MD vs. DNP: 20,000 hours make a difference

Physician
June 6, 2017

As Southern states entertain legislation granting nurse practitioners independent practice rights, there are some finer details which deserve careful deliberation.  While nurse practitioners are intelligent, capable, and contribute much to our healthcare system, they are not physicians and lack the same training and knowledge base.  They should not identify themselves as “doctors” despite having a doctor of nursing practice (DNP) degree.  It is misleading to patients, as most do not …

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Overweight patients are not necessarily lazy

Conditions
June 4, 2017

My nurse practitioner was pleased to see me at my annual physical this year. “So how does it feel to be 20 pounds lighter?”

“It feels terrible,” I replied.

Allow me to explain.

Weight has been an issue my entire life. Raised on a standard Midwest diet of complex carbohydrates and the best processed delicacies that government assistance could buy, I spent most of my childhood socially segregated by my peer group due …

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How can relationships survive medical school applications?

Physician
June 4, 2017

Medical school applications can raise big hairy questions about the long-term potential and trajectory of your relationship as well as the question of whether you get a say in where the applicant applies and attends medical school. For some, the timing of these questions arises in synchrony with the relationship’s natural progression that is at a time when you and your partner are beginning to discuss your long-term prospects. Other …

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It’s time for graduating medical students to celebrate their dream

Education
June 3, 2017
YouTube video

A transcript of the Loyola Stritch School of Medicine 2017 commencement speech, Saturday, May 20, 2017.

Angela Jiang: Good morning! As the class vice president, it is my pleasure to welcome Dr. Pamela Wible to our graduation. Dr. Wible is a family physician and a pioneer in the ideal medical care movement. After completing a family medicine residency and working in different family practices for over ten years, Dr. Wible …

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Why it’s hard for physicians to order fewer tests

Policy
June 2, 2017

It’s common knowledge in medicine: Doctors routinely order tests on hospital patients that are unnecessary and wasteful. Sutter Health, a giant hospital chain in Northern California, thought it had found a simple solution.

The Sacramento-based health system deleted the button physicians used to order daily blood tests. “We took it out and couldn’t wait to see the data,” said Ann Marie Giusto, a Sutter Health executive.

Alas, the number of orders hardly …

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Here’s the place where burned out physicians go

Physician
June 2, 2017

Burned out cardiac surgeon seeks opportunities or empathy,” one message reads. “I feel stuck,” another confides. A third says simply, “I don’t want to be a doctor anymore!”

The posts come in from across the globe, each generating its own thread of commiseration and advice. “I just wanted to reach out and let you know I feel your pain,” a doctor-turned-MBA replies to one surgeon. “Your story is so similar to …

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A retired physician asks: Am I still a doctor?

Physician
June 1, 2017

Monday morning and no place to go. After 35 years of practicing medicine and GI, including a year of eager anticipation, the day had arrived when there were no patients in my schedule. Nor would there be tomorrow. Nor the next day.

I was happily accustomed to a scheduled life. For me it had been decades of awakening early, working out, assembling a breakfast to inhale in the car, kissing the …

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The abscess that surprised this emergency physician

Conditions
June 1, 2017

I carried it around with me the entire shift. I showed it to my E.R. colleagues, the internists, and even a couple of surgeons. I’d tell them the story. “Never,” one of them said. “Not in twenty-eight years. Never seen that before.”

One of them held the small urine jar up to a light and began unscrewing the lid.

“Don’t!” I said.

“Why not?”

“It stinks. You wouldn’t believe how much it stinks. We …

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CSF is soap for your brain

Conditions
May 31, 2017

Recently after pulling a couple 20-hour shifts, people kept encouraging me to sleep on my break. They were obviously concerned for my well-being but it got me thinking more about the role sleep plays in our lives. If the average life expectancy is 78 then we spend 30 percent of our lives asleep which is also the same amount we spend in our cars commuting, and a meager 0.16 percent …

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6 tricks that pharmaceutical marketers use

Meds
May 30, 2017

Long before the Internet and direct-to-consumer advertising, the medical profession tried to reassure people about their health concerns. Remember “take two aspirins and call me in the morning?”

Flash forward to today’s online “symptom checkers.” They are quizzes to see if someone has a certain disease and exhortations to see their doctor even if they feel fine. Once drug makers discovered that health fears and even hypochondria sell drugs, there seems …

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Listen up GEHA: Vaccines should not be an out of pocket cost

Policy
May 29, 2017

In a little piece of legislation known as the Affordable Care Act, preventive services are mandated to be covered with no out-of-pocket expense to consumers. According to the Healthcare.gov website, approved insurance plans must cover a “list of preventive services for children without charging a copayment or coinsurance.”

Number 18 on that preventive care list is childhood immunizations for children from birth to age 18, acknowledging regional variation in the standard …

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Is there a medication that can combat rigid and robotic thinking?

Meds
May 29, 2017

I had an interesting conversation with a patient in the office some time ago.

He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel. I did not think that these laboratory abnormalities portended an unfavorable medical outcome. Beyond the medical issue, he confided to me a harrowing personal tribulation. Often, I find that a person’s personal story is more interesting and significant than …

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Seeing your gynecologist is not just for a Pap smear

Physician
May 29, 2017

Some days, I get so frustrated at work. Yes, we all have our frustrations. Maybe traffic is slow, and you get to work late. Maybe you spill your coffee on your work clothes as you walk into your office. Maybe someone calls in sick, and you are short help at work. But this is big! Like so big, it can impact the trajectory of someone’s life. They, in turn, are forced …

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To help patients, doctors should consider going on strike

Physician
May 28, 2017

Last fall I was witness to a miraculous event. I rarely take off from work, but did so on a Friday to go to Baltimore to lend moral support to my family doctor friend, Cathy Maslen. She and her workmates at Chase Brexton Health Care (a community health clinic in the Baltimore area with a focus on the gay and transgender community and the inner-city poor) were doing something that …

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The unhappy couples after a cancer diagnosis

Conditions
May 26, 2017

asco-logoThe couples I see for counseling are not always perfect, not that any couples ever are. But when cancer enters the relationship, for some couples, things get ugly and get ugly fast. I believe that we like to think that cancer makes people “better”; that people rise to the challenge and become the best they can be. I think that we …

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How to give constructive criticism as a physician

Education
May 26, 2017

Here are some questions that are still on my mind as I approach the tail end of my chief year. I’m thinking about the best ways to offer constructive feedback.

  • What is the best way to approach a struggling learner?
  • What is the best way to give guidance and feedback without being perceived as a tyrant or overbearing?
  • How can I maximize the potential of my team members and the trainees …

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4 ways to take a break from your career

Finance
May 26, 2017

My cousin visited me in sunny Cali this past weekend. She lives a life that many in the medical community can appreciate: a stable and successful job for many years, but burnt out. She then decided to take six months to work on her writing and try establishing herself through various pursuits. While successful in some ways, she decided she needed a more stable position. So she found a job, …

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Residents performing surgery: Why can’t we reach a middle ground?

Physician
May 25, 2017

A comparison of appendectomy outcomes for senior general surgeons and general surgery residents revealed no significant differences in early and late complication rates, use of diagnostic imaging, time from emergency department to operating room, incidence of complicated appendicitis, postop length of stay, and duration of post-op antibiotic treatment.

The only parameter in which a significant difference was seen was that attending surgeons completed the procedure significantly faster by 9 minutes — …

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Do expired EpiPens still work?

Meds
May 24, 2017

A small study published this month showed that most Epipens retain their potency for at least 4 years after their expiration date. That’s no guarantee, of course. I’d still recommend as a “best practice” that families replace them as they expire. But it’s reassuring to know that they’ll usually be effective even when expired. And using an expired EpiPen is almost certainly better than using nothing …

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