A guest column by the American College of Physicians, exclusive to KevinMD.com.
The administrative burden associated with caring for patients in today’s health care system has emerged as a primary driver of the loss of joy in the practice of medicine and the epidemic of burnout among physicians.
No medical specialty is immune from the upward …
How the administrative burden contributes to physician burnout
Next in a series.
In my previous post, I explained the basics of my Healthcare Incentives Framework, which enumerates the jobs we want a health care system to do for us and links them to the parties in the health care system that have the greatest incentive to fulfill those jobs. If you haven’t read that post, I recommend you read it first. For those …
How to structure financial incentives in our health care system
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old woman undergoes follow-up consultation regarding a pre-employment physical examination. She reports feeling well, with no recent illness. Medical history is notable for gastroesophageal reflux disease. Her only medication is omeprazole. She is black.
On physical examination, vital signs and other examination findings are normal.
A peripheral blood smear shows …
MKSAP: 28-year-old woman follows-up after a pre-employment physical examination
I woke up to him, pacing the bedroom.
Within an hour, I was pacing the ER at his bedside.
Our experience at one of the country’s best-ranked hospitals lasted only three days before we were discharged home. What led us there will last a lifetime in our minds. When faced with your own mortality (or that of your husband’s), you are forever changed. We are grateful for his continued recovery from myopericarditis. …
If you’ve ever been in the hospital for a surgery, you probably had a resident speak to you about the procedure; you were presented a laundry list of risks, the benefits mentioned, asked if everything was understood. And finally, you initial in several spots before signing your name on the dotted line. You looked at the wall clock and noted that the conversation took a mere six minutes.
Is this proper …
Patients: Be proactive in your health care
As an academic psychiatrist who treats people with anxiety and trauma, I often hear questions about a specific class of medications called benzodiazepines. I also often receive referrals for patients who are on these medications and reluctant to discontinue them.
There has been increasing attention into long-term risks of benzodiazepines, including potential for addiction, overdose, and cognitive impairment. The overdose death rate among patients receiving …
Why your doctor may be concerned about prescribing benzodiazepines
I consider myself one of the lucky ones because my wife and I couples matched to the same institution for residency. At the time we put our residency match lists in, we were just boyfriend and girlfriend, and the decision to couples match felt like a bigger leap forward for our relationship than deciding to ask her to marry me about a year later. It was the right decision for …
Women who become doctors must often choose between motherhood and medicine. I’m a mother and a surgeon. I never thought of choosing between the two, even though my employers often asked me to.
Today I work as a trauma surgeon in a busy practice. It’s been a long journey since the day five years ago when I …
The stigma of motherhood in medicine
The health challenge recently faced by Sen. Bernie Sanders has brought two issues to the forefront of the 2020 presidential election. Should there be a disqualifying upper age limit to become president, and should an existing health issue preclude a candidate from running for president?
As scientists in the field of aging, we cannot tell the voting public how to answer these questions. What we can do is inform you about …
Should there be a disqualifying upper age limit to become president?
Nowadays, patients are used to seeing physicians who are not their doctors. Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician. A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that: Your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely.
The medical universe …
Patients are used to seeing physicians who are not their doctors
The doctor opened the door after a gentle knock. He was greeted with warmth, offered a seat by Mary, and promptly sat down on the end of the hospital bed. As he sat, the family stood to greet him. They discussed the grandkids, the trips taken since they last saw each other. The room felt peaceful. Time slowed down.
Walking in behind my attending, I had been ruminating about the lengthy patient list, the work to be done. Then …
When we walk into a patient’s room, we are entering a story
Along with a steeper financial burden and an increasingly competitive academic environment, this year’s incoming freshman university class will likely be confronted with the pressure to take a little pill that some popular culture references say will make you “awesome at everything.” Or they may eschew the temptation and rely on the standard practice of study, sleep, repeat.
Welcome to #GenerationAdderall, the …
Don’t use stimulants to cram for exams. It ruins sleep and doesn’t help test scores.
I recently had the amazing opportunity to both witness and participate in an event where my Children’s Hospital of Philadelphia (CHOP) pediatric mentor received a lifetime achievement award for her many years of exemplary service to the pediatric community of Southern New Jersey.
My mentor’s leadership, compassion, and dedication to serving the Latino community have set an example — not only for patients and their families but for generations of pediatricians …
How best to support, honor, and show gratitude for your mentors
The availability of up to the minute information, presented 24/7/365, could assist a democratic society in making the best choices in determining its future. That was the promise of cable news. Unfortunately, cable news has fallen short of its potential and has led to the further polarization of America. More than that, it has changed the way your brain works. Not for the better!
The various cable …
What does cable news do to your brain? A neurosurgeon explains.
In response to concerns about the unnecessary use of antibiotics, researchers have sought to identify simple, non-specific tests to help clinicians determine which patients require antibiotics and which do not. Indeed, such tests could facilitate challenging management decisions, which currently rely predominately upon a thorough clinical assessment. To compound the challenge, patients often have pre-conceived ideas about whether or not …
Can CRP testing guide antibiotic decisions?
First in a series.
Way back as a business strategy undergrad and then as a medical student, I developed a framework for understanding health care systems. I call it the Healthcare Incentives Framework, and I believe it clarifies the big-picture components of health care systems that people need to grasp to be able to understand the sources of problems, which then leads to appropriate solutions. The whole thing cannot be explained …
A framework for understanding health care systems
An excerpt from The Doctors Guide to Real Estate Investing for Busy Professionals.
Cash flow is the only method I use to determine the value of the property to me and is my decision-making tool.
This is how I determine the price I’m willing to pay. This is the only way …
The gold standard of evaluating real estate investments
Last June, I became a freshly-minted young doctor, bright-eyed, and enthusiastic about heading off to my dream residency program. By August, I found myself crossing the street on my way home, wondering if I had made a horrible mistake that could have harmed a patient. The most painful thing was, I hardly had the energy to care.
This is not why I chose to dedicate myself to medicine.
Like many medical trainees, …
The Resident and Fellow Bill of Rights
How can we possibly get to standardization in medicine? And is that a good thing?
Standardized checklists save lives; rigid procedures for sterilization of equipment saves lives; universal compliance with recommended beneficial treatments saves lives. And while it’s sometimes a wonderful thing to let a surgeon solve a problem creatively or to allow a patient visit to go overtime in order …
Why electronic medical records should be standardized
I’m an ER doc, and proud of it. But I never mention it when I meet new people. Unless someone’s fixing to die, I avoid it like the plague. “I work in a hospital,” I say. “Where in the hospital?” “The ER. How about you?” That’s a topic changer, since most people would rather talk about themselves.
Why not own it, you ask? There’s no shame in being a doctor. It’s not like …
Why this physician never tells anyone she’s a doctor
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