MKSAP: 26-year-old woman with recurrent feelings of fear and anxiety

Conditions
August 6, 2016

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

A 26-year-old woman is evaluated for a 10-year history of recurrent episodes of acute-onset feelings of fear and anxiety. These episodes initially occurred approximately 4 times per year but for the past 3 months have been occurring once or twice per month, especially when she is under stress. She describes the episodes as …

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It’s time to stop using the language of war in health care

Physician
August 5, 2016

Summer is heating up, and so is the election rhetoric. In this year’s campaign for the White House, when it comes to verbally attacking each other, neither candidate seems to recognize any limits. Personally, I think this behavior reflects poorly on both candidates.

In heath care, it’s almost impossible to escape this negativity. The media devours and thrives upon it. In our hospitals, televisions in the doctor’s lounge, cafeteria and in …

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Pass-fail is here to stay in medical schools. And that’s a good thing.

Education
August 3, 2016

Starting this fall, second-year students will no longer have the stress of grades at our medical school, Washington University in St. Louis (WashU). In extending the pass-fail system from the first year to the second preclinical year, WashU joins the other 18 of the top 20 research medical schools on U.S. News and World Report that grade the entire preclinical curriculum on a pass-fail basis. (The sole holdout is Penn, …

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You don’t have to love your specialty. Here’s why.

Education
August 2, 2016

It’s that time of year where upcoming fourth-year students are frantically preparing applications for their chosen specialties.   Statements like “I LOVE psoriasis,” and “’I’m fascinated by the colon,” are heard from eager, smiling, seemingly-passionate faces when asking preceptors for a “strong letter of recommendation.’”

But what about you? You know, the one whose specialty decision-making process feels more like being tossed into an M.C. Escher lithograph than the instant, undeniable attraction …

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10 pieces of advice for new physicians

Education
August 1, 2016

I am blessed to love being a doctor.  As the child of two physicians, and the fifth generation of physicians in my family, I had no choice but to go to medical school.  But from the first day of medical school, I loved it.  What a privilege, to know how the human body works! And I didn’t think medical school was particularly fun: I thought it was hard. The first …

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A medical student’s first trauma

Education
August 1, 2016

“Code fifty-two, emergency room.  Code fifty-two, emergency room,” blared over the loud speaker in the hospital.  Simultaneously a chorus of beepers went off, like crickets on a sticky summer day.

I glanced down at my pager that echoed the same message “CODE 52, EMERGENCY ROOM.”  The same message flashed across the screen three more times as I ran quickly down the main hallway.  Code 52 meant trauma.  I was about to …

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The worst thing about being an internal medicine intern

Physician
July 31, 2016

The only thing I love more than complaining about being a doctor is actually being a doctor. Intern year sucks. There’s no way around it. I wake up at 5:15 a.m. to get to the floor at 6:00 a.m. and I rarely leave at 5:00 p.m. when my shift is scheduled to end assuming I’m not on call until 9:00 p.m.

I often feel my stomach growl at 9:00 a.m. and …

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Don’t let these 5 reasons prevent you from becoming a doctor

Education
July 29, 2016

What is holding you back from pursuing a career in medicine? What keeps you from going in 100 percent? Have doubts crept into your life and destroyed your premed dream? Is there someone whispering in your ear that you are not good enough or this is the wrong career option for you?

There are many misconceptions about doctors and often times these are perpetuated by individuals who have never walked in a …

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Should doctors and nurses wear scrubs outside the hospital?

Physician
July 29, 2016

Every few months when things are slow, someone publishes an article about the imaginary dangers associated with doctors wearing scrubs in public. A recent version is from The Atlantic. An associate editor saw some people in scrubs having lunch in a restaurant and was, of course, horrified. She questioned the magazine’s medical editor, Dr. James Hamblin, whose response was remarkably reasoned (until the end).

He pointed out that it …

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A rude awakening for many medical students

Education
July 28, 2016

When I started medical school, I was most excited to start learning again. Having spent the last couple years as a teacher in a classroom, I sorely missed the experience of being the student. Reflecting on my college days, I missed the intellectual conversations generated in our seminars, hours poring over literature under dimly lit alcoves of the library; even the far-too-frequent all-nighters spent hashing through complex biochemical pathways with …

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What I learned from the 2 Mikes, and why physicians should be like them

Physician
July 27, 2016

They were both named Mike. Both were superstar physicians and educators at MedStar Health. Both had a wife named Pam, a son, and a daughter. And both died untimely deaths within a year of 50 at the mid-point of their ascending careers, 18 months after being diagnosed with cancer. I don’t believe they knew each other, but having worked with each of them, they will be forever linked in my …

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A letter to my son, the surgeon

Physician
July 25, 2016

It is too easy to lose your way as a physician when faced with the daily stress of real medicine. Spending time with the next generation of physicians gives me faith that we will always have a few doctors who stand out as not just competent, but caring healers.

My son is currently a surgical resident. After the break, is a letter I wrote to him when he was an intern. A …

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Benzodiazepine addiction is real. This physician shares his story.

Meds
July 24, 2016

Say the words, “drug addiction,” and most of us think of heroin, alcohol, cocaine, or opiates. However, lurking in the shadows is a less talked about epidemic: addiction to benzodiazepines, commonly known as “benzos.” I should know because after taking a nighttime dose of lorazepam (Ativan) for about ten years; I finally weaned myself off this and all other prescription sleep medications.

About twelve years ago, my father died and then …

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A medical student delays reporting his needlestick. Here’s what he learned.

Education
July 24, 2016

A few months ago, I was on my general surgery rotation on the colorectal service as a medical student. It was in the late afternoon that we started a case of a robotic rectopexy to repair a rectal prolapse. Our patient was a kind and warm 89-year-old woman. The operation finished without a hitch.

As we undocked the da Vinci machine, the resident and I began to suture closed the multiple …

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What we can learn from old school physicians

Physician
July 23, 2016

The term “old school” in many facets of life has negative connotations. We live in a modern, technologically advanced and fast-paced world — and there’s no room for certain people who appear to hold us back.

Last year I wrote an article about an experience I had with an “old school” physician. That experience really caused me to reflect on the situation the medical profession finds itself in, and …

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This is why hospice work is so fulfilling

Physician
July 22, 2016

I make my way down the aisle of the plane, squeezing past my fellow passengers and plop down in my assigned seat.  Sitting next to me is a middle-aged woman with a kind smile. As the plane takes off, she begins making small talk: ”What do you do?”

I silently debate, do I adopt my travel persona or answer truthfully?  Answering honestly will result in one of two things; either we …

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How maternity leave cost this physician

Physician
July 22, 2016

When I had my first baby, I was a busy resident trying to complete my residency on time.  I didn’t want to extend my residency even if it meant sacrificing time with my newborn.  In order to get my 8-week leave, I banked days whenever I could.  There was one period I worked 45 days straight (well, not straight, I did get the mandatory 24 hours off between once a week) so …

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The art of taking an excellent medical history

Physician
July 21, 2016

The art of eliciting the medical history requires medical knowledge, cultural knowledge, and many “people skills.”  History taking is not science, but rather, art, because it requires interpretation and clarification.  Patients with the same symptoms express them differently.  A major feature of the art of medicine involves learning how to interpret different descriptions of the same phenomenon.

A few examples might clarify these concepts.

The patient tells you that they have chest …

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I have seen both worlds, and the naturopathic one is terrifying

Physician
July 20, 2016

I find it amusing to be accused of being an unsuccessful practitioner of naturopathic medicine. I graduated with high grades from Bastyr University. I landed a highly competitive naturopathic residency. Had I remained in practice, I would currently be eligible to take the naturopathic pediatrics “board-certification” exam offered by the Pediatric Association of Naturopathic Physicians.

I was making decent money at my practices in Seattle and Tucson. By all accounts, I was …

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The cost of taking the USMLE exams is staggering

Education
July 18, 2016

Based on recent data, medical students pay approximately $136 million dollars each year in registration fees for the U.S. Medical Licensing Examination (USMLE) Step 1, Step 2 CK, Step 2 CS and Step 3 exams.

Current registration fees to take the four USMLE exams are $3,320 per U.S. medical student and $4,125 per international medical graduate (IMG).  Estimated annual registration fees for the USMLE exams …

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