MKSAP: 52-year-old woman with shortness of breath

Conditions
April 6, 2019

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

A 52-year-old woman is evaluated during a follow-up visit. She was discharged from the hospital 3 weeks ago following a small non–ST-elevation myocardial infarction treated with drug-eluting stent placement in the right coronary artery. An echocardiogram obtained during hospitalization showed normal left ventricular function and normal valvular function. Her …

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Can you put me to sleep? Why ER physicians have to say no.

Physician
April 2, 2019

The heavy young man curled on his left side is in the ER for a pain in his backside. The sweaty blue dragon on his chest smells like fear.

“It’s an abscess. I’ll have to open it. It’s gonna hurt.”

“Can you put me to sleep? I hate pain.”

I can. Should I? Remember Michael Jackson? I do.

His neck would make a Hereford bull proud; he’s missing a chin but he’s got a …

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An emergency physician does a tooth extraction

Conditions
April 2, 2019

I was working a few days ago and pulled a tooth.  Mind you, it’s not something I do with any regularity.  However, it was a very sweet little lady who was too weak and ill to get to the dentist and had other issues.  That lower incisor was loose, and constantly in the way. Furthermore, it was painful.

I had seen her for something else in the emergency department.  I took …

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13 tips every pre-med student should know

Education
April 2, 2019

If you’re reading this, you may have a son, a daughter, a family friend, or know of someone who is in college and considering medical school. As a medical student mentor, I share words of advice to my alma mater’s American Medical Student Association chapter and thought I would share them here.

1. When preparing for the MCAT, take a diagnostic test at the beginning of your study period, one in …

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Appreciative and respectful of my privilege in caring for elderly patients

Physician
April 1, 2019

I dedicate this to each of you who have cared for or are currently caring for an ill parent or family member. 

Recently, due to the stress that several of my dearest friends have been experiencing in caring for their elderly parents, I am even more appreciative and respectful of my privilege in caring for elderly patients who have attentive and loving adult children who accompany them to our ER.

Although this …

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A tragic Fentanyl story without redemption

Physician
April 1, 2019

Matt was 40, my sister’s age. He was training for a marathon and trying to talk his many friends into joining. He lay in bed with his three-year-old son every night to help him fall asleep. It’s hard to sleep train a toddler with a newborn to nurture at the same time, but he loved spending this time with his two kids and being the dad everyone counted on.

Matt’s best …

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Real estate syndication 101: a physician’s guide

Finance
April 1, 2019

Many physicians are looking for alternative sources of income and are looking for ways to diversify their investment portfolio from the volatility of the stock market. Some have heard of real estate syndications, but what exactly is a syndication? For those who have not heard of it, real estate syndications can be an attractive investment vehicle for busy professionals who do not have the time or experience to actively manage …

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I don’t plan to buy a home after medical school. Here are 12 reasons why.

Finance
March 31, 2019

I’m a graduating fourth-year medical student, and as most physicians know, this has been one of the best years of my life. I just matched into my top choice residency and am one step closer to becoming a primary care sports medicine physician, my dream job. Many of my classmates have capitalized on this time of excitement by making the controversial decision to buy a home before they start residency. I have not. …

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Do not take medical tests as gospel

Conditions
March 31, 2019

During my time in practice, I had at least eight patients who came to me sure they had systemic lupus erythematosus, also commonly called SLE or lupus. This is an autoimmune disease, characterized by joint pain, that can affect almost any organ, including skin, kidneys, brain, and heart, and can even be fatal. In every case, they had been given this diagnosis because of a blood test called an ANA, …

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How physicians can find meaning in their work

Physician
March 29, 2019

“Seriously, do you often/very often reflect on how your work helps make the world a better place?”

I was recently involved in an email exchange with a colleague when she sent me this line. We will get to the answer to that question at the end. I was disappointed, but not surprised because until about three years ago, I probably would have answered, “No.” However, I have had a paradigm shift …

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The financial barriers of applying to medical school

Education
March 28, 2019

In May 2018, it happened. The American Medical College Application Service (AMCAS) opened its floodgates. As we wrapped up our last years in undergrad, we felt a twinge of excitement as we finally began applying to medical school.

But we quickly found one thing that wasn’t all-too-exciting: the bill. In 2018, the AMCAS charged $170 for the first school applied to and $39 per additional school. Like most medical school applicants, …

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Remembering Dr. Denton A. Cooley

Education
March 28, 2019

Back in the 70s, Dr. Denton A. Cooley would do eight or so heart operations a day often on babies and children with heart defects. One day, he operated on four babies. Three of them died. It was around eight o’clock at night, and as Dr. Cooley walked down the hall with his team, he said, “Today was a bad day, but …

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The sweet path to hell: addiction in medical professionals

Physician
March 28, 2019

K: “I was assaulted by an intoxicated female. She punched me and ruptured two discs in my back. I lost my whole self. I could no longer take the CPR course required. I lost my income that was supporting me and my three children.

I needed the narcotics — not only to dull the physical pain but to numb the emotions. I found myself taking more than prescribed. I asked the …

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Fixing burnout among hospitalists is a leadership challenge

Physician
March 28, 2019

“Happiness is when what you think, what you say and what you do are in harmony.”
– Mahatma Gandhi

Burnout among physicians is at an epidemic proportion. National data suggests that more than 50 percent of our workforce is burned out, and this trend has been across the board from physicians in training to practicing physicians. Some of the specialties are more affected than others. Repercussions of provider burnout on health care …

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How Big Medicine is hurting patients and putting small practices out of business

Policy
March 27, 2019

Recently the CEO of a large health care network stated: “Market forces don’t apply to health care.”

Of course, economic and political forces apply to health care.  Big Medicine’s most powerful entities (insurers, hospitals, medical schools, pharmaceutical companies, pharmacies, and government agencies) formulate health care policy to enrich themselves at the expense of patients and small, independent medical practices.

As an independent family doctor, my practice’s existence is in jeopardy.  Small physician …

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Hospice didn’t stop suffering. But what it did for us was priceless.

Physician
March 27, 2019

My wife Uzma died peacefully at home. She didn’t take any painkillers for her last three days. Our kids, my parents, and I were next to her. In the weeks leading up to her death, many old friends visited her. Others sent her flowers, cards, and food. It was a good death. Yes, in the last five years cancer and its treatment took a physical and emotional toll. Yes, she left us a …

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Medical care was never intended to be daily fights against insurance companies

Conditions
March 27, 2019

Last month I saw Joan, a woman who has had low back pain for years. She’d been through the ringer like every other person in severe pain: countless procedures and medications. She continued to have daily pain that stopped her from staying focused at work, playing with her kids or being the spouse or friend she wanted to be.  After our long consultation and review of her records my prescription …

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Take the naloxone challenge

Meds
March 26, 2019

Last week I took the naloxone challenge. I walked up to a pharmacy window, waited in line, and requested naloxone from the pharmacist. She showed a supportive but knowing look, and I became acutely aware of the four people in line behind me. After giving her my name and date of birth, she was able to pull my insurance info from prior visits, and I left with a dose of …

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It’s time to acknowledge the developmental behavioral pediatric workforce

Conditions
March 26, 2019

There are roughly 15 percent of the nation’s children who suffer from a developmental-behavioral condition or about 1 in 6 children. Unfortunately, many of those children often do not get the help they need.

Children with developmental and behavioral challenges can easily be missed, especially when the behaviors are more subtle or impacts on function are not evident daily, such as with a …

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