MKSAP: 78-year-old man with symptoms of dysphagia

Conditions
June 9, 2018

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

A 78-year-old man is evaluated for symptoms of dysphagia that began 2 weeks ago. When he eats, he starts coughing after the first bite of food and occasionally has nasal regurgitation.

On physical examination, blood pressure is 135/90 mm Hg, pulse rate is 78/min, and respiration rate is 12/min. Left-sided weakness is noted in both extremities, …

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5 ways to live through medical malpractice lawsuits

Physician
June 8, 2018

Nothing troubles physicians more than an unforeseen outcome and a malpractice lawsuit. It cracks open self-doubts and assumptions about medicine and may be life-changing.

It commonly fuels burnout, loss of confidence, PTSD and early retirement. And there are links to depression and physician suicide.

There’s another side to this story, though. Like all of life’s great challenges, a patient’s unexpected loss, and professional litigation present us with huge opportunities for growth.

I am …

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New doctors shouldn’t buy houses

Finance
June 8, 2018

It’s that time of year again. Over 30,000 medical residents are about to finish their training and start their first job. Many of them will make some big financial mistakes during their first year that will haunt them for years to come.

One of the biggest errors many doctors make is to buy a house right after they leave residency. Society gives us a big push to own a house, after …

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Why this physician has an MD and an MBA

Physician
June 7, 2018

I made the decision to get an MD/MBA when I was still in high school. I had an interest in medicine but hated the idea of being yet another Indian doctor. How unoriginal. So when my dad introduced me to someone who had done this dual degree, it was my “aha!” moment. As far as I knew, this was something different. It could set me apart, and no one else …

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My patient, my friend: a sometimes stressful relationship

Physician
June 7, 2018

Seeing patients in my OB/GYN office this morning, I try to stave off the mild nervousness rumbling inside of me. My good friend Monica is having a C-section this afternoon, and I’m performing it.

We met ten years ago when I walked my three-year-old daughter into Monica’s preschool classroom for the first time. Monica sat on the floor, a child in her lap and others playing around her. Like them, I …

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The mental health implications of infertility

Conditions
June 6, 2018

While infertility may be a problem affecting nearly 7.3 million women in the United States between the ages of 15-44, it is a topic that women often don’t discuss. Rather, they suffer from the emotional pain that accompanies hormone injections, multiple procedures, and sometimes miscarriage. How is it best to treat this vulnerable population that rarely gets the attention it deserves? The answer lies in a team approach to medicine.

According …

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Borderline personality disorder in medical practice

Conditions
June 6, 2018

What is borderline personality disorder (BPD)? According to the National Institute of Mental Health, unstable moods; impulsive and reckless behavior, and unstable or volatile relationships may be indicative of BPD. People with BPD often have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides. They often make poor life choices and take unwise risks. Thus, adults with …

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The questionable ethics of ultrasound in pregnancy

Conditions
June 6, 2018

Having worked at both community hospitals and major medical centers, the issue of ultrasound in pregnancy has revealed itself to be more complex over the years. As a resident, I worked with an obstetrics office that only scanned their own patients who had private insurance and would send uninsured or Medicaid patients (often with a high risk of inadequate prenatal care) to the hospital late in the day to be …

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What you need to hear at your medical school graduation

Education
June 5, 2018

Well done! Strong work! You’ve done it!

Four years (often more) of perspiration have earned you two extra letters (often more) in your name. You should be proud. Nothing should get between you and a gigantic glass of bubbly today. The world feels different. You feel different. But are you?

The thing about ceremonies that feature costumes, protocols and rituals is that they confer upon participants a sense of change. Just look …

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Cyberbullying and mental illness in kids

Conditions
June 5, 2018

Cyberbullying is a major and growing public health problem associated with increased risk of greater psychiatric morbidity and mortality among children and adolescents. Its prevalence, varieties, associations with other forms of maltreatment, risk factors and deleterious effects in different populations are poorly understood.

Furthermore, effective, evidence-based approaches to screening and prevention in different populations are lacking. Developing such approaches is challenged by the rapidity and unpredictability with which electronic social media …

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Here’s why I left nursing

Conditions
June 5, 2018

Leaving the nursing profession is bittersweet. My heart left nursing a while ago when I came to the realization that nursing left me first. It never was a two-way relationship. The profession left me without acknowledgment of work-related stress, specifically post-traumatic stress (PTS).

First responders and emergency workers often hear the phrase, “It’s just part of the job.” So we all just deal with it — or not. I’ve heard this …

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Pregnant and in medical training? Here’s how to do it.

Physician
June 4, 2018

We hear all the time that maternity leave in the U.S. is in shambles. Let’s clarify: There’s no such thing as guaranteed maternity leave. Some companies are obligated to give some leave to some employees — that’s as good as it gets. No companies are obligated to give paid leave.

Medical training adds complexity to parental leave. Residents and fellows are expected to be deferential, the lowest on the totem pole …

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Physicians have become devalued in modern health care

Policy
June 2, 2018

I’m writing this piece because I’m finally at the point that I am truly angry. I am angry at how physicians have become devalued in modern health care. I’m angry at how systems of care have participated in this by replacing physicians with lesser trained mid-level practitioners. I’m angry at how our title “doctor” has been hijacked to allow patients to be misled or, in many cases, deceived.

It wasn’t that …

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The painfully fine line of pain management

Conditions
June 2, 2018

I’ve been practicing as an interventional pain management physician for over six years. It was a long road to get here — four years of medical school, four years of residency in anesthesiology and one year of fellowship (in addition to the four years of undergraduate education). So people say, “You must really love what you do.” Sure, during residency there was light at the end of the grueling tunnel …

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It’s time to recognize the rights of medical students and residents

Education
June 1, 2018

Goodbyes were confusing during my third and fourth years of medical school. Even on my way to a 28-hour labor and delivery call, I tended to say, “I’m leaving for school.” Rather quickly, my wife trained me to say, “I’m leaving for work.” I was never quite reconciled to this, as I couldn’t forget the upcoming exams and tuition costs around $30,000 per year.

For the uninitiated, “work” as a medical …

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Life on the night shift at the hospital

Physician
June 1, 2018

It’s 7 a.m. The hospital is just starting to wake up from its slumber, stretching arms and blinking eyes. I’m 54 minutes away from the end of another night shift.

Night shifts are curious creatures. They are a part of the fabric of emergency medicine life — one of the often hated aspects of our jobs. They steal us away from our families, cutting short bedtime snuggles and picture books so …

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When private physician groups get acquired: Who loses?

Policy
June 1, 2018

In the recent years, there is a growing trend in the health care industry whereby private practitioners and independent groups are being acquired by larger companies. This trend is a result of growing complexities of running a private practice and increased expectations of hospital administrators from hospital-based specialists such as anesthesiologists, radiologists and pathologists.

I will concentrate on anesthesia as it is my area of specialization, and I have some relevant …

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This doctor retired from clinical medicine. Here are his tax surprises.

Finance
June 1, 2018

Upon retiring from clinical medicine and becoming a full-time author/coach (I like to say I’m repurposed), I was uncertain as to the amount of taxes I needed to pay. I have a complicated tax return with several K-1s that don’t surface until March. My final return totals 32 pages for federal and 5 pages for state.  After making an estimate of my tax bill at year end, I figured I …

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Residents should not be mandated to do research

Physician
May 29, 2018

In a 2012 blog post called “Things that puzzle me about surgical education,” I wrote the following:

There was the emphasis that still exists today on making sure every resident did research. At last, some are questioning the value of this for the average clinical surgeon. Contrary to the prevailing wisdom, there is no evidence that a resident who is dragged kicking and screaming through a clinical research project or …

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