Facility fees are ruining quality care

Policy
May 1, 2017

The Affordable Care Act Medicaid expansion resulted in unanticipated negative consequences for many patients and physicians in rural, underserved or medically isolated communities across America. Consolidation of health care entities was financially incentivized by the ACA, and slowly my beloved corner of the Pacific Northwest is becoming a medical wasteland.

In a beautiful community on the Olympic Peninsula, just north of where I live and practice, it happened again; another private …

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MKSAP: 29-year-old woman with nodules over her lower extremities

Conditions
April 29, 2017

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

A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, and she takes no medications.

On …

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What medical school fails to teach

Education
April 28, 2017

This May, I will graduate from medical school. I will also be part of the first group of medical students to graduate from its new Literature and Medicine track. To me and the other participants, this has been one of the most important components of our medical education. In many ways, it has kept us grounded, serving as a constant reminder that there are experiences different from our own.

We know …

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Face it, doctors are bad leaders

Physician
April 27, 2017

As physicians, we are seen as leaders whether we like it or not. And as such, we are charged with modeling greatness. But do we? Our training, while teaching us to be experts and authorities, does not teach us how to be leaders. However, somehow we get out into practice and are automatically seen as leaders, and thrown into positions that require a skill that we don’t have. And we …

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The hardest thing to do as a physician

Education
April 26, 2017

I’ve been told that one of the hardest things that a physician endures is the passing of her first patient. However, what I imagine to be even more challenging than this is pronouncing the death to the patient’s family for the first time. Although I find myself in a similarly intimidating and burdensome position of addressing the loved ones of our gracious donors tonight, for my first time, I feel …

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Top 5 reasons why doctors lack self-confidence. And how to fix it.

Physician
April 26, 2017

In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back.

What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and compassionate humanitarians. Soon, we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? Attention, medical …

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The dangers of being overly apologetic

Physician
April 26, 2017

“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other.

“Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave …

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If she gets pregnant, she might die. Do I help?

Physician
April 26, 2017

When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability of allowing a patient who refuses necessary blood products to die. For this reason, these institutions are not welcoming to Jehovah Witnesses. This is of special concern in surgical specialties …

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A letter from my med student self to me now

Education
April 25, 2017

Dear Me, MD:

Now that you have opened this letter, you may have graduated or maybe you just matched into residency — somewhere, anywhere, hopefully?! As you read this, it should be some time during spring 2017. But, you never know, sometimes the train derails, and it takes a little longer than expected, so forgive yourself if that is the case. You learned a while back that the fast lane is …

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It is not a great time to be a pharmaceutical rep

Meds
April 24, 2017

More than a decade ago, the job of the pharmaceutical rep was enviable. Direct-to-consumer advertising pre-sold many drugs so doctors already knew about them. Medical offices welcomed the reps who were usually physically attractive and brought lunch. In fact, reps sometimes had their own reception rooms in medical offices.

By 2011 thanks to drug safety scandals and new methods of marketing, the bloom had fallen off the pharma …

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How I went from the bottom to the top 1 percentile on board exams

Education
April 24, 2017

Most doctors are very bright people. I believe that what often sets apart those who perform well on the job and on exams isn’t raw intelligence but rather the ability to learn effectively.

In the MCAT and USMLE steps 1, 2, and 3, I did poorly and barely passed. In 2009, I took my family medicine in-training exam and fell below the minimum passing score. After taking almost five years away from residency …

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A cancer scare changed my life in 7 seconds

Physician
April 23, 2017

So there I was — in deep denial. Maybe you’ve been there: Ignoring the symptoms. Hoping and praying that it would just “go away.”

A little knowledge is a dangerous thing. And as a doctor, I like to think I can Google with the best of them.

So when I had a persistent scary symptom (full disclosure: it was bloody discharge from my left breast. Not subtle. Not intermittent. Not OK, even …

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Watch what you say to patients

Physician
April 22, 2017

Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their personal role in the genesis of this problem. Our words matter. They can reverse the good we do with our medications and procedures.

If you are a heart …

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MKSAP: 68-year-old man with new-onset ascites

Conditions
April 22, 2017

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

A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, …

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Welcome to planet medicine

Education
April 21, 2017

Welcome to planet medicine, where four rides around the sun earns you a golden ticket to study more, to train more, and to enjoy splicing two sacred letters onto the end of your title. The days are long, the weeks go fast, and sleep is optional. In this world, all-star draftees leave their immaculate collegiate careers as masters of memorization and intellectual puzzle solvers only to still be no more …

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Normal aging: A steady loss of organ and process function

Conditions
April 20, 2017

Part of a series.

The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again.

There are many …

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