MKSAP: 63-year-old woman after right hemicolectomy for colon cancer

Conditions
June 15, 2019

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

A 63-year-old woman is evaluated at a follow-up appointment after undergoing right hemicolectomy for colon cancer 1 year earlier. Her paternal grandfather had colon cancer diagnosed at age 75 years. She reports that she has been feeling well and takes no medication.

All physical examination findings, including vital signs, are …

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A trauma surgeon reflects on the Yale System, 20 years later

Education
June 14, 2019

The best lens for reflection is to be immersed in the places and people that spawned those memories. Why else would reunions matter? Twenty years after we graduated the Yale School of Medicine, I found myself on campus embracing my classmates again. But it didn’t take long before I felt something creeping up behind the celebratory mood. Amid storytelling and laughter, I couldn’t help reflecting on some of the more …

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The ethics behind the world’s most expensive medication

Meds
June 14, 2019

With the recent FDA approval, Zolgensma became the world’s most expensive medication. Priced at $2.125 million per patient, the one-dose gene therapy is a potential life-saver for children with spinal muscular atrophy (SMA). Now, the treatment is at the center of an intensifying debate over the rising price of medications.

Industry watchdogs are outraged. They say Zolgensma is merely the …

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How failing Step 1 helped me pass the boards. Twice.

Physician
June 13, 2019

I remember the day well. The dean of my medical school called me directly. As soon as she announced herself on the other end of the line, I knew it was bad news. Deans don’t tend to make social calls, and I was right. She was calling to tell me that I had failed the USMLE Step 1, the first in a long series of standardized national exams to complete …

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OB/GYNs are getting old and tired. Who’s going to be left to deliver your children?  

Physician
June 13, 2019

I’m a 46-year-old OB/GYN. I’ve been on call at least as often as every fourth night for my entire career.

Let that sink in for a minute.

How many people get up and answer phone calls, remove ectopic pregnancies, deliver babies, and do C-sections every fourth night for an entire career?  Probably not many.

It’s 4:15 a.m. I just got a call from the hospital about a patient of mine who is term, …

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My caffeine-free residency

Physician
June 12, 2019

A kind resident or attending asks me, “I’m going for a coffee run. Can I get you anything?” I politely decline. “You sure?” “Yeah, I’m actually doing a caffeine-free residency.” A mix of utter disbelief and disgust crosses their faces, probably yours too. With skepticism, people ask: “Why?” I actually hate the taste of coffee. (That is absurd in Seattle, where I’m doing my residency training.) Whenever I try a …

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Speaking out about practicing medicine in Ethiopia

Physician
June 11, 2019

I am a young physician practicing medicine in the “motherland” of God-gifted Ethiopia, which is located in eastern Africa, south of the Sahara Desert. I want to share my personal story, as well as to expose some of the serious problems facing physicians and patients in my country.

I started medical school, which requires the highest academic performance of any career path when I was 18 after completing secondary school. Despite …

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To struggling medical students: Meet the physician who conquered the “no’s”

Education
June 11, 2019

I know what kinds of things I’m supposed to tell you. I know that your other would be advisors will usually stick to the same basic messages: “Keep reaching for your dreams” or “your hard work is all worth it in the end” or “your education will lay the world at your feet.” These platitudes are all well and good, but honestly, they’re forgettable. And pretty words don’t always translate …

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Bottle-feeding grandmothers vs. breastfeeding daughters: advice from a pediatrician

Conditions
June 10, 2019

Recently, a friend’s mother asked me how to best support her daughter’s decision to breastfeed her first grandchild.  The new grandmother questioned her ability to encourage her daughter’s decision because she had not breastfed her own child, and this lack of experience made her feel unqualified to provide support.  With mixed emotions and a lingering sense of guilt, this new grandmother wanted to learn, from a pediatrician friend, how best …

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If you won the lottery, would you quit being a doctor?

Physician
June 10, 2019

On October 23, 2018, the Mega Millions lottery jackpot was 1.6 billion dollars, making it one of the largest lottery jackpots in history.

The hospital was abuzz with chatter in the week leading up to the drawing. Discussions about the possibility of becoming an instant billionaire were just too good to resist.

During that week, I found myself sitting at the nurse’s station in one of the ICUs at midnight. A nurse …

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The inspiring story of a female orthopaedic surgeon

Physician
June 10, 2019

As a female orthopaedic surgeon, I am often asked how I ended up in this field. Although seeing women in orthopaedic surgery is becoming more common, we are still makeup only 6 percent of the orthopaedic surgeons in the U.S.

I actually had no idea what orthopedic surgery was before medical school. In fact, I started medical school thinking I would be an internist, but it really didn’t take me very …

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9 things I learned when purchasing disability insurance

Finance
June 9, 2019

As an incoming resident physician, I need disability insurance. Although a group policy is offered through my employer, it doesn’t provide enough coverage to adequately cover my monthly expenses or insure my future income. Thus, I purchased an individual long-term disability insurance policy. This is what I discovered:

1. Disability insurance is expensive. A substantial number of people use disability insurance, so companies raise the price to cover the payouts and ensure …

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When should you be tested for vitamin B12?

Conditions
June 8, 2019

Two recent patient experiences prompted this post. In the Wall Street Journal, Dana Hawkins-Simons described several years of being seen by specialist after specialist for her complaints of tiredness, dizziness, ringing in the ears, palpitations, shortness of breath and “brain fog.” She finally researched her symptoms and demanded that she be checked for vitamin B12 deficiency, which turned out to be the cause of her symptoms.

Recently, the …

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The 9 types of manipulative patients

Physician
June 7, 2019

One of the more common complaints that I hear from medical practitioners in jails and prisons (especially new practitioners) is, “These manipulative patients are driving me crazy!” Well, to be honest, I ran into a lot of manipulative patients when I worked in the ER, as well. But it is true that many of our patients in jails are especially …

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How depression made this doctor a better physician

Physician
June 6, 2019

Residing in all of us, whether or not we feel it, is an innate zest for life. As a family medicine resident, I live with enthusiasm daily, because I am happy seeing patients, no matter my rotation. From the acute care wards to the family medicine clinic, I enjoy and relish the opportunities to sit with patients. Unfortunately, this zest for life was once lost on me, and at times …

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When physician pay packages become hospital kickbacks

Policy
June 6, 2019

For a hospital that had once labored to break even, Wheeling Hospital displayed abnormally deep pockets when recruiting doctors.

To lure Dr. Adam Tune, an anesthesiologist from nearby Pittsburgh who specialized in pain management, the Catholic hospital built a clinic for him to run on its campus in Wheeling, W.Va. It paid Tune as much as $1.2 million a year — well above the salaries of 90% of pain management physicians …

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