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Physicians are not incentivzed to talk with patients on the phone

Physician

January 25, 2020

Talking to patients on the phone can be very efficient and quite rewarding, like when I called a worried patient today and told her that her chest CT showed an improving pneumonia and almost certainly no cancer, but a repeat scan some months down the road would still be a good idea. She told me she was feeling better, but still quite weak and that her sputum was still dark …

24 reasons to not vaccinate your kid

Rada Jones, MD

Physician

January 25, 2020

An excerpt from Stay Away From My ER, and other fun bits of wisdom.

1. You don’t like to be told what to do. Especially not by arrogant doctors, who act as if they know better, just because they’ve been through a few decades of training!

2. Your …

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24 reasons to not vaccinate your kid

Making humanism in medicine more humanistic

Ajay Khilanani, MD

Physician

January 23, 2020

Kahlil Gibran writes, “In friendship or in love, the two side by side raise hands together to find what one cannot reach alone.” What types of outcomes can physicians and patients achieve in healing, living, and life when Gibran’s message is incorporated into the physician-patient relationship? Can humanism in medicine become even more humanistic?

“Humanism in medicine” is characterized by the Arnold P. Gold Foundation as respectful …

Beyond red flags: Beware of black butterfly warnings

Raj Waghmare, MD

Conditions

January 23, 2020

I’ve just discharged a kid with a cough, and there are no patients waiting to be seen. “I’ll be back,” I tell the nurse, as I slip away to the hospital kitchen and unlock the door. I steal two frozen grilled cheese sandwiches from the freezer and throw them into the microwave. Minutes later, I’m in the call room.

I take a couple of bites and can already feel acid rising …

Does socialized medical care provide higher quality than private care?

Peter Ubel, MD

Policy

January 22, 2020

Americans are not fans of socialized medicine. Sure, some people want socialized health care payment, including many people who are fans of Medicare for all. But even most Bernie Sanders supporters probably aren’t in favor of socializing the entire U.S. health care system, thereby making hospitals and medical clinics into government property. Americans are proud of the high quality of care offered by non-government providers, from their local community …

A quick CT scan for the frail and elderly

Mary Braun, MD

Physician

January 22, 2020

First, you have to call up your daughter to pick you up and take you to the lab. It’s hard for the nurse to find your vein. The pain from his fishing around in your arm is not nearly as bad as the pain you always have in your hip, and back, and shoulders, but it’s the straw that breaks the camel’s back, and you cry a little bit. The …

This is a real problem in our ER. This is a real problem nationwide.

StorytellERdoc, MD

Physician

January 21, 2020

One of the largest problems in our ER, it seems, is that there is a subset of patients who visit us on a routine basis. Commonly known as “the regulars,” these familiar faces are sprinkled throughout our day between all our other patient visits. Whether it be for chronic pain, for chronic illness, for companionship, simply to have a place to hang out for a few hours, or to get …

Is obesity self-inflicted?

Anonymous

Physician

January 21, 2020

“Aren’t you happy for me?” asks the patient smiling from the exam chair in my office. I say yes, but that’s not entirely true.

Happiness isn’t the right word. Conflicted might be it. How do I reconcile my feelings when this patient, who I am not sure is deserving, reports that he was awarded Social Security disability?

Sure, he has severe arthritis, wildly uncontrolled diabetes, and a massive skin breakdown of his …

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Is obesity self-inflicted?

What to do if your doctor is excessively egotistical

Christopher Johnson, MD

Physician

January 20, 2020

Egotism is a common trait among doctors, although most of us keep it under adequate control when dealing with patients. The ideal doctor-parent encounter has been described as a collaboration among equals, each of which brings expertise to the exchange; the doctor knows medicine, the parent knows the child. This is the ideal, although sometimes the reality falls short of it. The way our medical system is now structured gives …

Stop the war on PAs and NPs

Brent Lacey, MD

Physician

January 18, 2020

I think it’s time for physicians to end the assault on the clinical practices of PAs and NPs.

Are you worried about PAs and NPs taking your job? If you’re a good doctor, you should stop worrying. Great PAs and NPs are everywhere, and I think it’s time physicians embraced them.

PAs and NPs have excellent skills

My first rotation as a third-year medical student was in the emergency department. There was a …

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Stop the war on PAs and NPs

Keep insulting doctors, and good luck finding a physician in 10 years

Karen S. Sibert, MD

Physician

January 17, 2020

If physicians are “muggers” and co-conspirators in “taking money away from the rest of us,” then journalists and economists are pontificating parasites who produce no goods or services of any real value.

I don’t think either is true, but the recent attacks on physicians by economists Anne Case and Angus Deaton, and “media professional” Cynthia Weber Cascio, deserve to be called out. You …

What Karl Marx can teach doctors about burnout

Farid Alsabeh

Conditions

January 17, 2020

Professional burnout is widely identified using the Maslach Burnout Inventory, which defines it along psychological lines: emotional exhaustion, a feeling of depersonalization and cynicism, and a low sense of personal accomplishment.

Accordingly, the phenomenon of physician burnout is often framed as a personal problem to be solved by means of self-care. While this approach is undoubtedly helpful, it doesn’t sufficiently address the structural factors that contribute to burnout in the first …

Setting the facts straight about The Joint Commission’s stance on food and drink

Mark Pelletier, MS, RN

Policy

January 16, 2020

A spirited discussion erupted over The Joint Commission’s role in prohibiting food in patient care areas: “Taking food and drink away from doctors and nurses is just cruel.”

The rumor that The Joint Commission is the enforcer of food and drink policies meant to starve clinicians has been around since I was working as a nurse in direct patient care capacities in the ‘80s and ‘90s. I’ve devoted plenty of time to clarifying my …

Please stop the over-diagnosis of UTIs

Scott Keeney, DO

Conditions

January 15, 2020

I admitted an elderly woman to the hospital recently. The previous week, she had presented to the emergency department (ED) with chest pain and shortness of breath. For some unknown reason, a urinalysis was obtained and was found to be abnormal. The patient left the hospital with a prescription for cephalexin, in addition to unexplained chest pain and shortness of breath. The patient presented to the hospital this time with, …

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Please stop the over-diagnosis of UTIs

The president’s plan for payment parity goes against what patients want

Lawrence John, MD

Policy

January 15, 2020

“Listen to your patient; he is telling you the diagnosis.”

This quote from famous physician William Osler is as true today as it was 100 years ago. And yet the latest version of President Trump’s executive order on Medicare threatens what patients overwhelmingly want: a physician involved in their care.

Section 5-C of the President’s order focuses on payment parity and supervision of mid-level providers. Changes to either issue would create unintended …

Can the physician credentialing process be saved?

Tom Clifford, MD

Physician

January 14, 2020

The physician burnout crisis and a national provider shortage have fueled a growing trend in health technology focused on better utilizing physicians and reducing administrative burdens. I became a surgeon because I wanted to help people, not because I had a strong desire to push paper. The high volume of administrative tasks increasingly consumes a physician’s time that could be better spent with patients. For example, primary care physicians Read more…

Can the physician credentialing process be saved?

When primary care handles the consequences of psychiatric medication prescribing

Hans Duvefelt, MD

Physician

January 13, 2020

If my hypertensive patient develops orthostatism and falls and breaks her hip, I fully expect the orthopedic surgeon on call to treat her. I may kick myself that this happened, but I’m not qualified to treat a broken hip.

If my anticoagulated patient hits his head and suffers a subdural hematoma, I expect the local neurosurgeon to graciously treat him even though it was my decision and not his to start …

After child sexual abuse, being “physically intact” doesn’t tell the whole story

Dr. Nkeiruka U. Orajiaka

Physician

January 13, 2020

The recent pardon of a convicted child rapist by the ex-Kentucky Governor has sparked a lot of controversies. The basis of the pardon was- “the victim’s hymen was noted to be physically intact.” Evolving studies have continuously shown that the hymen is not a reliable or accurate means to conclude sexual assault.

But if physical damage is the only criterion used to assess …

In the midst of physician burnout, remember the privilege of being a doctor

Micah Long, MD

Physician

January 12, 2020

I read the recent article on KevinMD: “I’m sorry: Why I lost my love for medicine” with great sadness. My heart goes out to the author; many of their concerns echoed deeply within me. I am sorry that we, as physicians, haven’t effectively succeeded in solving the myriad of problems facing health care today. And the author is right: Health care as a system, in the …

A patient who touches your heart in unexpected ways

Ann F. Beach, MD

Physician

January 11, 2020

I’m a pediatric hospitalist, and I know that most days in the hospital are routine. But every once in a while, a patient pierces through your armor, and touches your heart in totally unexpected ways. Willow did that to me.

Willow was five days old and had been admitted because her breathing was not quite right. I first met her in her hospital room, with her dad hovering over her bassinet, …

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