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Please stop the over-diagnosis of UTIs

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, …

Consumerism is killing us with the death of a thousand cuts

Cory Fawcett, MD

Finance

January 10, 2020

School has gotten back into full swing, and thus we begin another cycle. Will this cycle be better than the last? Every year we find ourselves in this same spot. Summer’s over, big vacations are in the bag, back to school shopping is complete, and we start recovering from our summer spending.

We often haven’t yet recovered from the summer splurges before it’s time to start Christmas shopping. Then we begin …

Doctors shouldn’t feel guilty about sick days

Navpreet Sahsi, MD

Physician

January 10, 2020

It’s 2 a.m. And I’m in the emergency room. There are beads of sweat dripping from my forehead. One of my nurses comments that I just don’t look quite right. I can feel the urge to vomit and know where the nearest trash can is at all times.

I’m clearly sick. Febrile. Shouldn’t be working. But it’s the middle of a night shift, and I’ve got patients to see. I place …

Doing extra for a patient or overstepping boundaries?

Jacques Balayla, MD, MPH

Physician

January 9, 2020

I wanted to go the extra mile for my patient. The resistance I found was unexpected.

She was young. Her life — an incredible journey in diplomatic circles — was crippled too soon by a recurring disease that would ultimately prevail. Day after day, I’d round on her in what seemed like a pointless exercise, waiting for the inevitable to come. Another round of chemotherapy would have to wait for her …

Corporate games have ruined the health care system

Osmund Agbo, MD

Policy

January 8, 2020

There are certain paradoxes of life that are beyond the realm of rational explanation. To me, one of such is that a country that figured out how to defy gravity and conquered the cosmos has time and time again proven to be incapable of taking care of the most basic human need, namely: a commonsense health care delivery system.

U.S. spending on health care in 2016 was estimated at about 17.2 …

Why intangible skills are so important for surgeons

Mara L. Schenker, MD

Physician

January 7, 2020

As a fourth-year orthopaedic surgery resident, we had some surgical autonomy. Always at arm’s length from the attending oversight, this was just enough to push us past our comfort zones.

My problem was I loved my comfort zone.

The single most influential day in my career happened late one evening as a PGY-4. I was about to start a complex ankle fracture by myself. The ankle fracture involved the fibula and the …

Why gratitude is a superpower

Michael Maddaus, MD

Physician

January 7, 2020

I found this note waiting for me this morning in the kitchen.

It was from my daughter, who is home for the holiday week from New York. I made her a cup of coffee yesterday morning, and it was waiting for her on the table when she woke up and meandered sleepily into the kitchen.

Seeing the warm and happy …

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Why gratitude is a superpower

A physician’s story of addiction, depression, hope, and recovery

Adam B. Hill, MD

Physician

January 6, 2020

An excerpt from Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery.

As a young child’s heart rhythm faded to a stop, I walked off the hospital floor and got in my car with a plan to end my own life. …

The sad demise of an idealistic family physician

Cory Michael, MD

Physician

January 6, 2020

Graduation from my residency program was a bittersweet experience. At the time, my specialty was suffering from a crippling job shortage, so our futures were uncertain, and a dark mood had come to permeate my radiology residency. We were disgruntled with the specialty, with the system, and with medicine in general. I attended my graduation without any guests and only stayed long enough to receive my certificate.

I was, however, honored …

What’s the hardest part of a physician’s job?

Rada Jones, MD

Physician

January 5, 2020

I work in the ER. It’s not an easy job. Not glamorous either. At least not as glamorous as my mother-in-law used to think.

Years ago, when I declared I was going into emergency, she looked at me askance. She didn’t ask why. She looked at me with her wise old eyes. “Let me tell you about ER,” she said. “I know all about it. I watch every show.”

She was politely dismissive …

My dream as a physician

Kamala Tamirisa, MD

Physician

January 5, 2020

Everything in life starts as a dream. Big or small. My dream was to become a physician since I was quite young — the first one in my family to walk the path. I wanted to understand the science of the human body and help the sick. Heal with my skills, knowledge, and empathy. Hold my patients’ hands with care and confidence. My work was to be like none other. …

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My dream as a physician

What doctors can (and should) learn from patients

Philip A. Masters, MD

Physician

January 5, 2020

A guest column by the American College of Physicians, exclusive to KevinMD.com.

In many ways, the patient-physician relationship is seen as being mostly one-sided, with doctors possessing medical knowledge and wisdom, and patients with less medical information being in a position where they need a physician’s help and guidance in managing their health issues. Consequently, …

Most medical offices are hopelessly old fashioned

Hans Duvefelt, MD

Physician

January 4, 2020

Imagine if your bank handled all your online transactions for free but charged you only when you visited your local branch — and then kept pestering you to come in, pay money and chat with them every three months or at least once a year if you wanted to keep your accounts active.

Of course, that’s not how banks operate. There are small ongoing charges (or margins off the interest they …

How your mind can turn against you

Kyle Bradford Jones, MD

Conditions

January 4, 2020

An excerpt from Fallible: A Memoir of a Young Physician’s Struggle with Mental Illness.

Jason had an entire group of voices in his head that he called “the committee.” They talked nearly constantly, sometimes in a flat roar but often escalating to shouting. He described it as …

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How your mind can turn against you

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