Maternity leave for physicians is a disgrace. It’s time to fix that.

Physician
October 22, 2015

Netflix listens to doctors.  Google, Facebook, and Apple listen to doctors.  The United States Navy and Marine Corps listen.

The above companies have updated their maternity leave policies — lengthening them all past 12 weeks.  And all paid.

But yet, health care doesn’t listen to doctors.  And let me tell you how.

I am pregnant.  Which is a blessing in of itself.  In fact, this is my 4th pregnancy, but I only have one child living. …

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This epic EHR video may save our relationship with patients #LetDoctorsBeDoctors

Tech
October 19, 2015
YouTube video

I have a love-hate relationship with the electronic health record (EHR).

To be precise, it’s 90 percent hate, 6 percent love. The missing 4 percent? That would be the percentage of time spent on the phone with tech support trying to figure out which order set I have to use to input percentages.

I’ve been in practice long enough to straddle the transition from paper … to even more paper (thanks EHR, you’re the …

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A medical student’s psychiatric hospitalization

Education
October 19, 2015

“You work here?!”

I nodded, a hint of a smile revealing my bemusement at his incredulity.

“Well … probably not after this.”

The other patients in the psych waiting area of the ER nodded in agreement. In my newly issued brown scrubs, stripped of my belongings, I was no longer a research coordinator at a top hospital, but rather one of them. And sadly, they believed being one of them meant you couldn’t …

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5 tips for physicians to achieve financial freedom

Finance
October 18, 2015

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In the ten years since I graduated from residency, I have noticed an interesting correlation between burnout and finances among my physician colleagues: The more secure we are financially, the more we enjoy our work. However, physicians working long clinic hours and moonlighting 15 times a month as a hospitalist in order to make alimony payments, boat payments, mortgage payments, or all …

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Lab coats and scrubs don’t make the physician

Physician
October 16, 2015

I was working at a small hospital when I heard the nurses talking about a new rule. The rule was that the only people who could wear lab coats would be physicians and administrators. It made me laugh a little. I’ve hated lab coats since medical school.

I currently sport what a family medicine resident told me was the ER mullet: khakis and polo shirt. (Who knew?) I find it much …

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When doctors stalk their patients

Tech
October 16, 2015

I peeked. Several months ago, I met a 60-year-old woman with shortness of breath. Her hospital stay was a whirlwind. She had lost weight, and a test detected her stool had blood in it. This was an ominous sign. Within a few hours, she underwent a colonoscopy that revealed she had colon cancer. The colorectal surgery team whisked her away from my general medicine team. I soon left that hospital for …

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The day I went to work and met a real vampire

Conditions
October 15, 2015

It all started out seeming like a pretty routine visit. My patient was in her early 30s and had come into the emergency department for weakness and was in no distress.

As I was talking with her about her symptoms she would flash the occasional smile. It was then I noticed that she had fangs. Not the kind that some people naturally have from misaligned teeth, but she had really long, …

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An emergency in public: When should doctors help?

Physician
October 12, 2015

Recently, Pope Francis visited Philadelphia to finish out his five-day visit to the United States. Prior to his visit, many hospitals in the city were preparing for possible emergencies involving visitors from many countries around the globe, particularly elderly visitors. On-call teams were present in these hospitals, and contingency plans were in place in case people needed to be transported emergently to different hospitals despite the high level of security …

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A young woman with anemia. A colonoscopy reveals a surprise.

Conditions
October 11, 2015

Overtesting and over treatment are big problems in modern medicine.  It sometimes goes like this: Have a minor complaint? It’s probably nothing, but we should do an exhaustive workup because there is a 0.00001 percent chance it could be cancer, maybe.

However, if you happen to be that one patient in 10 million that had cancer, and we actually found it early by aggressive testing, then you would be glad you went for …

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Why we need to stop calling physicians “providers”

Physician
October 10, 2015

It’s a change in nomenclature that’s come a bit out of the blue over the last few years. The forces appear to be aligning to gradually push the word “doctor” out of the center and towards the periphery of health care. Whether we are talking about administrative communication or health care information technology order entry — it seems that we are no physicians or even clinicians, but we have all …

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Test your medicine knowledge: 55-year-old man with elevated liver enzymes

Conditions
October 10, 2015

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

A 55-year-old man is evaluated during a routine examination. He feels well other than mild knee pain. He drinks six to eight cans of beer per night. He has no personal history of liver disease, but his older brother was recently diagnosed with hereditary hemochromatosis.

On physical examination, vital signs are normal; BMI is 24. He …

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The aroma of medicine can be found everyday in hospitals

Physician
October 9, 2015

As a physician, you are required to have keen senses.  Touch, smell, hearing, and sight are absolute necessities for most practicing physicians while we can only hope that taste is reserved for meals and non-professional situations.  I recently returned from a week of vacation in the great outdoors and found myself wishing that I had more olfactory agnosia.  Olfactory is a Latin adjective from olfacere that translates “of or relating …

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A patient turns down hypertension treatment. What happens next is tragic.

Physician
October 8, 2015

I have previously written about a patient on this site: “How elderly patients can be stubborn to their own detriment.” In that post, I discussed how the patient repeatedly turned down appropriate therapy for her hypertension, saying she didn’t need the help.  Now I’m writing an update.

Due to the patient’s refusal to accept treatment for her hypertension, despite counseling on the part of her cardiologist and primary care …

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Terminal dehydration: A gentle way to die?

Physician
October 7, 2015

My father suffered a massive stroke on a September night not long after his 83rd birthday. It left him conscious yet unable to talk and communicate, unable to swallow and almost completely paralyzed.

After numerous scans and other tests, his doctors determined that there was no chance of recovery. My father would never walk, talk, or swallow food again. With nothing more to do for him in the hospital, we — …

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The surprising reason behind an early refill of alprazolam

Physician
October 2, 2015

Theresa arrived in a cloud of noise and commotion.

She had called after four o’clock the day before, but I hadn’t noticed the new message in my electronic inbox before I left the clinic.

Her almost brand new alprazolam bottle and her pain pills were missing, and Theresa was reeling. As she walked down the hall to the exam room, I heard her explain to Autumn how she had been to Walmart …

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Bundled payments means the death of quality medical care

Policy
September 30, 2015

A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by CMS earlier this month. Apparently most of the comments were not, shall we say, favorable. Even the Federation of American Hospitals protested

For those who are unaware, “bundled payments” means that …

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It’s time to remove EHR gag orders. For patient safety’s sake.

Tech
September 29, 2015

I recently read an article in Politico entitled “Doctors barred from discussing safety glitches in U.S.-funded software.”  The article states that, despite massive public funding of electronic health records (EHR), the EHR corporations (including Epic Systems, Cerner, Siemens, Allscripts, eClinicalWorks and Meditech) routinely attach gag clauses to contracts with the hospitals and medical groups who purchase their systems. We are talking about gag clauses that prevent criticism by …

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Medical Jeopardy is a terrible way to learn. Here’s why.

Education
September 28, 2015

Confession time: I despise presentations that involve the use of a PowerPoint Jeopardy! game. To be clear, I get uncomfortable when any game-like activity appears in a medical teaching presentation.

Not that I don’t think games can have an important role in education — far from it. Heck, I once worked on a presentation that turned our residency conference room into a giant Game of Life board with …

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Health inspectors should be trained to do what doctors do

Physician
September 28, 2015

This story is a great one.

It’s about a female dog with only three legs. Her fourth leg was amputated following a traumatic accident as a puppy.

Now, when she walks, she has a hitch in her step. And, when she hitches, she kicks the stump of her injured leg outward.

Step, step, hitch. Step, step, hitch.

One day, the female dog has puppies. And, her puppies do what all puppies do. They nurse. They watch. …

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