On February 12, 2020, the National Board of Medical Examiners (NBME) announced that the USMLE Step 1 will transition to a pass/fail exam in January 2022 at the earliest. This move comes amidst increasing pressure on the NBME regarding its financial conflicts of interest, as well as the tangible sense among medical school deans that students were neglecting …
USMLE Step 1 pass/fail winners and losers
By the time I turned 40, I had gained and lost 40 pounds at least ten times. It started with the “freshman fifteen” plus another twenty-five in college. In medical school, I was introduced to sweetened coffee beverages, and I snacked on pretzels and candy to stay awake while studying. I got through overnight call during residency by using my meal tickets to buy chocolate-covered ice cream bars. And once …
The simple step that helped this physician lose 10 pounds
Growing up in a Korean household meant that I had very little experience with the type of baking that most Americans are used to; My grandma made rice cakes, not birthday cakes.
But during my third year of medical school, an intern recommended a show called The Great British Bake Off. After watching a few episodes and seeing what devoted home bakers could do, I was smitten and resolved to bake a …
As I become a better baker, I hope that I will continue to become a better doctor
An excerpt from Dottoressa: An American Doctor in Rome.
The great bidet mystery: What’s it for? Americans can live here for decades thinking Italians go to the trouble of installing bidets just so they can soak their feet. If they’ve read Henry Miller, they add so women can …
A guest column by the American College of Physicians, exclusive to KevinMD.
Engaging personally with our health care system either as a patient or family member is usually an eye-opening experience for most physicians. It provides a glimpse of what those under our care likely deal with on a daily basis while attempting to manage …
Treating the patient, not the disease
There is good news and bad news in the world of women’s health.
The good news is that women do not need annual Pap smears. The bad news is that, upon hearing the good news, many women incorrectly assume they no longer need annual pelvic exams, either.
Historically, Pap smears were performed annually, and during the same time as pelvic exams, so it is understandable why women would conflate the two. But …
Cervical cancer guidelines leaves women confused about annual pelvic exams
Medical school prepares doctors for patient care: perform a history and physical, and based on the findings, consider the next diagnostic tests to order, review all data, and develop a treatment plan. By graduating from medical school, you are skilled to perform those duties with a certain level of competency and confidence.
Success in the next phase of this journey and the rest of your life depends on honing those skills …
My wife and I had a baby a few months ago. Or, more accurately, she birthed a child while I sat in the corner, contemplating the miracle of reproductive physiology in a vasovagal fugue. In the months leading up to and following that wondrous moment, we found ourselves navigating the labyrinthine complexity of parental leave in graduate medical education.
To start with the positive, we are both residents in the same …
Medical residents need parental leave
I just watched the movie 1917 at the theatre. Shot in a unique way giving an immersive experience, showing the frontline reality of war through an unforgettable human story, it has to be one of the greatest war movies ever made. I’d encourage everyone to go watch it. I learned a fair bit about the First World while I was in high school in the United Kingdom. Its stories are …
Health care is like lions for lambs
Being a physician is an important role. It’s easy to forget the impact that you have on a patient just by being at their bedside.
It’s huge.
Have you ever been a patient? It’s an incredibly vulnerable experience.
You’re not really sure what’s happening and what is going to happen next.
People are really putting their faith in you to understand their needs and to ease their suffering. It’s a powerful thing to ease …
How you can show patients you are listening
Every winter, flu season descends upon the hospital. The most consistent reaction among any of our physicians — trainee and attending alike — who succumb to this nasty virus is one of guilt. Even the thought of “calling out sick” leads to such extreme guilt that many colleagues choose to come to work sick instead.
Several trainees have admitted to suffering from flu-like symptoms but pushing themselves to come to the …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a 6-month history of loose stools, bloating, and a 3.2-kg (7-lb) weight loss. Her medical history is otherwise unremarkable. Her brother has type 1 diabetes mellitus, and her mother has autoimmune thyroid disease. She reports no other symptoms and takes no …
MKSAP: 32-year-old woman with loose stools, bloating, and weight loss
Sometimes, old ideas and time-tested treatments remain the best. Newer doesn’t always mean better. Except in the case of one of our oldest antihistamines, tried-and-true Benadryl. It is time for that old drug to be retired, sent off to pasture, and never used again. Goodbye, Benadryl. Fare thee well, adieu, and don’t let the door hit you on the way out.
Benadryl (diphenhydramine) was introduced in 1946. The top single that …
Goodbye, Benadryl: It is time for you to retire
In recent times, physician burnout has rightfully surfaced as a social concern for the medical fraternity. Physician burnout is a thing, and lately, I was thinking about it related to nephrology.
Many national physician organizations and local hospital systems are developing strategies to reduce work-life stress and improve the engagement of the workforce. In November 2018, I represented the Renal Physician Association at the interim meeting of the American Medical Association …
Every day, children are cared for in clinics and hospitals. And every day, some of them are unhappy about it; some of them deeply unhappy about it.
The contemporary practice of nursing and medical care includes health care providers having to touch their patients. This may include an abdominal exam, listening to their lungs with a stethoscope, or even slightly invasive maneuvers, such as having to put an otoscope into their …
Reconciling consent culture and bodily autonomy with pediatric care
It is well known by now that a physician’s demeanor influences the clinical response patients have to any prescribed treatment. We also know that even when nothing is prescribed, a physician’s careful listening, examination, and reassurance about the normalcy of common symptoms and experiences can decrease patients’ suffering in the broadest sense of the word.
This has been the bread and butter of counselors for years. People will faithfully attend and …
How to build trust and therapeutic relationships in 15-minute office visits
Tiramisu, chocolate mousse, red velvet cake, freshly baked cookies, and warm brownies topped with ice cream. These are some of my favorite desserts and the things I start thinking about when I am under intense stress. I often gaze at the bakery section at the grocery store just to take a look when I feel overwhelmed with stress at work or home. It is the classic description of what we …
Stressed is desserts spelled backward
Most of us are, to some degree, procrastinators. We avoid or postpone doing unpleasant things. In this sense, physicians who are avoiders are no different from anyone else. For a doctor, however, avoiding things often leads to poor, or at least less than frank, communication with parents.
One kind of avoidance behavior is when the doctor avoids answering your questions. These doctors do not behave this way because they are poor …
The doctor who avoids answering your questions
Wow, you’re in medical school? So you are going to be a doctor? What year are you? When are you going to finish? What are you going to go into?
You should become a skin doctor, what do they call them again? It doesn’t matter, but they do good. But they are not real doctors, so maybe it’s not worth it.
You should become a doctor that gives vaccines. Are vaccines real? …
The questions people ask medical students
As a rising fourth-year med student, these are my words of wisdom for all students who are on their clinical rotations.
Your mental health is paramount; do not neglect how you are feeling!
There is not one med student that I know of who hasn’t felt anxiety, paranoia, or depression. Some of your peers may even be diagnosed with psychiatric disorders and take medications. And that is OK! As a mentor of …
A medical student’s advice for clinical rotations
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