A patient with Creutzfeldt–Jakob disease. An unconditional love.

Conditions
December 23, 2015

Today, I talked at length with that lady whose husband has Creutzfeldt–Jakob disease (CJD). That patient — the one with arbitrary myoclonic jerks, always naked and uncovered by blankets due to uncontrolled flailing, his penis and Foley catheter exposed. That one with overgrown mycotic toenails and eyes that are always only half-open, his gaze drifting everywhere. He was until now just a patient for me — the CJD patient.

Yet today …

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Misogyny in medicine is alive and well

Education
December 20, 2015

In 1978, my mother interviewed for dental school. On her post-interview tour of the school, her male tour guide assumed she was applying for dental hygiene school and showed her only those areas of the school. Upon my mother informing him that she was applying for dental school, he smirked and said, “Good luck getting in, you’re a woman,” and walked away laughing.

Of course in 1978, overt sexism was neither …

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7 things doctors should consider before signing for a new job

Physician
December 16, 2015

So, you’ve finished all your job interviews and think you’ve found a perfect fit. Graduating from residency is exciting, but did you get any training on what it all means to sign on the dotted line?

Below is a quick and dirty run-down of the contracting process from an industry insider.

1. Non-compete clauses. Non-compete clauses are not just a big med phenomenon; they are part of contracts in many different clinical settings. …

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A low-grade fever that humbled this physician

Conditions
December 16, 2015

The clues are usually there, even in the hardest of cases. They just aren’t presented to you on a silver platter.

Gwen Stephenson had an ill-defined polyarthritis and had been on methotrexate for some time. Her rheumatologist, Norm Fahler, had tapered her off the medication while keeping an eye on her inflammatory markers and they had leveled off at just above the normal range.

Seven or eight years ago, Gwen had suffered …

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Physicians are jaded, but this is what keeps them in medicine

Physician
December 15, 2015

I am constantly coming across articles of physicians with strong voices. Physicians that are jaded.  Physicians that didn’t go into medicine to be defined by patient satisfaction surveys. Physicians that didn’t go into medicine expecting that people wouldn’t trust in their training because the Internet begs to differ. Physicians that cringe at the drive-through mentality that patients can present with diagnoses in hand and demands for tests to be done. Physicians …

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My first year as a nurse taught me what true resiliency is

Education
December 13, 2015

I remember attending an eight-hour seminar on my job, where experts educated new nurses about the transition we would experience in our profession. We learned about the change theory and the different levels of transition, from novice to expert. I remember not taking the two-day session very seriously, thinking that my accelerated three-year nursing degree had prepared me well for the workplace. Now that my one year of practicing as …

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We should radically change the way we play football

Physician
December 12, 2015

As the awareness and recognition of concussion in sports continue to increase and the frightening long-term outcomes for frequently and severely concussed athletes are realized, as a physician I cannot help but advocate drastic changes in football.  Of the major sports, it sees the highest rates of concussion, and for every highly publicized Greek tragedy of a broken NFL star (Jim McMahon, Junior Seau, Dave …

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MKSAP: 28-year-old woman with progressive dyspnea and fatigue

Conditions
December 12, 2015

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

A 28-year-old woman is evaluated for a 1-week history of progressive dyspnea and fatigue. She was diagnosed with Hodgkin lymphoma 2 months ago and is receiving chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). She takes no other medications.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 134/82 mm Hg, pulse rate …

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When an advocate goes too far in the exam room

Conditions
December 10, 2015

asco-logoWhen is an advocate not an advocate? When should a spouse step back and let the husband make a treatment decision? When should an adult child of a man with prostate cancer let their father decide what is best for him? These are questions that, fortunately, I don’t have to ask all that often. Most men I see for prostate cancer …

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Why a patient panel is an outdated concept in primary care

Physician
December 10, 2015

“How many patients do you have?”

I’m not sure what you mean. How many patients do I see on average each day? About twelve.

“No. How many patients do you have?”

Let’s see: Last week I saw about sixty patients altogether. Five of them were new patients.

“No, no. How many patients do you have on your panel?”

My panel? I don’t know what you mean by that. I don’t work as an employer in …

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Medical students are depressed, but they’re taking the wrong drugs

Education
December 9, 2015

Studies have varied in their estimates of depression in medical school students, but they all show a similarly startling trend. Medical students have a higher depression rate than their non-medical counterparts. This culminates later in life with physicians with higher than average alcohol abuse problems and higher than average suicide rates, with male MDs 1.5 times as likely, and female MDs twice as likely to commit suicide than their Read more…

There is no oversight for prior authorizations. There should be.

Meds
December 6, 2015

The letter from the insurance company was addressed to my patient. The two pages of information boiled down to one simple sentence: “After a thorough review, our decision to not cover the medication Provigil (modafinil) is unchanged.”

The letter went on to explain that there was no further recourse, and that the medication would not be approved because it was not Food and Drug Administration–approved for the condition my patient had: …

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The general radiologist is still valued. Here’s why.

Physician
December 4, 2015

In times of shortage, we find out what we value most. And in these times of relative penury in the job market for radiologists, it appears that employers value — above and beyond anything else — the general radiologist.

Yes, the general radiologist. The radiologist who is able and willing in one shift to perform a barium enema, follow the intricate anatomy of the inner ear on an MRI of the …

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Use the power of psychology to ace your medical school interview

Education
December 4, 2015

Receiving medical school interview offers simultaneously provides relief, justifies the incredibly hard work you’ve put into your primary and secondary applications, and confirms that you are indeed cut out for medicine.

In other words, you’ve convinced them — at least on paper — that you will succeed in their program and make an excellent doctor.

So why do they even want to interview you?

Consider what schools can only learn about you in …

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5 health questions every presidential candidate should answer

Policy
December 2, 2015

With fewer than 100 days until the first primaries, the leading candidates have received ample airtime to address the important issues our nation faces. But even though health care accounts for around 18 percent of our nation’s GDP and consumes close to half of the total tax revenue collected by the federal government, their silence on providing solutions to the most pressing health care challenges our nation faces continues with …

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Do psychiatrists have value? Yes, they do.

Physician
December 2, 2015

While slogging through a crappy first draft of a document about the value of psychiatrists in mental health and substance use disorder services, I did a literature search for supporting evidence.

I found nothing. (1)

“So how exactly are we helpful?” I mused out loud. Maybe we aren’t: There are groups out there who do not believe that psychiatrists can or do help anyone.

I am an N of 1. …

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Listening to the patient is the first part of the physical exam

Physician
December 1, 2015

The first posting on my blog explained why I chose to name it “Auscultation.”  I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod to my being a cardiologist, I believe auscultation has long been an act that defines us as physicians and connects us in a profound way with our patients. The act of …

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Physicians are not providers: An open letter to the AMA and medical boards

Physician
November 30, 2015

Dear AMA and state medical boards,

The last few years have been a period of unprecedented change in the world of health care. The need to reign in costs, expand access, and ensure higher quality care — all at a time of rapid medical and technological advancements — has changed innumerable aspects of the practice of medicine.

Throughout this, one common theme has been the dedication and determination of hundreds of thousands …

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I got rejected from medical school twice. It was the best thing that happened to me.

Education
November 28, 2015

Most people who apply to a graduate school and/or graduate medical programs apply to get accepted the first time of applying. No one wants to have to apply a second time and definitely not a third time. After a second rejection, a lot of people would probably recommended someone picking another field to enter or even giving up altogether.  For me, both of my rejections were taken hard and still …

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If urgent care centers don’t innovate, how long will they last?

Physician
November 27, 2015

Part of a series.

Urgent care clinics provide a useful service to the community, but their days may be numbered with survival questionable resulting from intense competition from the chain pharmacies and soon from Walmart.

Urgent care companies began to proliferate 30 years ago but have gained traction in recent years as emergency room wait times rapidly lengthened. Urgent care is less expensive than the ER, is open 24/7 or …

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