MKSAP: 35-year-old woman is evaluated for intermittent fever

Conditions
May 12, 2018

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

A 35-year-old woman is evaluated for intermittent fever, sweats, fatigue, and dull midchest pain of 2 weeks’ duration. Medical history is significant for liver transplantation 6 months ago for primary biliary cirrhosis; she was seronegative for cytomegalovirus and Epstein-Barr virus, and her donor was positive for both. Results of pretransplant testing for tuberculosis …

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What makes you an effective change agent in health care?

Physician
May 11, 2018

Change and health care are closely interconnected. Health care organizations are continually faced with the need to adapt to change, whether it be advances in medical care or technology, growing demand for care delivery, a patient population that is increasingly active and involved in their own health and well-being, or evolving reimbursement and cost models. By recognizing that change is inevitable in the health care sphere, organizations can focus on …

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A physician’s guide to getting more time with family

Physician
May 10, 2018

Do you ever feel like time is always slipping away? Do you feel like you hardly get time to enjoy the things you love? For example, do you feel like you get enough time in your day to spend with your kids? If your answer is “no,” welcome to the club. You are not alone! I am a physician mom of young kids who used to feel like I never …

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When someone is not dead but not alive

Physician
May 9, 2018

May lay in a hospital bed, her wrinkled skin covered with sensors that monitored her every breath and heartbeat. Her husband sat at her bedside gently stroking her withering gray hair as her chest moved slowly up and down accompanied by the soft whoosh-whoosh of the ventilator that breathed for her.

He stared expectantly at her face as if at any moment she would rise and free herself from the multiple …

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An emergency physician makes the case for circumcision

Conditions
May 9, 2018

Whether to circumcise a newborn male child is not the simple, binary “yes/no” question it appears to be. Rather, the choice is affected by an astonishing array of issues: religion, culture, health and hygiene, sexually transmitted infections, expense, pain and medical recommendations. Some cite ethical concerns regarding usurpation of a child’s free choice. Others claim an equivalency between neonatal male circumcision and the practice of female genital mutilation.

As a practicing …

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Never undermine the work of a nurse

Physician
May 9, 2018

A few months ago a nurse I know vented her frustration at a misperception she had received several times, unfortunately. She recalled a conversation in which someone had asked her in a condescending manner if she does anything else at work besides “handing out pills.”

I became visibly irritated at this, not only was this person purposely making disrespectful comments to bring her down but was also perpetuating her own biased …

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What could be worse than being sued for malpractice? Prison.

Physician
May 6, 2018

Kang Se-hoon, a surgeon in South Korea, operated on a popular rock singer and song writer in October 2014. According to reports, Shin Hae-chul had abdominal pain, and the surgeon performed laparoscopic lysis of adhesions. Without having obtained consent, he decided to also do a weight reduction procedure.

The patient was discharged a few days after surgery but returned a day later with fever and severe abdominal pain. Kang did not …

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Internet support forums for benzodiazepine withdrawal: the good, the bad, and the ugly

Physician
May 5, 2018

Since the advent of the internet and rise of social media, patients can connect and compare their experiences with prescribed drug withdrawal. A problem that was once considered rare is a worldwide epidemic that is finally getting noticed.  A recent New York Times article discussed the problems many have discontinuing antidepressants, and more than 8,800 readers responded about their difficulty stopping …

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When a physician gets yelled at

Physician
May 4, 2018

It was not so much the words as the overall tone of the interaction. The doctor-patient relationship had been generally affable. There was the usual exchange of pleasantries over the years. Questions about family, children, and grandchildren. It was a good relationship — until Harvey got sick, that is.

Originally, there was weight loss and fatigue. The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle-aged …

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5 ways young physicians can advocate for themselves

Policy
May 4, 2018

Why don’t doctors advocate for themselves? Or young doctors, at least. Maybe it’s because we’re bombarded with patient care, never ending-educational opportunities or the mountain of electronic medical records that still need signed.

Maybe it’s because it’s too overwhelming. Understanding and conquering the health care behemoth that organizations, third-party payers, and the government have created seems nearly impossible if you’re not already on your way to adding a master of health …

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Your patient has judged you 7 seconds after meeting you

Physician
May 3, 2018

A doctor is working down their long list of patients, powering through the day, striving to use their skills to get them better. Some of the patients will be follow-ups who they already know; others will be brand new patients, who they are meeting for the first time. Of course, the job of any doctor is first and foremost to heal their patient in whatever way they can. That’s what …

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When preventive care becomes upselling in medicine

Physician
May 2, 2018

For many years, I’ve held a brief huddle with my team every morning to make sure we are ready for the day: Anybody with complex problems coming in today? Anybody who’s been in the ER? How is Mrs. Jones’s husband over at the nursing home, is she worried about his condition? Where can we squeeze in more add-on’s?

Now other people have tried to hijack the word “huddle” for a completely …

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A surprising cause of rectal bleeding

Conditions
May 2, 2018

“I can’t stand the site of blood!”

We’ve all heard that adage. Blood can provoke emotional reactions from even steely muscle-bound bodybuilders. We gastroenterologists routinely receive fearful phone calls from patients who have observed even minor rectal bleeding. Fortunately, in most of these cases, there is a benign explanation for the sanguinary seepage.

If blood repels you, then gastroenterology should not be on your short, or even long list of professions under …

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How to give patients bad news

Physician
April 30, 2018

I would like to give some tips to younger doctors regarding how to tell your patient that he is going to die. Your approach should also incorporate your unique personality, as well as published literature and other resources.

For your first case, watch someone more senior tell the patient. See what you think worked and what could be improved. When it is your turn, make sure to have …

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Why is it difficult to be a doctor?

Physician
April 30, 2018

As part of the interview for my book, I asked why it is difficult to be a doctor. Some of it has to do with integrating information and making decisions.

“The public thinks that we know more or can do more than we can. Ultrasounds don’t mean it’s a perfect baby. All of the tests and technology moves so fast that we don’t know what we see.” A doctor explained, “You cannot know …

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Are you an artisan or just a medical professional?

Physician
April 28, 2018

Take a moment to ask yourself the following:

1. Did I come to practice medicine because it was a calling, rather than a possibly lucrative career path?
2. Do I consider the practice of medicine primarily an art, a craft and the consistent application of evidence-based care?
3. Do I respond to inner measures of prideful work more than the appeal of external motivators?
4. Are there lines that cannot be crossed, even if …

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A pulmonary physician’s take on vaping

Conditions
April 27, 2018

Walking down the street, I sometimes see people who appear to be strolling in a cloud. These folks are wrapped in vapor they inhale from e-cigarettes — a practice called vaping.

Vaping devices first emerged in the late 1990s. They feature a battery-powered heating element that heats up liquid nicotine to create an aerosol, which is free from the toxic byproducts of cigarette combustion. In theory, this device …

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How to match into a fellowship

Education
April 27, 2018

Residency training is an opportunity to get a good feeling of the specialty that interested you when thinking about what to pursue in the future. You may think that after applying for premed college, medical school and residency, applying for fellowship would be a piece of cake for you. Let me tell you: applying for fellowship is probably the hardest one among all other applications you went through so far. …

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I’m retiring my first stethoscope

Physician
April 26, 2018

I retired my first stethoscope today. I bought my Littmann Cardiology III during my first term of medical school in 1999. It came with a penlight, otoscope, ophthalmoscope, manual blood pressure cuff, tuning forks and reflex hammer, all contained within a traditional black leather physician’s bag with my initials in gold. Receiving your medical student diagnostic kit is one of the rites …

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Oh, are you a nurse? The physician gender bias

Physician
April 26, 2018

A man and a woman step into an elevator wearing the exact same hospital scrub uniforms. The man’s pager suddenly starts beeping, and the stranger in the elevator says to him, “Do you doctors really still use pagers?” The stranger then notices the women next to him and asks her, “Oh, are you a nurse?”

It’s something that has happened to every female physician. It’s not that we mind getting mistaken …

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