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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 …

Second-tier, off-label treatments for anxiety

Wallace B. Mendelson, MD

Meds

October 10, 2019

In previous posts, we have reviewed the use of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as the off-label prescribing of gabapentinoids, for treating anxiety disorders. Anxiety is such a ubiquitous problem that it is not surprising that many other compounds have been used off-label as well. In this posting, we will review some of the common ones: propranolol, mirtazapine, and quetiapine. …

We have to do better than DNR tattoos

Fred N. Pelzman, MD

Physician

October 9, 2019

Returning from my week of vacation, I was greeted by the usual stack of mail, faxes, forms to be signed, throwaway journals, and a fully loaded group of in-basket messages that had piled up in the electronic medical record that needed attending to.

One of the pieces of mail was an unsolicited package with a bright red label on it, along with …

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We have to do better than DNR tattoos

Being oversensitive to others’ opinions can be harmful

Ariela L. Marshall, MD

Physician

October 9, 2019

We all want to get home as quickly and safely as possible at the end of the day. The other day — as I braked for a red light and turned my right blinker on — I not only looked to see if cars were coming from the left but also checked my rearview mirror.

In a moment of introspection, I suddenly wondered: “Why am I doing that?” What difference would …

Burnout in fashion and medicine: A fashion designer turned physician compares notes

Hisla Bates, MD

Physician

October 8, 2019

“Fashion Is Moving Too Fast, and It’s Killing Creativity,” by Veronique Hyland, talks about burnout in the fashion industry. As a former Fashion Designer turn physician, my curiosity was piqued. If you substituted the word “medicine” for “fashion,” the title would be just as relevant to the medical industry, as it is to the fashion industry. Yes, medicine is moving too fast, and it’s killing creativity and our doctors. Burnout in the fashion industry stems from the need to …

A physician is worried about gender transition in pediatrics

Julia W. Mason, MD

Conditions

October 7, 2019

My first transgender patient was a teenager who said although he was born female, he’d protested his gender from the time he could talk. He told a story of being asked, “Well, if you are a boy, where is your penis?” and he pointed to his umbilicus (which was an “outie”). OK, no problem, we have a gender clinic I can refer you to.

When he came back and asked for …

Advice to a pregnant surgical resident

Lauren A. Umstattd, MD

Physician

October 6, 2019

As a profession, we’ve yet to standardize maternity leave and breastfeeding allowances for women. Given the length of medical training (seven-plus post-graduate years), timing (prime reproductive years) and slow increase in the ratio of female to male surgical residents, females choosing to start families during training are particularly afflicted.

We just celebrated my son’s first birthday. I had him during one of the busiest years of my surgical residency, and it’s …

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Advice to a pregnant surgical resident

Avoiding late-stage dementia with advance directives for stopping eating and drinking

Thaddeus Mason Pope, JD, PhD

Conditions

October 6, 2019

On October 1, 2019, Nevada began allowing individuals to avoid living in late-stage dementia. The new statute recognizes the legitimacy of an advance directive that instructs health care providers to stop hand feeding food and fluid by mouth. Individuals have already been completing such directives in New York and Washington. The Nevada law is the first that explicitly authorizes such instructions.

Growing …

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