The powerful phrase that’s ruining medicine

Physician
April 20, 2019

Within the clinics, hospital corridors, and halls of medicine, a new phrase has emerged and taken hold of the practice of medicine. Whenever confronted with the challenging, inconvenient, undesirable, underinsured or maybe when just overwhelmed, health care personnel have begun to utter the phrase “I’m not comfortable with …”

Upon the utterance, all responsibility to the patient, institution or the honorable practice of medicine is immediately and completely discharged until the …

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MKSAP: 39-year-old woman with fatigue, intermittent rectal bleeding, and abdominal pain

Conditions
April 20, 2019

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

A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or …

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What physicians should know about investing in real estate

Finance
April 19, 2019

As someone who can’t stop talking about passive income investments, I inevitably end up having a lot of conversations about investing in real estate.

I’ve heard countless stories of how real estate investing has helped people achieve their goals, but from those who don’t invest, I often hear this objection commonly voiced, “I don’t want to be called in the middle of the night to unclog a toilet.”

What I …

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8 things to watch for if you, or a family member, is hospitalized

Physician
April 18, 2019

Hospitals are busy, hectic, and unpredictable places. Professionals who work in health care are highly trained and competent individuals, and if you are receiving acute care in America — the standard of your treatment and access to high-quality tests and an array of specialists, is unparalleled (take it from someone who has worked in different countries). Nevertheless, the hospital experience itself, despite our best efforts, often falls short. Here are …

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What distinguishes good physicians from truly seasoned medical professionals?

Physician
April 17, 2019

One thing that gastroenterologists know about is stool. But, I’m not referring to that kind of stool in this post. Follow along.

When we do a colonoscopy, for example, we are relying upon stool, or more accurately a stool, as in a three-legged stool. This metaphor illustrates that the three legs must be equally strong or the stool will not stand. The three pillars of support that a colonoscopist needs include:

How physicians and administrators can get to a place of greater trust

Policy
April 16, 2019

Recently, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46 percent of survey respondents viewed …

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Was she a doctor? Or was she a hack?

Physician
April 14, 2019

Separating fact from fiction had once been her favorite activity. Going over research with a fine-toothed comb, she caught the inaccuracies that riddled popular culture like unruly strands of hair. It came down to this simple algorithm: there were things that could be proven and things that could not. In other words, there were things that would happen consistently given the same set of conditions, while other things were random. …

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MKSAP: 62-year-old woman with a sun allergy

Conditions
April 13, 2019

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

A 62-year-old woman is evaluated for a “sun allergy,” manifesting as a rash on her scalp, eyelids, upper back, and knuckles. This started 2 years ago, but is less pronounced over the winter months. Medical history is unremarkable. Her only medication is hydrocortisone cream.

On physical examination, vital signs are …

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A medical student grew up without health insurance. Here’s why that matters.

Education
April 12, 2019

I’m constantly awed by the fact that I get to be part of one of the best hospitals in the world, especially because as a kid, I grew up without health insurance.

These were the days before the Affordable Care Act; there was no penalty for going without health coverage. As a non-citizen, I was ineligible for Medicaid, and private health care was prohibitively expensive for my family. Fortunately, I was …

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These are the only 3 reasons to file a tax extension

Finance
April 12, 2019

There are only three valid reasons to file an extension on your taxes, which changes your required filing date from April 15th to October 15th. Unfortunately, I see many people who have filed an extension incorrectly or for the wrong reason that end up getting billed by the IRS for interest and penalties. There is no reason anyone should have to pay penalties for late tax filing since correctly filing for …

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Fleece pajama bottoms in the ER

Physician
April 12, 2019

Can someone please tell me the exact moment when fleece pajama bottoms became the fashion sensibility of America?

I can’t pinpoint the moment exactly, but several years ago I began to notice that many of our ER patients were presenting for treatment wearing nice fluffy fleece bottoms. Men. Women. Old. Young. These fleece bottoms seemed to be enjoyed by a variety of the population. Most of these earlier bottoms for the …

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Screening elderly men for prostate cancer: More harm than good?

Conditions
April 10, 2019

Most men diagnosed with prostate cancer don’t die of the disease. Between 2011 and 2015, 112.6 per 100,000 men per year were diagnosed with prostate cancer in the U.S., but only 19.5 per 100,000 men per year died of the disease over that same period of time. That is still far too many deaths. But the huge disparity between deaths and diagnoses arises in large part from overdiagnosis of prostate …

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How to study smarter for USMLE Step 1: 5 tips for success

Education
April 10, 2019

To reach my current position as a general cardiologist, I have taken nine board exams. I have also been teaching medical students for over ten years with several colleagues who write questions for the USMLE Step 1 exam. Through this experience, I have observed a number of themes about what works and does not work for board preparation. I share these with you now in the hopes they may help …

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Important new information in the tragic cases of child abuse

Conditions
April 9, 2019

Like many pediatric intensivists, I care from time to time for victims of child abuse in the form of what is often called “shaken baby syndrome.” This syndrome is a characteristic constellation of finds that happen when a strong person grasps a child around the chest and aggressively shakes the infant. It was first described by Caffey, a pediatric radiologist, fifty years ago. The baby may have …

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Work-life balance is hard. Here’s how this physician does it.

Physician
April 8, 2019

Work-life balance is hard, and that’s true for so many career options both in and out of the medical field. The topic is something that you consider as you choose a career path. It’s something that you struggle to achieve and maintain as you train for your job, and as I have found out over the past eight months, something that you have to invest energy into after finishing training …

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Innovative approaches to solve physician burnout

Physician
April 8, 2019

Health care organizations are moving to address clinician burnout with a real sense of urgency. It is now commonly accepted that burnout is widespread among health care professionals and has serious repercussions for patient safety and the quality of care. A report released by several major Massachusetts health care organizations labeled the situation “a public health crisis” and warned about the adverse impact “on the health and well-being …

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Bias when treating supporters of President Trump

Education
April 7, 2019

President Donald Trump held a rally near my medical school last week.

While sitting in a small conference room during a lecture the morning of the event, my professor chuckled while clutching his phone. He looked up and around at all of us, remarking that his friend had texted him about the Trump supporters waiting outside for the rally to start; the message read, “Jesus, the maggots are already here!” My …

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Should medical residents appear in reality TV shows?

Physician
April 6, 2019

This notice appeared on a general surgery news website in early February.

I don’t know who has been long anticipating this, but I’m pretty sure it’s not people on medical Twitter. My informal, nonscientific Twitter poll garnered 707 votes with 87 percent of those responding saying they would not allow their residents to participate in a reality television show.

Many of those who …

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