Should we write that patients are “pleasant” in medical notes?

Physician
May 17, 2019

When writing medical notes, some clinicians include an appreciation of their patient’s personality and disposition in their opening line (the “chief complaint”), or when they’re wrapping up (in the “assessment and plan”), or in both locations.

You know — it goes like this:

“CC:  Ms. Smith is a very pleasant 62-year-old woman admitted with …”

or:

“A/P:  To summarize, Mr. Jones is a delightful 89-year-old man presenting with …”

or:

“CC:  This lovely 74-year-old retired school teacher was in her usual state of health …

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The simplest and most important question to ask in the exam room

Conditions
May 16, 2019

It was the first time the young woman had come to the health center in a suburb just north of Chicago. When the 26 year old walked into the exam room back in 2008. There was no paper chart or electronic health record (EHR) accompanying her, no background information — nothing to indicate anything but a routine annual gynecological exam.

She and her husband were about to try to have their …

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The problem with burning health insurance down

Policy
May 16, 2019

Let’s burn health insurance down. Greedy corporate bastards should burn. Big Pharma and big hospitals should probably burn too. You know who else is really, really, bad? Wall Street. Let’s burn the banks. And let’s burn Big Tech and the entire Silicon Valley cartel. Let’s also burn Big Agribusiness that’s making us fat and sick. And let’s burn the Oil companies that are destroying the planet, and let’s burn the …

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How a Minnesota Supreme Court decision could affect curbside consults

Physician
May 16, 2019

“In a case that could have wide-reaching implications for medical practice in Minnesota, the Minnesota Supreme Court issued a ruling on April 17 in the case of Warren v. Dinter holding that the existence of a physician-patient relationship is not a prerequisite for a medical malpractice action. Rather, a person may sue a physician for malpractice – even if that person was not a patient of the physician – if the harm …

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Second victim syndrome: a doctor’s hidden struggle

Physician
May 15, 2019

As physicians, we have embraced a calling where we help others. A commitment many of us fully relish. We are grateful for our patients and the families who put their trust in us as we diagnose and treat their sometimes incredibly complex illnesses. I have been genuinely inspired by the stories I have heard from patients and my colleagues on the work we do.

Yet, in spite of the incredible advancements …

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The truth about Caribbean medical schools

Education
May 15, 2019

I graduated from St. George’s University School of Medicine in Grenada and now work as an emergency medicine physician at a trauma center in Northern California. To some, that may seem like an extreme jump or a rare success story. The stigma of a Caribbean medical school education is built on rumors — and they’ve run their course. Let’s address some.

1. Students only go to Caribbean medical schools if they …

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Treating a VIP benefactor of a hospital

Physician
May 13, 2019

My local hospital has been petitioning the local city zoning board for permission to build an on-site parking garage for years now.  The city zoning board is very strict about the height of buildings and has turned the requests down repeatedly.

This past fall, the hospital administration announced that it needed a capital partner to expand and stay solvent.  Most of the members of the hospital medical staff have absolutely no …

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Why would adult children disapprove of their parent’s happiness?

Physician
May 13, 2019

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Going through the process of diagnosis, treatment decision making, and often lengthy treatment without a partner can be challenging. While children, friends, and other family members are supportive, for the single individual, there is no one to talk to in the middle of the night when fear and doubt often surface. I often counsel people who have finished treatment for their …

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Physicians: Don’t let administration intimidate you

Physician
May 13, 2019

One of the things I am most grateful for, as a doctor who has worked in at least a dozen different hospitals over the last decade, is the broad range of experiences I’ve had and the variety of physicians I’ve met and gotten to know. I enjoy hearing experienced physicians’ perspectives on how the practice of medicine has changed from what it used to be in the 1970s to 1990s.

I …

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Questions about physician disability insurance answered

Finance
May 12, 2019

As resident physicians with a tight budget, one of the last things on our mind is paying for added insurance. Trust me; I get it. However, as a [future] high-income earners, long-term disability insurance is essential. It may not be at the top of our priority list, but it should be.

What is it and who needs it?

Unless you are already financially independent or were lucky enough to have a trust …

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The brutal emotional challenge of medical training

Physician
May 12, 2019

I can vividly remember the day the phone call came. My cousin screaming over the phone, trying to make out words but unable to speak, disbelief, horror, the fear in her voice palpable even though she was thousands of miles away. It was barely 5:30 a.m., I was frantically rushing out to beat traffic, hoping to get a head start on pre rounding since I was on call. Confused, I …

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Want to create a review course? Here’s how this physician did it.

Education
May 11, 2019

When I told my colleagues that I was going to try to create the first psychiatry review course at the University of Toronto, I received the same two responses: “It’s about time somebody did that!” and “What is wrong with you?” — sometimes from the same person!

The first reaction taps into the excellence of our department. With approximately 1000 faculty with diverse expertise and the largest residency program in Canada, …

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The systemic poverty in Navajo Nation is a national travesty

Physician
May 10, 2019

“I have the CPAP machine. I’ve had it for a year, but I don’t have electricity in my house. I stayed with my aunt who has electricity but things didn’t work out,” said the young Navajo man, his massive belly protruding out from underneath the tray table.

The old Navajo man with Parkinson’s disease, unable to walk fast enough to make it to the outhouse in time, had started taking anti-diarrheal …

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Should physicians lie when asked these questions?

Physician
May 10, 2019

Dear colleagues, I know you have seen these questions:

Do you currently have any physical or mental impairment that could limit your clinical practice?
Are you currently taking any medication?
Have you ever been hospitalized for any reason?
Have you ever been hospitalized for, or diagnosed with, a psychiatric disorder to include substance abuse?

Ugh! I hate, hate, HATE these questions! “It is none of their business,” or at least that is what I told …

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Avoid the stigma: money advice for young doctors

Finance
May 9, 2019

Whenever I discuss matters of money and business with medical students and residents, I‘m surprised by the responses: “Zilch, nothing,” or “Are you kidding?”  Sadly, our doctors-in-training still receive little to no education in this arena.

There’s a stigma surrounding physicians and money, based largely on fact, which has become a beacon for all sorts of disingenuous, exploitive people who view doctors as over-stuffed pinatas, belly-full of money, ready to be …

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Success in medicine does not equate to a successful life

Physician
May 9, 2019

I sat across the table from my physician client and listened to her story. She asks, “How can it be that after four years of medical school and three years of residency training in my chosen field, I feel so disillusioned and disconnected?”

Instead of seeing the excitement of starting a new chapter in her career or even acknowledging some trepidation about becoming an attending with the increasing pressures of this …

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How to manage narcissistic doctors

Physician
May 8, 2019

Anyone can exhibit narcissism or narcissistic personality traits or types from time to time in different forms from mild to severe. When doctors are under stress, they can “act out,” or their behavior can worsen. Greater awareness of damaging behaviors is therefore important. The more we recognize the traits in ourselves and others, the less likely they become a problem. However, unfairly labeling or stereotyping doctors as narcissists is to …

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What do organized crime and health care have in common?

Policy
May 8, 2019

During college and medical school, my summer employment acquainted me with members of organized crime families. Now, reflecting on my full career as a primary care clinician, geriatrician, and researcher on health care delivery improvement, I have discovered that several insights from organized crime could guide medical professionals’ responses to our country’s health care crisis.

Organized crime and the U.S. health care industry have more in common than might be immediately …

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The journey of being a parent in medical school

Education
May 7, 2019

One big life event for me was having my son Matthew during medical school. It has been a fulfilling and interesting journey.

I met my husband Andrew during college, and we were lucky to matriculate together at the University of Minnesota Medical School. I decided to do a dermatology research year between the third and fourth years of medical school, and Andrew did a neurology research year at the same time. …

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