Is direct primary care doomed to fail?

Physician
June 19, 2017

A recent Medical Economics article asked “Is the DPC model at risk of failing?”

The piece focuses on two large DPC-like organizations, Qliance Medical Management of Seattle, Washington and Turntable Health of Las Vegas, NV, working in partnership with Iora Health, which recently closed their doors. Qliance and Turntable were not actually DPC practices by strict definition; they were innovative large business operations providing health care services to patients and excluding …

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Radiologists have an image problem

Physician
June 19, 2017

Here’s a question that has been debated for several years: Should radiologists talk to patients about their imaging results?

Citing several issues, I came down solidly on the “no” side in a 2014 blog post.

Two major radiology organizations have committees looking into the concept, and New York Times article said, “they hope to make their case [for it] by demonstrating how some radiologists …

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Test prep companies are more powerful than medical school

Education
June 18, 2017

High-stakes standardized testing is an enduring facet of medical education, and the standardized test that is on every medical student’s mind is the USMLE Step 1. The paramount importance of this test for getting into residency creates a demand for high-quality test preparation materials. Established test prep names like Pathoma, Sketchy Medical, First Aid and UWorld fill that demand in a market consisting of more than 40,000 test takers worldwide …

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Interested in being a locum tenens physician? Read this first.

Physician
June 16, 2017

I receive a significant amount of email in response to my blog posts about locum tenens work. Curious colleagues (from surgeons to internists and emergency medicine physicians) ask for insider insight into this “mysterious business” of being a part-time or traveling physician. I am always happy to respond individually, but suddenly realized that I should probably post these conversations on my blog so that all can benefit.

The most common question …

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Observing Ramadan as a medical student

Education
June 14, 2017

3 a.m. The alarm blares. Get up, make food, study. Maximize caffeine intake, maximize studying efficiency.

4:12 am. Take the last sip of water, pray. Maximize studying with residual caffeine power.

7 a.m. Get dressed, go to work. Stay awake, stay alert, see patients, present well, regurgitate answers, retain information. Produce saliva, clear dry throat. Study during lunch break. Stay awake, stay alert, see patients, present well, regurgitate answers, retain information.

6 p.m. …

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Medical school is miserable. Here’s the secret to surviving it.

Education
June 13, 2017

Dear future medical student:

It’s graduation week. I’m running into people I haven’t seen in a long time. There are a few things on my mind currently, and in four years, you’ll have the same conversations.

“Did you have so much fun in med school? Did you love it?”

“No.”

“Wow! Those four just FLEW by, didn’t they?”

“No. They absolutely did not.”

“Well just WAIT ‘til you get to residency. THAT was hard. What you …

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The slow death of private practices

Physician
June 13, 2017

Doctors have been bemoaning changes in the practice of medicine for years and with good reason. It’s harder and harder to make a go of it in private practice. In recent years our area has lost several small practices — Hal Grotke’s Redwood Family Practice closed, Dr. Garcia retired, Teresa Marshall’s solo office shut its doors, Eureka Internal Medicine transitioned to Humboldt Medical Specialists (which then became St. Joseph Hospital …

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Stop asking doctors for free advice

Physician
June 12, 2017

My husband is a doctor. Similar to any other career, this is what he spends most of his time doing. It’s also our family’s livelihood — how we pay our mortgage, our bills and send our daughter to preschool.

He went to through seven years of training after college, often working all night or even 24-plus hour calls. He’s had to miss family dinners, birthday parties, nights of putting our daughter …

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Doctors: You have a PR problem

Physician
June 12, 2017

Over the last few decades, public perception of physicians has been on the decline. Many issues are to blame, but a largely overlooked contributing factor is the media. Physicians are often portrayed negatively, with stories of narcotic abuse, greed and medical mistakes dominating the news. Rather than fight back, physician organizations have stood silently and allowed their reputations to be tarnished. On the other hand, nursing organizations have been busy …

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Better care: Private practice or academic center?

Physician
June 12, 2017

Throughout training, I had an idea. And that idea was — I would be a great academic physician. I had the right training. I had done research from college through fellowship. I had received research grants from medical school through fellowship, published numerous papers and started defining a niche. Everything was going great.

Academia — here I come!

Then attending-hood arrived. I looked for positions in academic centers. I was limited by …

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How a one-time bridging prescription became an every time refill

Meds
June 11, 2017

At what point, we have to ask ourselves, does a medical error that we do over and over again cease to be an error, and simply become business as usual?

At one of the patient safety conferences this week, where we reviewed sentinel events that occurred in the hospital and in the outpatient setting, one of the cases was about a patient who developed an abnormal cardiac rhythm as a result …

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MKSAP: 37-year-old man with low libido and fatigue

Conditions
June 10, 2017

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

A 37-year-old man is evaluated for a 2-year history of low libido, loss of morning erections, fatigue, and decreasing muscle mass. His medical history is otherwise unremarkable. He takes no medications.

On physical examination, vital signs are normal. BMI is 35. The remainder of the examination, including genital examination, is normal.

Laboratory studies:

Luteinizing hormone 10 …

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This is what it’s like to be a military physician

Physician
June 7, 2017

After another long shift of patients with colds, bug bites, ankle sprains and sore throats I eagerly looked through the wine selection at the local grocery store. It was my wedding anniversary and nearing 9 p.m. at the beginning of a holiday weekend. While at the checkout line, an elderly woman in front of me thanked me for my service. At that moment, I realized that I was wearing my …

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A nurse was raped and tortured at her hospital. Here’s what you can do to help.

Video
June 6, 2017

A inmate, while a patient at Delnor Hospital in surburban Chicago, escaped and took two nurses hostage.  One of nurses was raped and tortured at gunpoint.  There is little mention of this horrific story in mainstream media.  Violence against health care workers cannot remain silent.

ZDoggMD recently spoke with this individual, who shared her story. #silentnomore

Please send your notes of support to her:

Delnor Nurse
PO Box …

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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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