Why paying hospitals for clerkships is good, and necessary

Education
April 24, 2016

Critics have been making the rounds again with a warmed-over complaint: International medical schools that offer U.S. teaching hospitals financial support for clerkship programs are unfairly buying access for their students instead of “more deserving” U.S.-based students. As the proud dean of a Caribbean medical school, I want to set the record straight yet again: This argument is hollow and based on a false dichotomy. In fact, the argument has …

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Every physician is a wounded healer

Physician
April 24, 2016

I recall during my freshman year in medical school, sitting in class and listening to what were supposed to be 50-minute lectures from people who’d been teaching the same course for years. These were highly educated and intelligent folks; they knew how much material they could cover in 50 minutes. Yet, they frequently went past their time; encroaching on what was for some a badly needed bathroom break, and for …

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Ask patients how they feel, along with how they are feeling

Physician
April 23, 2016

“How are you feeling?”

It’s a question we frequently ask patients — on rounds, in the clinic, post-operatively — and with all good intentions and gentility.  But, do we ever stop to think: What is really the point of this question?  What information are we trying to glean?  I think for most of us, we’re asking the question with a cognitive bias towards the physical.  How are they “physically” feeling: better, …

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Learn the physical exam by following an oncologist

Education
April 23, 2016

asco-logo “Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
– Sir William Osler, “The Father of Modern Medicine” (1849–1919)

In this modern era of oncology, the potential extent of malignant spread is staged by high-quality scans. Further, when …

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Medicine is the most emotional profession. This story proves it.

Physician
April 19, 2016

There you are in your father’s arms. He is practically running to keep up with the triage nurse. The nurse is walking quickly toward the room that we leave open for true emergencies and the sickest patients. Your father’s eyes are full of fear, and the nurse’s tone is worrisome.

I look down at you all snuggled up to your father’s chest. You are beautiful. So small and bright-eyed. You don’t …

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You should want surgery residents for your operation. Here’s why.

Physician
April 19, 2016

A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed …

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How to destroy a great ER: A step by step guide

Physician
April 19, 2016

I took a fantastic emergency medicine (EM) job when I finished residency.  There was no question in my mind that it was the best job within a hundred mile radius, maybe more.  When I first started, my expectations were met.  My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed.  The hospital was independent, …

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Doctors need to fall back in love with medicine. Here’s how to do it.

Physician
April 17, 2016

If you are a doctor, everywhere you hear or read about all that is wrong in medicine.  Please do not get me wrong, the medical profession is under assault.  Change is occurring all around us, and much of it has the potential to be disastrous to not only us and our families, but more importantly to our patients.  For many of us in the profession, we feel helpless.  We feel …

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Your anger towards doctors is misplaced

Physician
April 17, 2016

I learned that the 148-year-old community hospital that I did my residency at will be closing, and I am angry. Who am I angry at? Myself. Oh, and you. I’m angry at us because we as a country have turned our backs on one another. And in the end, your relationship with your own doctor is in jeopardy.

Pawtucket, Rhode Island, home of Memorial Hospital, used to be a prosperous mill …

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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:

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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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