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Should nurse practitioners complete medical residencies?

Anonymous

Physician

March 1, 2020

About three months ago, something awful happened. The oncology nurse practitioner (NP) whom I trained for the past two years in my subspecialty decided to seek employment elsewhere in order to have a more flexible work schedule.

My team and I lamented we had a going-away dinner to say thank you for her work. And for the next three months, I trudged through my days in a busy oncology clinic, seeing …

A peek behind that 8-minute $300 doctor visit

Kausar Javed, MD

Physician

February 29, 2020

If you or a loved one has ever been hospitalized, by day two or three of your hospital stay, you likely remember the doctor visiting you every day but not staying more than seven or eight minutes or 10 to 15 minutes max.

It may have felt like he or she was just “dropping by and laying eyes on you.” A month or two later, you get a bill with the …

I struggle with my pride in the profession and fear of the health care system

Santina Wheat, MD, MPH

Physician

February 29, 2020

I believe in the practice of medicine and enjoy teaching others this amazing art. However, after experiencing nine months of interactions through medicine as the daughter of a sick patient, I struggle with my pride in the profession and fear of the health care system.

My mother would proudly tell all her physicians that her daughter was a doctor. I knew she was proud, but I didn’t believe in using my …

Core values were key to reclaiming my physician identity

Tracy Asamoah, MD

Physician

February 28, 2020

My identity crisis attempted its first appearance five years ago. I had decided to leave my job as a psychiatrist in an outpatient, community-based practice. My professional role had become incongruent with the doctor I had envisioned becoming. In my misalignment, I had lost clarity in my identity as a physician. I was frustrated and felt ineffective and disconnected from my work.

I suspected that some of my colleagues were struggling …

Everyone needs rudimentary statistical training

Christopher Johnson, MD

Physician

February 27, 2020

Every day we get bombarded in the news with health statistics. Coffee causes cancer! Coffee cures cancer! And so on. Many of these are meant to grab headlines (and, these days, web page clicks), and the articles they accompany are often very poor at telling the reader what they mean. They often have statistics, and health statistics can be complicated. Sad to say, even many physicians are pretty poor and …

Working as a digital nomad physician practicing telemedicine while travelling the world

Claire Young, MD

Physician

February 27, 2020

This is not the career path I set out to practice when I left medical school; in fact, it’s a career path that didn’t even exist. But after making a number of lifestyle choices this is where I find myself today. I am sitting writing this article from the hot, tropical lowlands of Colombia, on the site of Pablo Escobar’s Hacienda where, in a few hours, I will …

How to find your squad in residency

Ellen Poulose Redger, MD

Physician

February 26, 2020

At nearly every stage in our education and training, we find “our people.” Maybe it’s your table-mate in kindergarten, or the kid with the really cool light-up sneakers in preschool who becomes your best friend. Maybe it’s your next-door neighbor who you play with after school or a coworker from your first job in high school. These people become part of our squad — even if their membership is only …

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How to find your squad in residency

Confessions of a bed-sharing pediatrician mom

Sonal Patel, MD

Conditions

February 26, 2020

I remember lying in my bed after my second delivery in severe pain. With my first delivery, I had already endured a C-section. Four years later, I wanted to experience a “natural” delivery. I opted for a vaginal delivery after C-section (VBAC).

The VBAC quickly turned into an emergency where the maternal-fetal medicine (MFM) physician gave me two options: Get this baby out now or emergent C-section.

My mind flashed back to …

The art of diagnosis is like a riddle

Raj Waghmare, MD

Physician

February 26, 2020

“I have a riddle,” Paul says, as the dining room falls silent.

“You’re at the bottom of the stairs. And on the wall, there are three light switches labeled one, two, and three. There’s a room upstairs with three lamps, labeled X, Y, and Z.

You can turn on and off as many switches as you want while you’re downstairs, but you can only go upstairs once. And once you’re upstairs, you …

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The art of diagnosis is like a riddle

Here’s why you should get a chaplain for your patient

Anna Delamerced

Education

February 26, 2020

It was my first week of internal medicine rotation. A newly-minted third-year, I was rotating on the wards back in the spring, when I met a 90-something-year-old gentleman. He had come in for confusion after a fall.

There were no relatives or friends in the waiting room.

I was assigned to follow him. During his stay, his words were few; it was often difficult to engage him in conversation. Whenever I pre-rounded, …

Welcome to prior-authorization hell

Rob Lamberts, MD

Physician

February 25, 2020

“What diagnosis do you want to use for those ear drops you sent on Mr. Johnson,” Jenn texted me. “ICD-L21.8 for seborrheic dermatitis?”

Sigh. Welcome to prior-authorization hell.

These are generic ear drops I ordered for presumed fungal infection of the external ear. The cash price for the drops is $15 for a 10-milliliter bottle (I checked before prescribing them). “No,” I responded, “it would be ICD-B36.9 for otomycosis.” (translation: ear fungus)

Jenn …

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Welcome to prior-authorization hell

The best teacher of medicine I ever had

Suneel Dhand, MD

Physician

February 24, 2020

The best teacher of medicine I ever had was during my medical residency. He was a tough, old-school physician, trained at one of the premier institutions in the country, and specialized in pulmonology and intensive care. Before I had even rotated through the ICU, I had seen him around on the medical floors—and must admit I didn’t like him very much at first. He seemed extremely serious, not particularly friendly to any …

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The best teacher of medicine I ever had

Urgent care is emblematic of problems in our health system

Rosalind Kaplan, MD

Policy

February 23, 2020

Working in urgent care, I’ve started supervising some of the other providers at sites other than my own — 19 sites in all in Pennsylvania and Delaware — so I hear about a lot of patient situations.

The urgent care site where I work is in an affluent area. Most of our patients are employed or retired and have health insurance, though I have certainly encountered a number of patients …

What is “good enough” for a surgeon?

Mara L. Schenker, MD

Physician

February 23, 2020

A surgery resident from halfway around the world emailed me the other day looking for advice as she was nearing graduation. She confessed, “I am beginning to question myself if I am good enough … what is ‘good enough’ anyway?”

I had absolutely no idea how to answer the question – what is “good enough” for a surgeon?

First, I tried Google.

“Am … I … Good … Enough”?

2.5 billion hits and some …

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What is “good enough” for a surgeon?

Why I love caring for geriatric patients

Sarah C. Smith, DO

Physician

February 22, 2020

As I enter the exam room, I hear, “Don’t get old honey!”

As a physician caring for a large population of geriatric patients in Florida, I hear this approximately five times a day. To this statement, I always reply, “There’s no alternative, though!” I also try not to get offended by repeatedly being called “honey.” Although I am waiting to someday state; “it’s Doctor Honey.” Usually, my level is offense is …

How artificial intelligence will affect brain surgery

Robert Louis, MD

Physician

February 21, 2020

Brain surgery is getting smarter. The journal Nature Medicine recently published a study that found a new imaging technique that allows pathologists to diagnose brain tumors faster and more accurately than ever before.

The study focused on Invenio Imaging technology’s use of artificial intelligence (AI) in making accurate diagnoses. So, will computers replace doctors? That’s unlikely. Treating the human brain requires a human approach. But AI is …

The impact of economic inequality on the incidence of mass shootings

Niran S. Al-Agba, MD

Policy

February 20, 2020

Gun violence has become a public health epidemic. Despite countless deaths in mass shootings over the last two decades, the Dickey Amendment—a provision inserted into the 1996 spending bill which blocked federal funding for research on gun violence—remains on the books. While every politician, media pundit, and policy expert “know” the solution, the answers are not that simple.

In reality, the factors which have fueled the rise in gun violence across …

What is the application process for physician long-term disability insurance?

Bob Bhayani, MBA

Policy

February 20, 2020

Protecting your lifestyle starts with protecting your income. Disability insurance provides a solid foundation for your financial future by providing you income when you’re unable to work due to an illness or injury. When most people hear the word “disability,” they immediately think of accidents. But the reality is that 90 percent of disabilities are actually caused by illnesses.

Disability insurance is more complex than other types of insurance. We recommend …

5 disruptive trends transforming health care

Richard S. Isaacs, MD and Chris Grant

Policy

February 19, 2020

Spiraling costs, poor quality outcomes, and inequities in access to care are driving significant and long overdue changes to the way health care is administered and managed in the United States.

And while the U.S. spends more on health care per person than other wealthy countries, its health outcomes are no better than those in other developed countries. In fact, it performs worse in several health metrics, including life expectancy, infant …

What to do with the extremely defensive doctor

Christopher Johnson, MD

Physician

February 18, 2020

Let’s talk about the doctor who is excessively defensive.

I divide this kind of communication blocker into two varieties: physician personality and physician mode of practice. The physician with a defensive personality is one who interprets questions from parents as questioning of her medical judgment. Unlike the supremely egotistical doctor, who is often sufficiently secure in her image of herself that she is magnanimous toward parents who ask questions, the overly …

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