A physician was fired for standing up for his beliefs

Policy
June 17, 2018

Dr. Eugene Gu. He is — was — a surgical resident at Vanderbilt University. His resume exemplifies academic perfection: valedictorian in high school, undergraduate degree from Stanford, medical degree from Duke, surgical residency at Vanderbilt. He also founded his own research company. Not once throughout the span of his academic or professional career would one have any reason question his capability or competency. But several weeks ago Vanderbilt fired him, citing “performance” issues.

Why?

Because …

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The Handmaid’s Tale and the state of medicine

Physician
June 15, 2018

Spoiler alert!  I recently started watching Hulu’s The Handmaid’s Tale after continuing to hear rave reviews about the show.  It is based on the dystopian novel by Margaret Atwood.  I just started watching this weekend and am now caught up to season 2; it’s that good.  It portrays a world in which fertility and birth rates have declined so drastically, that fertile women have been forced to serve as handmaids …

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5 mistakes hospitalists should avoid when starting a locum tenens position

Physician
June 15, 2018

For the last 8 years, I have worked as a locum tenens hospitalist. I began on this path when it was the least popular option upon graduation from residency.

I did countless hours of research trying to find accurate information about locum tenens companies, but never found anything written by physicians, only by the companies themselves. So, I stepped into this field blindfolded and learned the hard way. Since then, I have …

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Medical students: You are more than your grades

Education
June 15, 2018

Recently, I entered an essay contest on advice you would give to future medical students. I sincerely believe that the best person to write an article offering advice to younger medical students should come from a person who didn’t match. Also known as me. Why, you say? Well, for everyone else, Match Day is a culmination of four years of mentally, physically, and emotionally taxing work. They might even forget …

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The worst enemy of a doctor should never be another doctor

Physician
June 14, 2018

“The worst enemy of a doctor is another doctor,” said one of my professors during rounds when I was doing my internal medicine clerkship as a third-year medical student.

I remained skeptical. That did not match the idea of becoming a doctor nor did it support what Dr. Pellegrini said: “Medicine is the most humane of the sciences.”

Nonetheless, my old professor explained that when it comes to patient care planning and …

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Am I the cold and detached physician?

Physician
June 13, 2018

It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry …

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The U.S. is failing at mental health care

Conditions
June 13, 2018

Where I practice, the process of referring a patient suffering a mental illness is quite infuriating. The wait to get in to see a psychiatrist or psychologist can be months all the while patients are suffering. Worse yet, with certain insurances, there are just no mental health providers available for any of their covered patients. The failure of treating mental health disease in the U.S. is glaring.

In the U.S., approximately …

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7 habits of being on call

Physician
June 11, 2018

1. You sleep when you can. Despite what medical television dramas portray, call room beds are for sleeping. Period. As you curl up into the bed you have no idea whether you are about to get a couple hours of sleep or a couple of minutes, but in that moment of sheer exhaustion, the drab hospital cot or bunk suddenly transforms into a luxurious sleeping pad. Bonus if you can …

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Identifying social determinants of health is critical to the patient interview

Policy
June 11, 2018

After a semester of medical school, I returned home to the Antelope Valley in California, an area CNN coined, “health care’s nowhere land” because of low health insurance rates and limited provider networks that force residents to travel far for care. I wanted to help my family and neighbors by using the physical exam skills I learned during my first few months as a medical student, but …

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A better way to follow-up your office visit is needed

Physician
June 10, 2018

Actual conversation heard in the hallway outside an exam room earlier this week:

Doctor: “So, we’re going try this medicine for your blood pressure; you keep checking it at home as we discussed. If the numbers remain high, we can increase the dose or add another medicine.”

Patient: “Well, what do we do if the pressure stays high; if this medicine doesn’t work?”

My partner told me later that she had explained the …

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Being idealistic is a necessary component in achieving your goals

Education
June 10, 2018

I am a first-year medical student, and just like some of you once did, the primary reason I am becoming a physician is to really make a difference for my patients by [insert x, y or z].

“Wow, that’s really great, but we’ll see how you feel about it in a few years.”

“That’s not how it works once you’re actually out there.”

“Trust me, medicine isn’t what it used to be, get …

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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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