Don’t forget this common trigger of cyclic vomiting syndrome

Conditions
May 21, 2019

There is a condition known as cyclic vomiting syndrome which causes people to develop episodes or “attacks” of frequent vomiting lasting for a few days at a time without an apparent cause. Sufferers of cyclic vomiting are totally fine between episodes … it’s kind of like a migraine of the upper gastrointestinal tract! Just like treating migraine headaches, treatment of cyclic vomiting syndrome is aimed at identifying and removing triggers, and using …

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Celebrities are bringing a myriad of health conditions into the public consciousness

Physician
May 21, 2019

It seems now as if every day and every month is associated with a “national day” or an “awareness month.”  Some such as “national taco day” may be less important than others, well depending on one’s priorities.  Although many illnesses now also have a dedicated day or month, many of these diseases will go unnoticed.  They will rarely be discussed — that is until a celebrity or someone in the …

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The financial disadvantages of being a doctor in California

Finance
May 20, 2019

Geographical arbitrage is a huge component to being able to build wealth in a timely manner.  For doctors, the formula for rapid wealth accumulation calls for geographical arbitrage even more strongly as our salaries do not have wide ranges across the country.  A doctor in Texas will probably command a similar salary in Arizona (maybe slightly less).  A doctor in the midwest might earn more, spend less, and work less …

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No, the HPV vaccine isn’t optional

Meds
May 19, 2019

A lot of parents ask me about the HPV vaccine, “Isn’t that the optional one?” Well, let me walk you through why my answer to that question is a hard “no.”

Human papillomavirus (HPV) is a virus that causes warts and several types of cancer. There are over 200 different strains of HPV, some of which tend to cause warts on the hands, feet, or face. Other strains …

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A medical student’s first patient presentation

Education
May 18, 2019

In medical school, you’re not taught how to give stellar patient presentations. Yes, you’re shown the traditional order of things: “Give an effective one-liner first, then tell the HPI [history of present illness] but only give pertinent info, etc.” Just exactly how to deliver the punch that impresses your attending is an art. And it’s an art that takes some time to perfect.

My very first time presenting a patient was …

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Medicine was consuming this medical student. Was it worth it?

Education
May 18, 2019

For as long as I remember, studying medicine has always been the goal I focused on the most. For years, I thought that I knew the path I was taking, and that I calculated the benefits and drawbacks. However, with time, I learned that no matter how much one assesses his decisions, one cannot have a full grasp of it, until he/she “begins” to experience it.

I wasn’t aware how much …

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Should we write that patients are “pleasant” in medical notes?

Physician
May 17, 2019

When writing medical notes, some clinicians include an appreciation of their patient’s personality and disposition in their opening line (the “chief complaint”), or when they’re wrapping up (in the “assessment and plan”), or in both locations.

You know — it goes like this:

“CC:  Ms. Smith is a very pleasant 62-year-old woman admitted with …”

or:

“A/P:  To summarize, Mr. Jones is a delightful 89-year-old man presenting with …”

or:

“CC:  This lovely 74-year-old retired school teacher was in her usual state of health …

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The simplest and most important question to ask in the exam room

Conditions
May 16, 2019

It was the first time the young woman had come to the health center in a suburb just north of Chicago. When the 26 year old walked into the exam room back in 2008. There was no paper chart or electronic health record (EHR) accompanying her, no background information — nothing to indicate anything but a routine annual gynecological exam.

She and her husband were about to try to have their …

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The problem with burning health insurance down

Policy
May 16, 2019

Let’s burn health insurance down. Greedy corporate bastards should burn. Big Pharma and big hospitals should probably burn too. You know who else is really, really, bad? Wall Street. Let’s burn the banks. And let’s burn Big Tech and the entire Silicon Valley cartel. Let’s also burn Big Agribusiness that’s making us fat and sick. And let’s burn the Oil companies that are destroying the planet, and let’s burn the …

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How a Minnesota Supreme Court decision could affect curbside consults

Physician
May 16, 2019

“In a case that could have wide-reaching implications for medical practice in Minnesota, the Minnesota Supreme Court issued a ruling on April 17 in the case of Warren v. Dinter holding that the existence of a physician-patient relationship is not a prerequisite for a medical malpractice action. Rather, a person may sue a physician for malpractice – even if that person was not a patient of the physician – if the harm …

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Second victim syndrome: a doctor’s hidden struggle

Physician
May 15, 2019

As physicians, we have embraced a calling where we help others. A commitment many of us fully relish. We are grateful for our patients and the families who put their trust in us as we diagnose and treat their sometimes incredibly complex illnesses. I have been genuinely inspired by the stories I have heard from patients and my colleagues on the work we do.

Yet, in spite of the incredible advancements …

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The truth about Caribbean medical schools

Education
May 15, 2019

I graduated from St. George’s University School of Medicine in Grenada and now work as an emergency medicine physician at a trauma center in Northern California. To some, that may seem like an extreme jump or a rare success story. The stigma of a Caribbean medical school education is built on rumors — and they’ve run their course. Let’s address some.

1. Students only go to Caribbean medical schools if they …

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Treating a VIP benefactor of a hospital

Physician
May 13, 2019

My local hospital has been petitioning the local city zoning board for permission to build an on-site parking garage for years now.  The city zoning board is very strict about the height of buildings and has turned the requests down repeatedly.

This past fall, the hospital administration announced that it needed a capital partner to expand and stay solvent.  Most of the members of the hospital medical staff have absolutely no …

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Why would adult children disapprove of their parent’s happiness?

Physician
May 13, 2019

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Going through the process of diagnosis, treatment decision making, and often lengthy treatment without a partner can be challenging. While children, friends, and other family members are supportive, for the single individual, there is no one to talk to in the middle of the night when fear and doubt often surface. I often counsel people who have finished treatment for their …

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Physicians: Don’t let administration intimidate you

Physician
May 13, 2019

One of the things I am most grateful for, as a doctor who has worked in at least a dozen different hospitals over the last decade, is the broad range of experiences I’ve had and the variety of physicians I’ve met and gotten to know. I enjoy hearing experienced physicians’ perspectives on how the practice of medicine has changed from what it used to be in the 1970s to 1990s.

I …

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Questions about physician disability insurance answered

Finance
May 12, 2019

As resident physicians with a tight budget, one of the last things on our mind is paying for added insurance. Trust me; I get it. However, as a [future] high-income earners, long-term disability insurance is essential. It may not be at the top of our priority list, but it should be.

What is it and who needs it?

Unless you are already financially independent or were lucky enough to have a trust …

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The brutal emotional challenge of medical training

Physician
May 12, 2019

I can vividly remember the day the phone call came. My cousin screaming over the phone, trying to make out words but unable to speak, disbelief, horror, the fear in her voice palpable even though she was thousands of miles away. It was barely 5:30 a.m., I was frantically rushing out to beat traffic, hoping to get a head start on pre rounding since I was on call. Confused, I …

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Want to create a review course? Here’s how this physician did it.

Education
May 11, 2019

When I told my colleagues that I was going to try to create the first psychiatry review course at the University of Toronto, I received the same two responses: “It’s about time somebody did that!” and “What is wrong with you?” — sometimes from the same person!

The first reaction taps into the excellence of our department. With approximately 1,000 faculty with diverse expertise and the largest residency program in Canada, …

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