MKSAP: 49-year-old woman with obesity, hypertension, and type 2 diabetes mellitus

Conditions
September 1, 2018

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

A 49-year-old woman is evaluated during a follow-up visit. She is overweight and has hypertension and type 2 diabetes mellitus, both of which are well controlled. For several years, she has attempted to lose weight through various commercial diets; dietician-monitored, calorie-restricted diets; and physical activity. She has worked with a behavioral therapist, and …

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Why this physician quit her job

Physician
August 31, 2018

So last week, I did the bravest thing I have done in a very long time — I quit my job. Yes, I put in my 60-day notice. This was my dream job post service in the U.S. Air Force. I had dreamed of working in this establishment for months before my service time was up. I could not have been happier when I joined their team, a group practice …

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10 ways to make residency less stressful

Physician
August 31, 2018

The upgraded responsibility and authority given to starting residents is both a blessing and a curse. Suddenly, the need for co-signatures vanishes. There is greater autonomy in clinical practice. Residents get paid. However, residency can also be a time of significant stress. Residents are forced to navigate the demands of preceptors, other residents, medical students, nurses, patients, family members, and administrators. Residents have very little control over what they do, …

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How to be aware of patients’ non-medical needs

Physician
August 31, 2018

“It kind of strips you of any pride that you have. It was very humbling.”

As a care manager, Mary helps patients follow their care plans by coordinating medical visits and community resource referrals, but this was the first time Mary shadowed one of her patients out in the community. At the food bank, Mary watched her patient, who was living with diabetes, receive one box of macaroni along with other …

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Let’s talk about the psychiatric boarding crisis

Physician
August 30, 2018

Imagine spending days or even weeks in an emergency room without treatment for a broken leg or painful kidney stone.

Patients in psychological crisis across the country are living this exact scenario. Long waits in an ER, hospital room or prison for an inpatient psychiatric bed, otherwise known as psychiatric boarding, are their unfortunate reality.

Rewind to over 50 years ago — as institutionalized patients were gradually integrated into communities, the availability …

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Welcome to medical school. Welcome to the rest of your life.

Education
August 30, 2018

Dear first-year medical students,

Welcome to medical school — congratulations! You have worked, sacrificed, waited for this moment for many long years, have left blood, sweat, and tears along the tracks of your life marathon. This is the first checkpoint in your journey. You’ve made it. Your loved ones are right here cheering your accomplishments, there are many. That new, freshly-pressed, short white coat makes you look like an absolute stud(ent). …

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You can’t always expect a miracle, but you can always hope for one

Physician
August 29, 2018

I began practicing as an internist/nephrologist in the early 1960s. Having rented an office in Los Angeles, I introduced myself to the local medical community and set out to build a practice.

With a growing family, a mortgage and an office to support, I was hungry for patients. Hospital emergency rooms were good referral sources, so I took ER call at three different hospitals.

Late one Friday night, I got a call …

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3 ways to decrease emergency department wait times

Policy
August 28, 2018

Have you ever been the only customer in your local supermarket? Although the experience can be a bit unnerving, at first, you soon start to notice the advantages: No line at the deli, no pushy shoppers, no carts jamming up the produce section. As you breeze through checkout, you think to yourself, “Gee, I could get used to this.”

Now, imagine walking into an empty waiting area at your local emergency …

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Food allergy: Death is not our only fear

Conditions
August 28, 2018

Recently, a respected allergist reassured his audience: the mortality rate for food allergy is very low. The risk of dying in a car crash is much greater than the risk of dying from food allergy. The implication seemed to be that the anxiety around food allergy is misplaced. Though any loss of life is too great; statistically, food allergy deaths are rare. To the food allergy community, it just doesn’t …

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Not all doctors are physicians

Physician
August 28, 2018

A colleague recently sent me a link to the American College of Cathopathic Physicians a new organization whose mission “is to protect the professional autonomy and advocate for a full, broad scope of practice for DNPs as a ‘cathopathic physician’ completely equal in every way to our MD and DO counterparts.”

I was, I admit, so stunned by the statement that I thought the whole thing might be an elaborate joke. It was only …

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How many bones in the human body? It’s not what you think.

Conditions
August 28, 2018

If somebody asks you how many bones there are in a human body, please do not blurt out, “206.” The correct answer is nuanced. To respond accurately to the query, you have to address five questions. Who? What? When? Where? Why?

Consider first that humans vary from one another in facial features, hair color, height, and shoe size. Unknown to nearly everybody except …

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How this physician paid off $100,000 in debt in 6 months

Finance
August 27, 2018

First of all, I am far from a financial genius. I am also not a natural saver. Thanks to scholarships and jobs, I made it out of college without loans. But, I took out a $191K for medical school. In the middle of med school, I took a year off to teach. During that year, I didn’t put anything towards student loans and lived it up. Unfortunately, in forbearance, those …

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Burnout in pediatric intensive care physicians

Physician
August 26, 2018

Burnout has been a descriptive term for years, but lately, psychologists and others have assigned it specific characteristics with a view toward being able actually to study and measure it. One common definition of burnout is a state of chronic stress that leads to physical and emotional exhaustion, cynicism, detachment, and feelings of ineffectiveness. The PICU environment is often one of high stress, so it’s a place where this …

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What’s life like after not matching? A physician’s story.

Physician
August 25, 2018

Match Day is the culmination of a medical student’s education: the day all graduating seniors and non-traditional applicants find out where they will spend the next three to seven years to train in a desired specialty. I fell in love with obstetrics and gynecology (OB/GYN) as it was the perfect way to combine my passion for women’s health with medicine and surgery. I also liked that the patients were relatively …

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MKSAP: 25-year-old man with dark-colored urine

Conditions
August 25, 2018

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

A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical history is otherwise unremarkable, …

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How to deal with hardships in life

Conditions
August 22, 2018

We’ve all been through difficult times. It may be the death of someone we love or suffering abuse with no one to help. In life, many events fly at us that are hard to manage. Many of us just suffer silently through the pain, not allowing anyone in. And even while we do that, we also know that is not the healthiest response.

Many patients come to me struggling with anxiety …

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Physicians can’t take things personally. Here are some tips.

Physician
August 22, 2018

A natural part of life is emotionally growing (hopefully) with experience. If I was to look back at my own journey, when I was in medical school and just graduating, I would say that without doubt, one of the biggest things I would tell my younger self, would be to not take things too personally. This would be particularly true in professional situations.

I look back at how personally I used to …

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What physicians need to know about living trusts

Finance
August 22, 2018

One common question that doctors face in estate planning is whether to establish a trust. This topic gets brought up in the doctors’ lounges, especially after someone gets a pitch from their financial planner. Most doctors who bring up the topic are quite enthusiastic, and cite that doctors need a trust because “we make a lot of money.”

Fair enough.

Medical students and residents probably do not need a trust

I’ll get this …

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A physician explains the afterlife to his child

Physician
August 21, 2018

Death and dying — it is one of the first topics I was taught about in medical school.  I was fortunate to attend a medical school that only made us spend half our time falling asleep in lectures.  The other half we were in small group sessions, working our way through real patient scenarios, trying to learn to think like a physician.

As part of our first-year curriculum we had to spend time doing …

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What do the Fidelity ZERO mutual funds mean for physician investors?

Finance
August 20, 2018

Vanguard, Fidelity, and Schwab have been engaging in a fierce competition to claim the mantle as the leading provider of low-cost index funds. As a result, each has aggressively lowered their fees for their index fund offerings over the past few years and advertised their low-cost offerings to investors.

After the latest round of fee reductions in mid-2017, I wrote a post speculating whether it was inevitable that Vanguard, Fidelity, …

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