Debunking the myth that life gets easier once you finish medical training

Physician
November 11, 2019

Residents and fellows around the country have bought into the “medical training myth.” The myth states: “Life will get so much better when I finish residency/fellowship.”

Sadly, too many house staff buy into this false belief and experience tremendous letdown when they graduate.

Residents often see their attending stroll into the team room with a cup of coffee at 8 a.m., ready to round. Meanwhile, they think, “I’ve been …

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Debunking the myth that life gets easier once you finish medical training

How we can help our veterans die in peace

Policy
November 11, 2019

The World War II veteran, now in his 90s and receiving hospice for end-of-life care, was playing military anthems on his harmonica for fellow veterans. But the next minute, reliving the horrors of combat, he grew agitated and started to cry.  “Oh, all those bodies!” he suddenly called out. “Terrible, terrible! Oh, the bodies.” He finally blurted out what he had kept to himself for decades. Two days later, he …

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How we can help our veterans die in peace

What does a cardiologist think of the keto diet?

Conditions
November 8, 2019

Being a cardiologist, the most frequent question coming my way for the last few years is “Doc what do you think about the “keto” [ketogenic] diet.”

All foods contain both micronutrients and macronutrients that are essential for the body to function optimally. The human body requires macronutrients in large amounts, which include carbohydrates, proteins, and fats. These nutrients provide energy for your body in the form of calories. Micronutrients are nutrients …

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What does a cardiologist think of the keto diet?

A poem for the pediatrician on a Monday

Physician
November 8, 2019

It’s Monday, I recall as I step into work;
“Preparing for battle,” I say with a smirk.
Surviving all weekend with a sick kid in tow,
the parents’ relief as they waited to show
you their child with fever, diarrhea and sneezing,
the one who is too hot, too cold or is freezing,
the one who forgot that a helmet is needed,
the one who is eating too much, they conceded.
The one who still haunts you when …

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A poem for the pediatrician on a Monday

How illusions impact how we practice medicine

Physician
November 7, 2019

We can learn a lot about ourselves by looking at, and thinking about, perceptual illusions and our biases.

Look at the image above. The classic, Muller-Lyer illusion.

We know that the two lines are the same size. But no matter how much we intuitively “know” this to be true, we see the top line as bigger. We can’t unsee it — even if we …

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How illusions impact how we practice medicine

How compensation can affect physician burnout

Finance
November 7, 2019

Burnout in medicine has reached epidemic proportions. A recent systematic analysis found that the prevalence of burnout was as high as 80.5%. All medical specialties are affected, although prevalence rates of burnout vary widely between specialties.

Classically, burnout is defined as a triad of emotional exhaustion, depersonalization, and inefficacy. Recently, moral distress or moral injury has also been recognized as a potential component of Read more…

How compensation can affect physician burnout

Why diverticulitis can be an elusive diagnosis

Conditions
November 7, 2019

I have been treating diverticulitis for 30 years the same way. When I suspect that a patient has this diagnosis, I prescribe antibiotics. This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through.

It is an easy task to miss the diagnosis. Every physician has done this.

The diagnosis can be …

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Why diverticulitis can be an elusive diagnosis

What rushed patient encounters are doing to patients and physicians

Physician
November 5, 2019

Research shows that as many as 50 percent of physicians report some level of burnout that manifests as depression, dissociation, indifference, and even substance use disorders. Medicine has become focused on monetary gains by large corporations, major hospitals, and insurance companies. As much as doctors want to focus on quality patient care, they are forced to focus on electronic medical records that are cumbersome, seeing multiple patients with quick assessments …

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What rushed patient encounters are doing to patients and physicians

How the administrative burden contributes to physician burnout

Physician
November 4, 2019

acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

The administrative burden associated with caring for patients in today’s health care system has emerged as a primary driver of the loss of joy in the practice of medicine and the epidemic of burnout among physicians.

No medical specialty is immune from the upward …

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How the administrative burden contributes to physician burnout

How to structure financial incentives in our health care system

Policy
November 2, 2019

Next in a series.

In my previous post, I explained the basics of my Healthcare Incentives Framework, which enumerates the jobs we want a health care system to do for us and links them to the parties in the health care system that have the greatest incentive to fulfill those jobs. If you haven’t read that post, I recommend you read it first. For those …

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How to structure financial incentives in our health care system

MKSAP: 28-year-old woman follows-up after a pre-employment physical examination

Conditions
November 2, 2019

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

A 28-year-old woman undergoes follow-up consultation regarding a pre-employment physical examination. She reports feeling well, with no recent illness. Medical history is notable for gastroesophageal reflux disease. Her only medication is omeprazole. She is black.

On physical examination, vital signs and other examination findings are normal.

A peripheral blood smear shows …

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MKSAP: 28-year-old woman follows-up after a pre-employment physical examination

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Our healers need healing

Physician
October 30, 2019

I woke up to him, pacing the bedroom.

Within an hour, I was pacing the ER at his bedside.

Our experience at one of the country’s best-ranked hospitals lasted only three days before we were discharged home. What led us there will last a lifetime in our minds. When faced with your own mortality (or that of your husband’s), you are forever changed. We are grateful for his continued recovery from myopericarditis. …

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Our healers need healing

Patients: Be proactive in your health care

Conditions
October 30, 2019

If you’ve ever been in the hospital for a surgery, you probably had a resident speak to you about the procedure; you were presented a laundry list of risks, the benefits mentioned, asked if everything was understood. And finally, you initial in several spots before signing your name on the dotted line. You looked at the wall clock and noted that the conversation took a mere six minutes.

Is this proper …

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Patients: Be proactive in your health care

Why your doctor may be concerned about prescribing benzodiazepines

Meds
October 29, 2019

As an academic psychiatrist who treats people with anxiety and trauma, I often hear questions about a specific class of medications called benzodiazepines. I also often receive referrals for patients who are on these medications and reluctant to discontinue them.

There has been increasing attention into long-term risks of benzodiazepines, including potential for addiction, overdose, and cognitive impairment. The overdose death rate among patients receiving …

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Why your doctor may be concerned about prescribing benzodiazepines

A guide to couples matching

Physician
October 29, 2019

I consider myself one of the lucky ones because my wife and I couples matched to the same institution for residency. At the time we put our residency match lists in, we were just boyfriend and girlfriend, and the decision to couples match felt like a bigger leap forward for our relationship than deciding to ask her to marry me about a year later. It was the right decision for …

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A guide to couples matching

Should there be a disqualifying upper age limit to become president?

Conditions
October 28, 2019

The health challenge recently faced by Sen. Bernie Sanders has brought two issues to the forefront of the 2020 presidential election. Should there be a disqualifying upper age limit to become president, and should an existing health issue preclude a candidate from running for president?

As scientists in the field of aging, we cannot tell the voting public how to answer these questions. What we can do is inform you about …

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Should there be a disqualifying upper age limit to become president?

Patients are used to seeing physicians who are not their doctors

Physician
October 27, 2019

Nowadays, patients are used to seeing physicians who are not their doctors. Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician. A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that: Your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely.

The medical universe …

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Patients are used to seeing physicians who are not their doctors

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