America leads the world in high tech care and health care costs

Policy
April 14, 2018

Why is U.S. health care so costly compared to other developed countries? A recently published report provides some insights.

In a study of 11 countries, Harvard researchers found that while the United States has the highest health costs relative to its GDP, its use of services is average. More specifically, the U.S. ranks lower than nearly every other country in doctors’ visits, hospitalizations, hospital days, and consultative services.

The difference is …

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Push back on toxic behaviors from other doctors

Physician
April 13, 2018

“Don’t get tired! Don’t f*cking move! Don’t you f*cking move, or I’ll f*cking die!”

That’s an excerpt from an OR in St. Louis on March 12th. This is just one of the outbursts that was reported from a single, multi-hour surgery — an attending’s toxic mandate to her resident, who was poised in a precarious situation under the drapes. The rest of the OR staff caught plenty of its own abusive …

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Physicians and medical students: Unlearn helplessness

Education
April 13, 2018

Learned helplessness. It’s a psychological concept marked by a perceived loss of power, and it’s prevalent in medicine. We are taught early on how little we are in this colossal world. We are told what to do, when to do it, and what we will get for it. Our objections go unheard or—worse—ignored.

Let me quote a paragraph from The Paradox of Choice by Barry Schwartz:

They were conducting a series of experiments on basic …

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Do whatever it takes to have fun and spend time with your family before it is too late

Finance
April 13, 2018

Recently I had three important events happen during a three day period that reminded me of the brevity of our life and the need to live life to the fullest every day.

On July 4th, having planned celebratory events that day with friends and family, a CRNA in my home town awoke feeling poorly just before sun up. He was in great health the day before and lived a very active …

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Financial independence: the story of the 3 brothers

Finance
April 12, 2018

There was once three brothers who set off on the journey of a lifetime by embarking on three separate roads.  Each brother was uniquely different, and quickly these roads diverged.

It was believed that the eldest brother was most wise because his path was clear and straight.

The middle brother was a strong walker but easily distracted.  It was hard to keep him concentrated on the task at hand.

And finally, the youngest …

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How physicians dress matters. Here’s why.

Physician
April 11, 2018

Anybody who has ever been to Europe, knows that fashion trends and the way people dress are very different from the United States, and generally more formal and fashion conscious (not to make a generalization — but it’s true). Growing up in England, every school has a uniform from an early age. (There are pictures of me wearing a tiny little shirt, tie, blazer, and hat to preschool when I …

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A physician thanks those who made her who she is today

Physician
April 11, 2018

To the intern on the trauma surgery service when I was a medical student: Thanks for occasionally wearing leather pants to work. Thanks for smiling and having a sense of humor despite having to round on thirty patients. Thanks for teaching us medical students while running a significant sleep deficit.

To the internal medicine resident who wanted to become a cardiologist: Thank you for indulging me and telling me how you …

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What happens to the kids of child abuse when they grow up?

Physician
April 11, 2018

As he sat in the driver’s seat and started to whistle that dreaded Willie Nelson song, my heart started racing, and my world started to spin. While most kids may be annoyed hearing their father whistling that toneless noise, terror started seeping into my very bones. I knew what that sound meant and it was no Pavlovian response, but rather a foretelling of the horror coming. Simply put, it meant …

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First date with a medical student

Education
April 10, 2018

Her: “So what do you do?”

Him: “Well, I’m applying to medical school. If I make it, I’ll spend the vast majority of my time studying for the next four years. You and I will be able to go on cheap dates occasionally, but even then I’ll feel guilty about not studying. I won’t have any money, so you’ll have to support me on your income. Otherwise, I’ll have to take …

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Why cataract surgery is more complicated than it should be

Policy
April 9, 2018

Eye surgery is a delicate business. It involves operating within an orb the size of a large marble to remove a cataract or repair a retinal detachment.

Not only is superb eye-hand coordination a must, but also an awareness of the myriad other medical issues in the elderly population most in need of eye surgery.

Traditionally, patients undergoing cataract surgery had a preoperative medical evaluation, including blood work, chest X-ray, and EKG, …

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Why your physician wellness programs aren’t working

Physician
April 9, 2018

The other day a colleague and I were discussing a topic to be presented at an upcoming conference: “How much wellness is too much wellness?” This got us contemplating. What exactly is “wellness?” Can you ever spend too much time pursuing wellness? Or is “too much wellness” merely a surrogate for a much bigger problem with the way we’re approaching wellness in the health care setting?

According to the 2018 Medscape …

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Public vs. private medical school: Which should you choose?

Education
April 9, 2018

It’s a question that reverberates in the minds of premeds around the country.

If you have a choice between multiple medical schools, should you go to the cheapest medical school available, or should you go to the more prestigious, more expensive medical school?

MD vs. DO vs. Caribbean

I think it is worth the investment to go to a U.S. allopathic (MD) school if at all possible.

It’s an unfair bias, because every medical …

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The many benefits of self-rooming patients

Physician
April 7, 2018

In 2017, the flagship multispecialty practice of Oregon Medical Group, moved into its new digs — a 46,000 square foot redesigned medical office building. Practice leaders and the 30-odd clinicians in six different specialties were committed to a coordinated patient experience. They wanted to ensure that patients could move smoothly between sequential visits with different care providers — on the same day. To this end, the group invested in a …

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The referral system to specialists: It’s a nightmare

Physician
April 7, 2018

I need your help.

I’m trying to figure out how to get rid of something that’s terribly broken in our process of taking care of patients, and I can’t do it alone.

It’s time to kill the referrals process, get rid of them altogether.

Every day, a huge proportion of the messages we receive through the electronic health record are requests for us to “put in a referral.”

Patient has low back pain, has …

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MKSAP: 41-year-old woman with burning epigastric and chest pain

Conditions
April 7, 2018

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

A 41-year-old woman is evaluated in follow-up after presenting to the emergency department 1 week ago for burning epigastric and chest pain. In the emergency department, a complete blood count and liver chemistry studies were normal, but a radiograph of the chest and upper abdomen demonstrated calcified gallstones. The pain resolved with administration …

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If you go to medical school, you will be stressed: bigly

Education
April 6, 2018

Two recent posts highlight the problems facing many medical students today.

The first was by an anonymous rising fourth-year student who has come to the conclusion that going to medical school was “a terrible, terrible decision.” It ended with a comment that medical school “is not fun. It’s jarring, scary, disappointing and absolutely depressing.”

The second was by another anonymous student who described how miserable he (or she) has been …

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The unintended meaning behind medical schools’ pass-fail system

Education
April 6, 2018

In recent years, there has been a push across medical schools to change the grading scale towards that of a pass-fail system. The appeals of a pass-fail system to me were obvious. Instead of worrying about my grades as I had in college to maintain an adequate enough GPA to get into medical school, I believed that merely passing would lessen much of the pressures I faced as an undergrad.

Those …

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When you leave primary care, you leave people behind

Physician
April 4, 2018

“The ones you leave behind …”

That phrase often connotes loved ones who have lost a family member, friend or colleague through death.

I have thought of the same phrase often lately in a different context — one of increasing prevalence.

Here, I refer to the patients and colleagues left behind by the loss of a primary physician.

No one would begrudge the retirement of a physician who has served his or her patients …

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Physicians must learn to say no

Physician
April 4, 2018

As a physician, is it acceptable to say no? After working as a hospital medicine physician across five different states and internationally, I’ve realized that saying no is actually imperative. Physicians are stretched thin, abused, demonized and expected to be superhuman when it comes to patient care. We secretly complain in online forums, we commiserate with other physicians in on-call rooms, sometimes we even seek mental health help, but rarely …

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