Doctors can’t see the forest from the trees. And it’s cost them.

Physician
April 15, 2016

Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to …

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Who are the patients that stay in the hospital for a very long time?

Physician
April 11, 2016

I just finished reading a very delightful A Piece of My Mind essay in JAMA.  JAMA is primarily a research journal, filled with new scientific or semi-scientific studies and comments on those, plus reviews of the literature and editorials on science or politics. There are also letters and announcements and educational sections for doctors or patients, even poems, but the part I like to read all the way through is …

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How duty hour restrictions are hurting residency training

Education
April 10, 2016

As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues.

As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers …

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Making your own infant formula at home is a recipe for disaster

Physician
April 9, 2016

Recently, former reality television star Kristin Cavallari released a potentially lethal recipe for homemade baby formula in her new lifestyle book, Balancing in Heels.  Cavallari, who rose to fame as high-schooler on MTV’s Laguna Beach, is attempting to rebrand herself as an all-organic Suzy homemaker and offering dangerous medical advice along the way.

In her book, Cavallari goes against all conventional medical wisdom, advocating for feeding young babies a homemade concoction instead …

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American health care has a customer service problem

Physician
April 7, 2016

No, customer service in the U.S. is terrible when it comes to health care.  No, the customer service in the U.S. health care system is horrendous.  No, health care has the worst customer service of any industry in the U.S.

There.  That seems about right.

What makes me utter such a bold statement?  Experience.  I regularly hear the following from people when they come to my practice:

Permission to take my patients’ plasma. It’s a harder decision than you think.

Conditions
April 6, 2016

“I hereby authorize xxx, my patient, to donate plasma up to two times per week.”

I moved to Cleveland over the summer to start work as a full-time primary care internist. Within a few weeks, I started receiving a form in my mailbox that I had never seen during my training in San Francisco: an authorization request for my patients to donate their plasma.

By the time the fourth form came, I realized …

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Patient-centered perioperative checklists to improve surgical care quality

Physician
April 4, 2016

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

With the recent expansion of ambulatory surgical centers, the number of outpatient surgical procedures has increased at an exponential rate. Coupled with the rise in volume has been the increasing complexity of procedures and underlying diseases of patients. The convergence of these factors …

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Visualize the abnormal prostate with Medcomic

Conditions
April 3, 2016

The Abnormal Prostate

In this Medcomic, we’ll visualize three common abnormalities of the prostate.  Let’s meet our new friends. On the left is Burney and he could certainly benefit from a trial of antibiotics and an analgesic. The large fellow in the middle straining to urinate goes by the name of Turp. On the far right is Grampa Addy, currently dealing with the …

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What surgeons aren’t saying about sex after hip replacement

Conditions
April 2, 2016

As far as follow-up appointments go, this one was routine. My 65-year-old patient had undergone hip replacement surgery two weeks prior, and we discussed her pain level, progress with physical therapy, and eagerness to return to everyday activities. But as she stood up to leave the exam room, I could tell there was something left unsaid. She stepped out the door then stopped, turned around, and leaned in close to …

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How chaplains are a valuable part of the health care team

Education
March 31, 2016

As health care settings become more focused on patient experience and care for the whole person, issues of culture, diversity, personal beliefs, and values have come to the forefront. Staff are expected to deliver not only high-quality clinical care but to do so with compassion and care. Neither of these elements are new, but they are gaining attention as health care is increasingly measured on a number of quality indicators, …

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Medical school has killed my soul. What can I do?

Education
March 30, 2016

DearPamela-900x607

Hi Pamela,

I’m a medical student in the UK. Though I’ve only been in med school since September, it has already taken its toll on me. Before I started, I was so in touch with my emotions, spirituality, and nature. Now I feel so empty and desensitized. I hate that when faced with the horrible circumstances of another person, I just don’t feel …

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Are today’s surgical residents poorly trained?

Education
March 29, 2016

A surgical resident writes:

I’m sure you have read several recent studies suggesting that current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency.

My questions for you:

1. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?

2. What should we do differently? I personally don’t feel that “more simulation activities,” which …

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Why the best administrators are doctors and nurses

Physician
March 29, 2016

Over the last several years since I graduated from residency, I’ve worked in many different hospitals up and down the east coast. These have ranged from large urban medical centers to rural community outposts. In all of these places I’ve felt the inevitable conflict that exists between physicians and administrators — to varying degrees.

It almost seems like a rite of passage that the world of clinical medicine and administration are …

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Doctors are more than just skilled workers. Here’s why.

Physician
March 28, 2016

Physicians today are increasingly viewed and treated as skilled workers instead of professionals. The difference is fundamental and lies at the root of today’s epidemic of physician burnout.

Historically, there have been three learned professions: law, medicine, and theology. These were occupations associated with extensive learning, regulation by associations of their peers, and adherence to strong ethical principles, providing objective counsel and service for others.

Learned professionals have, over many centuries, worked …

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Why we need hope in health care

Physician
March 28, 2016

Hope is a tricky thing. On the one hand, false hope can lead patients to opt for painful, futile treatments at the end of life. On the other, unnecessarily bleak outlooks can lead to depression and inaction. When health is at stake, presenting information with the right amount of hope can guide patients away from both suffering needlessly and/or succumbing to treatable disease.

I was reading a sad story about a …

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What is wrong with medical students today? 

Education
March 28, 2016

This question has been circulating in the academic medical world for years. As an intern and resident, I would hear complaints about how “unready” they seemed. The grievances often include adjectives like ill-prepared, lazy,  or uninterested.  The complaints have burgeoned over time, and the examples are numerous in my institution: Students show up late to rounds with coffee in their hands; one med student had the gall to go directly to the attending and …

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This doctor quit medicine. But she really tried to make it work.

Physician
March 27, 2016

It is exactly 49 steps from my bedroom to my garage.  It is a 23-mile drive to the hospital and 75 steps to the unit.  It takes 10 seconds to walk to the nursing station.  I can measure what it takes to get me to work each morning with absolute certainty.  I know because I have measured it a million times hoping something will prevent me from reaching my destination.  …

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This doctor orders pregnancy tests on men. You’re probably doing it too.

Tech
March 27, 2016

I order pregnancy tests on men. In fact, I do it pretty frequently.

Now before you go and question my professional competency, let me assure you that I went to a good medical school. I also completed a four-year residency in emergency medicine at a top-notch residency program. I was board-certified less than one year after finishing and have maintained that status ever since.

Despite this, I still order pregnancy tests on men.

Perhaps …

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