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Let’s talk about hierarchy and priorities in medicine

Physician

July 23, 2021

Life is full of hierarchies — whether you are the older brother in the family, the supervisor in a company, a chief resident in medicine. There is always a hierarchy. It is a pecking order that keeps our society organized. You know where to look for guidance. Who is the person above your title that can help you with a challenge you are facing?

Even within surgical specialties, there is a …

The horror of keeping a loved one alive at all costs

Debbie Moore-Black, RN

Conditions

July 23, 2021

He was in his ICU bed without movement or brain stem involvement. His weight was down to 90 pounds.

His six-foot frame and skeletal body made me gasp.

After countless sessions with the patient’s daughter to make her 92-year-old dad “comfort care,” the intensivist sadly hung his head down low.

The daughter insisted on doing everything for her daddy.

It was my night shift, and I knew what was to be expected. Another endless …

Advocating for people with disabilities: People First Language

Leonard Wang

Education

July 23, 2021

You are more likely to be struck by lightning than be born with cri du chat syndrome and OCD. The chances of becoming a performer with these diagnoses are even smaller, and yet, what a show Tanner performed.

His performance is meticulously planned out. Pump soap dispenser twice. Rub hands three times. Wash quickly. Create bubble! As the first bubble emerges, the kids take notice.

Pushing her wheelchair forward, Maria pops the …

Is Open Notes as good in practice as it is in theory?

Jennifer Henderson

Tech

July 23, 2021

Earlier this year, a federal rule that requires clinical information such as doctors’ notes and lab and imaging results to be made immediately available to patients took effect. A little more than three months out from implementation, there are mixed reviews as to how well the so-called “Open Notes” rule is actually improving patient care.

Patient advocates and even many physicians have supported the concept of electronic health information …

Prior authorization reform for health care coverage takes center stage

Afua Aning, MD

Policy

July 23, 2021

One of the leading reasons for provider frustration is prior authorizations. The insurance companies initially created prior authorization (prior auth) to keep down the cost of care when a service fee was the primary payment method for payers. However, it has become a hindrance for providers and staff as they spend hours waiting for authorization to provide medical care.

In the past, hospital organizations needed approval (prior authorization) from an insurance …

How a homeless teen became a physician [PODCAST]

The Podcast by KevinMD

Podcast

July 22, 2021

“During my medical school clerkships, an attending recognized a truth within me that I’d hidden for many years. Just a few hours into my pediatrics rotation, the attending asked me, ‘You had a rough childhood, didn’t you?’

I was astonished. How had he known? I asked him, needing to know …

Menopause changes women’s singing voices

Nancy Bos, Cate Frazier-Neely, and Joanne Bozeman

Conditions

July 22, 2021

Singing during the years around menopause can bring unforeseen challenges for some women. To Elaine, a 56-year-old professional singer and voice teacher, her voice has felt like a mystery for the last few years. Her vibrato was wider than it used to be, her usual songs didn’t feel good anymore, and her flexibility and agility had decreased.

On top of that, the vocal transition, or break, between her high and low …

Teens need later school start times

Hina Talib, MD and Shelby Harris, PsyD

Conditions

July 22, 2021

Daily cries from parents, pediatricians, the press, and the public to reopen schools in the fall are certainly well-intentioned, but they are overlooking a critical opportunity to advance adolescent physical and mental health long after the COVID-19 pandemic is over. Delaying school start times for teens by an hour, or even two, could optimize a teen’s sleep and their ability to learn throughout the day.

Sleep is critical for teen health …

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Teens need later school start times

Why it’s important to embrace dialectical thinking

Steve Adelman, MD

Physician

July 22, 2021

“Embrace dialectical thinking, stupid!”

That’s the mantra I repeat when I catch myself getting worked up about a deep-seated belief, idea, or cause. Understanding the flip side of the equation helps me to neutralize powerful negative feelings like righteous indignation, bitter disappointment, and utter disgust with the incompetence of fill-in-the-blank.

Dialectical thinking is the ability to view an issue from multiple perspectives. Embracing it helps us recognize that it’s almost always possible …

What this physician learned from medicine in developing countries [PODCAST]

The Podcast by KevinMD

Podcast

July 21, 2021

“On a recent call with a small health organization in rural Uganda, I asked the director about the C-section rate in the community. In some private maternity centers, this procedure is performed far more often than one might expect. I’ve learned that while this practice may be financially motivated, the …

JAMA retracts controversial masks study

Crystal Phend

Conditions

July 21, 2021

A controversial study suggesting that masks may harm children by exposing them to high carbon dioxide levels was retracted on Friday.

The research letter released in JAMA Pediatrics on June 30 had reported unacceptably high levels of carbon dioxide by German standards in air inside masks worn by children in a laboratory environment.

In the retraction notice, the journal editors cited “numerous scientific issues,” that also included questions over the applicability …

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JAMA retracts controversial masks study

Exclusion of BIPOC from VIP floors in an academic medical center

Omar Mirza, MD

Physician

July 21, 2021

Omar Mirza is a psychiatrist and comic creator. In this comic, he discusses how Black, indigenous, and other people of color are excluded from VIP floors at an academic medical center (click to enlarge):

Omar Mirza is a psychiatrist.

Image credit: Omar Mirza

Exclusion of BIPOC from VIP floors in an academic medical center

Using nanoparticles to treat polycystic kidney disease [PODCAST]

The Podcast by KevinMD

Podcast

July 20, 2021

“Excited by the promise our research holds for PKD patients, we have been packaging a variety of PKD drugs into our nanoparticles, testing their ability to act as a courier service for renal drug delivery. We’ve been testing this process on drugs that show therapeutic benefits in animal models …

During COVID, older patients stopped going to the doctor. Here’s how to change that.

Romilla Batra, MD, MBA

Conditions

July 20, 2021

When the COVID-19 pandemic broke out last year, Helen (not her real name) took all the right steps to protect herself. The 74-year-old self-isolated, wore a face mask, and practiced social distancing.

Helen stayed safe from the virus during this time, but she put her health at risk in another way: for nearly two years, she didn’t see her primary care physician. Nor did she go to the eye doctor to …

I learned the most about medicine from my dad’s death

Dr. Gleeson Rebello

Physician

July 20, 2021

I had just finished a grueling orthopedic residency. Yet once again, I was on the run and bearing bad news. I was sprinting from a well-known Mumbai hospital to a nearby hotel room. But this time, the bad news wasn’t for the family of one of my patients. It was for my mother.

As I waded through the crowd whose constant overflow from the sidewalk onto the road left a shifting …

Hypertension is killing pregnant mothers. Blood pressure monitoring can help. [PODCAST]

The Podcast by KevinMD

Podcast

July 19, 2021

“Hypertensive disorders with onset during pregnancies are among the leading causes of maternal and infant mortality and morbidity in the U.S. and can have far-reaching consequences for the long-term health of the mother and child.

In Dr. Jerome Adams’ recent Call to Action to recognize and address hypertension control as a …

3 mistakes physicians make that triple charting time

Gail Gazelle, MD

Physician

July 19, 2021

Let’s face it, what’s getting most physicians down is not their patients. No, ask any group of physicians what the hardest part of the job is, and you’ll like get a pretty consistent response: It’s the EMR! With studies showing that we spend, on average, two hours on “paperwork” for every hour in the room with a patient, there’s no question that it is a massive time suck for most. …

When air hurts and becomes the harshest invader

Fery Pashang, PharmD

Conditions

July 19, 2021

Wood art

When Air Hurts
When the Lung Repulses Air
When Air Becomes the Harshest Invader
When Air Is Heavier Than Mountains

This work was inspired by my father and many other patients who were struggling to breathe. The soft, unnoticeable air suddenly becomes a palpable matter wildly invading the walls of the respiratory system, making noises and creating resistance.

A “refreshing” breath leaves the person more tired, …

Doctors and the 5 stages of grief

Robert Pearl, MD

Physician

July 19, 2021

Thanks to the marvels of medicine, newly vaccinated Americans are returning to life as normal and partying like it’s 2019. Doctors, who are emerging from the pandemic as national heroes, would like to turn back the clock even further—to the halcyon days of 20th-century medicine.

But doctors, unlike their maskless and freewheeling patients, will be disappointed with what the future holds.

Trying to turn back the clock

Physicians have had a rough century, …

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Doctors and the 5 stages of grief

The burden of the documentation and administrative tasks on physicians needs to be lightened significantly

Rosemary Eseh-Logue, MD

Physician

July 19, 2021

It takes a special person to care for people during their most vulnerable states, to keep intimate details about people while remaining compassionate even toward the seemingly vilest of persons. The white color of a physicians’ coat can be a metaphor for the purity expected of physicians. A physician’s signature or words carry weight. With such power comes the responsibility to be trustworthy.

Documentation is an important part of patient care. …

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