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A framework for understanding health care systems

Policy

October 25, 2019

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 …

The gold standard of evaluating real estate investments

Cory Fawcett, MD

Finance

October 24, 2019

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 Resident and Fellow Bill of Rights

Eden Almasude, MD

Education

October 24, 2019

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, …

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The Resident and Fellow Bill of Rights

Why electronic medical records should be standardized

Fred N. Pelzman, MD

Physician

October 22, 2019

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 this physician never tells anyone she’s a doctor

Rada Jones, MD

Physician

October 22, 2019

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 …

4 significant misconceptions about universal health care systems

Niran S. Al-Agba, MD

Policy

October 21, 2019

Recent polls show a majority of Americans support Medicare for all, but few seem to realize that no other system in the world operates like the current single-payer proposals in Congress. I addressed the concept of single-payer health care, with Cuba’s system as an example. Today I’m writing more about the ideas being discussed now in our country and how those compare to other nations that provide …

How internal medicine got its name

Philip A. Masters, MD

Physician

October 21, 2019

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

Of all medical specialties, perhaps the most difficult to understand is internal medicine.

While the name suggests that those who practice internal medicine focus primarily on non-dermatologic diseases of “Internal” organ systems (which in many ways is true), unlike other medical fields whose names …

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How internal medicine got its name

When you’re a physician, you’re a detective

Lauren Joseph

Education

October 21, 2019

A professor recently romanticized my idea of clinical reasoning as he began our session by saying, “When you’re a physician, you’re a detective.” He elaborated: “Every fact you have, every piece of evidence you have, must be consistent with your leading diagnosis.” As he said this, my eyes narrowed, and I sat up a little taller.

My fellow first-year medical students and I have begun our official training in clinical reasoning, …

A father-physician tests if a little peanut a day keeps allergy away

Edwin Kim, MD

Conditions

October 20, 2019

No one I knew had food allergy, let alone peanut allergy, when I was a child. I grew up at a time when peanuts were given freely on airplanes, and there was no such thing as a peanut-free table at school. Fast forward to today and the world has changed, with food allergies taking on almost epidemic-like proportions.

I am an allergist and became interested in food allergies …

Why this medical student chose to pursue medicine

Ton La, Jr., MD, JD

Education

October 20, 2019

Pain and suffering together is a universal language. It is unspoken, one that a person of any age feels when they see a loved one die, or when someone sees another human being suffer when nothing more medically can be done.

I once saw a Vietnam War veteran who, within a few years of returning home, suffered from a hemorrhagic stroke. He was robbed of his ability to walk, to talk, …

How “Joker” gets mental illness wrong

Dr. Sudhir Mane

Conditions

October 20, 2019

Spoiler alert: Plot points of the movie “Joker” are revealed.

“Joker” opened to a mix of rave reviews and criticism on October 2, 2019, amid fears of mass-shootings at theaters in the U.S.

This left law enforcement agencies scrambling to beef up security at movie theaters to prevent any untoward incidents. Quite ironically, October 2, is also the 150th birthday of Mahatma Gandhi — the crusader and champion of non-violence.

Warner Brothers even …

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How “Joker” gets mental illness wrong

Why the flu shot cannot give you the flu (and why you should get one now)

Libby Richards, RN, PhD

Conditions

October 19, 2019

Flu vaccination prevents millions of flu-related illnesses and deaths annually, but vaccination rates are low for many reasons.

During the 2018-2019 flu season, the Centers for Disease Control and Prevention reported that about 45% of U.S. adults received the flu vaccine. While this is an increase of 8% from 2017-2018, it falls way below the national goal of 70% of American adults …

Physicians explain Sia’s chronic pain

Michele R. Berman, MD and Mark S. Boguski, MD, PhD

Conditions

October 18, 2019

Australian singer/songwriter Sia (born Sia Kate Isobelle Furler), 43, is known for wearing elaborate wigs and headpieces that hide her face. However, the “Chandelier” singer is not hiding the fact that she was recently diagnosed with the connective tissue disorder Ehlers-Danlos syndrome.

In a t weet, Sia wrote:

“Hey, I’m suffering with chronic pain, a …

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Physicians explain Sia’s chronic pain

Get rid of the guilt. You matter as a physician.

Najma Hamdani, MD

Physician

October 17, 2019

“When you start seeing your worth, you will find it harder to stay around people who don’t.”
– Unknown

After graduating from my residency a few years ago, I accepted a job within my organization as a staff psychiatrist and a medical director.

The idea of familiarity was a big driver in my ambivalence towards pursuing alternate opportunities, even when they came knocking on my door. As the job started and progressed through …

Changing the habit of physician drinking

Kristi H. Angevine, MD

Physician

October 17, 2019

Tuesday, getting ready for work. Standing in the shower, it hit me. I couldn’t remember the last time I wanted a drink.

I almost got a blob of conditioner in my mouth as I snorted out loud.

“Mom, you OK?”

“Yeah, baby, I’m great.”

Incredible, actually.

Like so many, my habit of using external things to feel better was well ingrained. As a kid, I’d sneak ziplock bags of homemade cookies. In residency, stress eating …

5 hidden symptoms of physician burnout

Mitchel Schwindt, MD

Physician

October 16, 2019

As I lay there awaiting my shock, the doctors milled in and out of my room over the course of several hours. It was a normal but hectic morning in the emergency department with ambulances and code blues pulling my doctor away.

Before pushing the Propofol and completing my cardioversion, the doctor flatly stated something I’d heard many times before. With a certain look in her eyes, she shared a personal …

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5 hidden symptoms of physician burnout

Can answers to after hours calls be automated?

Fred N. Pelzman, MD

Physician

October 15, 2019

At a certain point, we’ve all got to go home.

Whether it’s the end of the shift when the factory whistle blows and the assembly line stops rolling for a brief period while new people take our place, or late in the day after the last patient has been seen and our notes are all written and our portal messages have …

The medical illiteracy epidemic

Nicolai Hinds, MD

Physician

October 14, 2019

This past August, I attended the American College of Obstetricians and Gynecologists (ACOG) District VI meeting in Wisconsin. The theme of this year’s meeting was “Bringing it Back Home,” with a keynote presentation focused on developing the emotional habits to influence others and “embody the inner attitude of a leader.”

After a day of much self-reflection, I decided to stop by the poster presentations during a break between the major talks. …

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The medical illiteracy epidemic

A cardiologist’s take on red meat consumption

Anthony Pearson, MD

Conditions

October 13, 2019

The Skeptical Cardiologist was recently greeted by headlines announcing that an international panel of 14 unbiased researchers had concluded that it was OK for humans to continue eating red meat and processed meat at current levels.

The startling news was a reversal of what the Dietary Guidelines for Americans, the American Heart Association, and the American Cancer Society …

Physicians need moments of reflection throughout their days

Navpreet Sahsi, MD

Physician

October 12, 2019

“The music is not in the notes, but in the silence between them.”
– Achilles Charles Debussy

Silence is an important part of our everyday lives. Yet, we often don’t consider its critical importance in helping us to reflect on what we’re doing. This is especially important in medicine where we’re so busy sometimes that we forget that what we say and do actually has huge implications on people’s lives.

This is even …

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