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

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, …

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