 2019

Claire Elise Boucher, 31, known professionally as Grimes, is a Canadian singer, songwriter, record producer, and visual artist. Her music incorporates elements of varied styles, including dream pop, R&B, electronic music, and hip hop. Since 2018, Boucher has been in a relationship with technology entrepreneur Elon Musk.

Grimes recently became the star of a new Adidas advertising campaign. In announcing this new …

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Pro tips for residency or fellowship relocation

Finance
August 7, 2019

Each spring, thousands of students and residents will relocate for their next career stages facing the same question: How am I supposed to move my stuff? The answer is varied and can be surprisingly complex.

Relocation is part of any industry, but medical trainees, in particular, relocate during a narrow time frame often without any employer reimbursement.

How does your move fit in with other major life events such as a wedding …

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How to make $5 million from investing in real estate

Finance
August 6, 2019

When I first started working on this blog post, the working title was “Different Ways to Make $1 Million in Real Estate.”

However, I realized that if you’re reading this, you’re likely looking for a similar type of life that I’m interested in: a life of financial freedom where I’m also able to make huge contributions to society as well.

Unfortunately, $1 million may not be enough these days to make that …

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White coats should no longer be worn by physicians

Physician
August 6, 2019

Did you know that the traditional doctor’s white coat that you probably associate with your physician actually was a look that doctors “borrowed” from another profession? Back in the early days of doctoring, to add some perceived legitimacy to the title physician, the white coat look was adopted from our colleagues in the hard sciences who did actual experiments in the lab. If you recall, what we doctors call a “white …

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Who are the best educators for medical students?

Education
August 6, 2019

I shared my assessment and plan with the preceptor as she walked into the room. She cut me off, “You think this patient needs surgery?” she smirked. “He has no idea what he is talking about, don’t mind him,” she whispered loudly to the patient. I kept quiet until the patient left, and my preceptor began writing her note. I pulled up a recent research article I had found prior …

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