The skinny on skinny health insurance

Policy
May 24, 2018

The Affordable Care Act (ACA), widely known as “Obamacare,” has survived several repeal attempts by Congress. Storm clouds, however, are still on the horizon.

The ACA’s individual mandate obligates every American to be covered by comprehensive health insurance. This requirement has been the most unpopular feature of the law. That’s because healthy people, especially those who are self-employed or between jobs, have found the ACA premiums too expensive.

They are not alone. Health …

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How to deal with devastating criticism

Education
May 24, 2018

“Why don’t you just get a shotgun and blow his brains out next time? Better yet, next time stay the hell away from my patient!”

I was frozen, and the ICU attending wasn’t even talking to me. My co-intern had barely started her presentation when she met damnation. Mind you — there was a senior resident, a pulmonary fellow, and a team of nurses caring for the patient also. Yet the …

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The good, bad, and the ugly of being a medical expert witness

Finance
May 24, 2018

I have spent a good part of my career investing time and energy towards side hustles.  I generally categorize them into two distinct types of ventures.  The lazy side hustle involves starting a business or consulting in a field tangential to ones main hustle.  For example, an accountant who works normally as an auditor may do a few tax returns on the side during tax season.  I call his …

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Don’t be mean: Treat your team members with respect

Education
May 23, 2018

“Those emergency room residents are f**king retarded!” This was the comment that rang through the workroom.  I had only been on this hospital service for three days, and I was having a discussion about a patient with my attending when the on-call resident had burst into the workroom and sat down next to me. He was fuming.

“Why the f*** would they think I need to be consulted for this? Only …

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Why the battle against being called a provider is probably lost

Physician
May 22, 2018

I recently needed to transfer my patient to a larger medical center for some urgent care. As I sat there in my relatively small hospital working out where they would be best served, a famous academic medical center that was not too far away, came to mind. I placed a call to the facility’s bed facilitator, who took the patient’s details from me, and was told to await a callback …

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The best medical specialty you’ve never heard of

Physician
May 22, 2018

The most common response when I introduce myself as a preventive medicine resident is an interjection, “You mean family medicine?” I have come to realize that the majority of the healthcare field has never heard of preventive medicine as a unique medical specialty. It’s a shame, because preventive medicine is truly the best medical specialty you’ve never heard of.

Preventive medicine practices at the intersection of public health and clinical medicine …

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Everyone needs someone to be a safe harbor

Physician
May 21, 2018

I met David on the internet. It was to become on of the closest, most intense relationships of my life.  For you see, a few months before he crossed my path his daughter finished the same protocol for the same type of brain tumor that my daughter just had started.  They had successfully traversed the waters that to me were completely unknown — and frankly terrifying.  On the pediatric brain tumor listserv, …

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Medical residents and academic due process: Know your rights

Education
May 20, 2018

I recently received a call from a physician resident in the Northeast U.S. who had been notified that she would be terminated from her residency program for a “weak knowledge base.” There would be no contract offered to her for the coming academic year. She reports that her scores are no worse than several of her colleagues and that her accredited program has a history of arbitrarily dismissing residents. She …

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I was accidentally accepted to an Ivy League medical school at 17

Education
May 20, 2018

Want to hear a crazy story?

Typical medical school students can relate tales of a college experience that includes summer research or hours spent reviewing for the MCAT. I didn’t even take the MCAT. Read on for the oddest medical school acceptance story you’ve ever heard.

I was driven in high school. I’d heard for years about smart kids going off to the Ivy League, and I wanted that experience — to …

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Personal finance lessons from Shaquille O’Neal

Finance
May 18, 2018

I’m always intrigued by those who earn millions of dollars per year or even per month. Some manage to blow all that money and then some. Others, like a select few NFL players, choose to spend wisely and save prodigiously.

Today’s Saturday Selection highlights the habits of one athlete who was among the highest paid NBA stars for many years. The headlines sadly feature athletes with similar …

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Too many things need physicians’ signatures

Physician
May 18, 2018

Just sign here.

How many times a day are we asked to do this? “Just sign here.” “Just put down your license number.” “We need a stamp with your doctor’s info on it.” “Give us your NPI.” “Initial here, here, and here.”

If we took the time to read all the things we’re signing, we wouldn’t have time to do any doctoring.

The other day I was asked to hand-write the date on …

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Why some physicians thrive and some struggle to survive

Policy
May 15, 2018

I’m sitting in the waiting area across the endoscopy room of a major hospital. Mindless talk show TV runs in the background. Patients are waiting patiently. They anxiously look up every now and then from their phones towards the reception desk.

It’s a scene I’ve experienced for years while working in health care while waiting for doctors.

But there’s something different in the air now.

Patients, like those around me, will encounter a …

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How this physician became a financial advisor

Finance
May 14, 2018

Growing up with a father who is a physician made for a natural draw to medicine. However, as young people are prone to do, I did my best to rebel. Early into my undergraduate career I proudly announced to my father that I had decided to go to law school. And perhaps to dig the needle a little deeper, I told him I planned on going into medical malpractice, on …

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10 reasons why doctors spend too much money

Finance
May 13, 2018

Once every couple of years I have medical students from the local medical school over for dinner. At some point, the conversation usually turns to finance, and I commiserate with them about their loan burdens. I typically toss them a few pearls of wisdom, wish them good luck, and we move on to something else. They always think it’s funny when I say, “If you can’t live on $200K, you …

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To Paxil, with love

Meds
May 12, 2018

In 1994, Penguin Books published what would become a national bestseller titled, Listening to Prozac written by Dr. Peter Kramer, a Clinical Professor of Psychiatry at Brown University at the time. Throughout the book, he debates the ethics of “cosmetic pharmacology” a term associated with the transformation of personality traits through medication. Kramer describes several patients as becoming “better than well” on Prozac — more socially adept, less inhibited, and …

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Health care is not a service commodity

Policy
May 12, 2018

As we continue to attempt to restructure how health care is measured, reimbursed and organized, we must hold true to the idea that health care is simply not a service commodity.

“A commodity is any good or service (“products” or “activities”) produced by human labor and offered as a product for general sale on the market.” Our health care delivery model continues to evolve as we move away from the fee-for-service (FFS) model …

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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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