We must make the word “diagnostician” the most prestigious term in medicine

Conditions
August 16, 2017

The Society to Improve Diagnosis in Medicine has on its website this quote:

  • 1 in 10 diagnoses are incorrect.
  • Diagnostic error accounts for 40,000-80,000 U.S. deaths annually — somewhere between breast cancer and diabetes.
  • Chances are, we will all experience diagnostic error in our lifetime.

The current focus on diagnostic error raises an interesting question:  Is this a larger problem in 2017 than in the 1970s and 1980s?

In this post, I …

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Why pediatricians should not kick out unvaccinated children

Physician
August 15, 2017

We in the medical community believe wholeheartedly in the prevention of all illness, especially by vaccination. Science and history continue to show that vaccination dramatically decreases both the mortality (death rate) and morbidity (severity of illness) of infectious diseases. And, more than 98 to 99 percent of the general population (non-medical) agrees with those statements as well.

Yes, it is absolutely frustrating when parents refuse to follow our advice and protect …

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The problem with the free market in health care

Policy
August 14, 2017

Competition often works. Competing dry cleaners or donut shops must either improve the quality of their product or keep their prices low, or customers will go somewhere else for their cruller fix. In time, the better businesses — the ones that provide tastier pastries at a lower price — will thrive, and less-good, more-expensive businesses will go away. In the long run, all customers benefit from competition between businesses.

That’s how …

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Residents need to learn medicine, not how to pass a test

Education
August 14, 2017

In his famous novel, Moneyball, Michael Lewis illustrates the phenomenon of professional baseball scouts focusing on all the wrong characteristics when looking at players. He describes how scouts focus on fastball velocity as a way to compare pitchers, despite the lack of correlation between fastball speed and the quality of a pitcher. As it turns out, the most important factor in a pitcher is deception, not a high-velocity fastball. The …

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A nurse was attacked in the emergency department. This is her story.

Conditions
August 14, 2017

Victim: Female nurse, age 25

Time: circa 1980

Place: A hospital in a sleepy Southern town with fifty beds, six emergency department beds, one nurse, one doctor and one secretary.

It was an unusually quiet Friday night in this small emergency department.

We all knew Friday was “party day”: pay day, play day, alcohol, pills, drugs, loud music and lots of really bad decisions.

Not only did we cover the entire city, but we also …

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As a physician, you will fail at your job in these different ways. Learn from them.

Physician
August 11, 2017

To me, five years ago:

Right now you are 28, seated at the top of everything: chief resident of the entire pediatric department. You are in charge of 19 other interns and residents. You are resilient, kind, funny and determined. You seem to have the solution for everything, yet you don’t actually have the answer to anything. At least that’s how you’ll feel on most days in your new leadership role. …

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Turn physicians into powerful health care influencers

KevinMD
August 11, 2017

Physicians have so many tools available to us that can turn them into powerful health care influencers.

A KevinMD keynote video excerpt.  I’m currently considering opportunities for 2018: Please visit my physician keynote speaking page to find out more.

Doctors: You’re just as unhealthy as your patients. Here’s why.

Conditions
August 8, 2017

Most people reading this would love to lose weight, feel better and live longer. Doctors are a smart and motivated group of people. Unfortunately, that intellect and drive has not prevented us from avoiding an increasing incidence of obesity, diabetes, and hypertension identical to the general population.

While this article may have started out sounding like an infomercial, I promise it will not end like one. …

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Why I got into medical school and chose not to go

Education
August 8, 2017

Imagine taking the MCAT, applying to schools, getting interviews and even being accepted into medical school. How would it feel knowing your dedication has paid off? I felt great, as I had studied hard and made sacrifices others were unwilling to make. As I saw the finish line for what would be the beginning of medical school, I began to ask myself, “Should I continue onwards toward medical school or …

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Love something other than medicine? It’s OK.

Education
August 8, 2017

When I entered college, I wanted to be a chemistry major. I had no idea what college chemistry would be like, but it was the class I loved most in high school and something I was pretty good at. The town I grew up in had little more than 3,000 people and more gas stations than stop lights. My school didn’t have Advanced Placement classes or partnerships with local hospitals …

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How long should I take antibiotics? Exploring the Goldilocks problem.

Physician
August 5, 2017

Antibiotics save lives, but antibiotics can have negative effects.  When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration.  So we have a Goldilocks problem — we want antibiotic duration to be just right — neither too short or too long.

Some clinical conditions have adequate research to define the Goldilocks duration.  Community acquired pneumonia only …

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Inappropriate patient behavior is not OK

Physician
August 4, 2017

“OK, one more patient to go,” I said to myself with my eyes quickly scanning the patient list in my hands. I was in the elevator, going up the spanking new glass tower in the giant tertiary care hospital I call my workplace. Today was turning out to be a better Monday than usual. I had worked over the weekend, so I knew the patients. And there were no major …

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3 reasons why July 1st should be a day to celebrate

Education
August 4, 2017

Fireworks, champagne toasts, sparkly hats, and the ball drop are all items that we conger up in our minds as we think of the New Year. For the majority of the world, January 1st represents the transition from one year to another on the calendar. New resolutions are made, and there is a global fresh start. However, for those of us in the medical field, there is another new year …

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10 reasons why being a doctor is a privilege

Finance
August 3, 2017

I feel privileged to be practicing medicine. Many people consider doctor careers and imagine how great it may be. Is it the right thing for you? Yes there are days of frustration, exhaustion, and utter defeat, but at the end of the day I home and know that I helped at least one person if not two from the 16 I meet.

The fact that I alleviated one individual’s anxiety or …

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Let’s talk about the ethics of breastfeeding

Conditions
August 2, 2017

In the spirit of World Breastfeeding Week, I want to highlight all we can about breastfeeding; why it’s great for you and your baby, some ways to make it easier, and how to manage common challenges.

But one challenge that often gets ignored in the offices of doctors and lactation consultants is the issue revolving around the ethics of breastfeeding. That is, addressing uncomfortable questions like these:

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Deep extubation is a useful technique for any anesthesiologist to master

Conditions
August 1, 2017

There are two schools of thought about how to extubate patients at the conclusion of general anesthesia:

Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patient’s head bleats, “Open your eyes!  Take a deep breath!”

Or:

Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence …

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When an erythrocyte sedimentation rate leads to a serious diagnosis

Conditions
August 1, 2017

In Sweden, back when I trained, three blood tests were the “routine labs” done at most doctor visits: hemoglobin, white blood cell count, and erythrocyte sedimentation rate. I’m trying to remember, but I don’t think everyone waited an hour to see the doctor, so they must have used a modified rapid sedimentation rate.

The “sed rate,” or “sänkan” as we call it, was invented by Robin Fåhraeus, a relative of one …

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Does the public shaming of Carmen Puliafito go too far?

Physician
August 1, 2017

Recently, the Los Angeles Times broke a story that Dr. Puliafito, former Dean of the Keck School of Medicine of USC, had been abusing drugs and keeping company with a group of younger individuals who engaged in drug use and illicit activity.  Much of this activity occurred while he was dean, and it is a shocking story: A 66 year-old titan of the field of ophthalmology, renowned for inventing …

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Health reform should simplify our health system. Here are some ideas.

Policy
July 30, 2017

We are a nation divided. Our two major political parties agree on essentially nothing. Republicans cannot agree even amongst themselves how to proceed on health care reform. It is demoralizing that even though U.S. health care has sunken to last among developed nations, our elected leaders are unable to envision or agree upon any effective solutions. We could all use a win. When it comes to health care reform, administrative …

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