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

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 …

MKSAP: 54-year-old woman with flushing of the face

mksap

Conditions

October 5, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 54-year-old woman is evaluated for flushing of the face of 1 year’s duration. These episodes occur two or three times per week and last about 30 minutes. She went through menopause at age 50 and is on estrogen and progesterone hormone therapy. She also experiences episodes of anxiety, …

What it means to be an attending physician

Mary Braun, MD

Physician

October 4, 2019

Dr. Ryme had been retired at least thirty years from medicine when he met me, his last pupil. I was a freshly minted doctor, and he became the first teacher of a new course at my new school called “Life as an Independent Doctor.”

At our first office visit, after telling me his life story, he quizzed me, “And furthermore, Dr. Braun, you’re an attending physician now. You are no longer …

20 minutes isn’t long enough for an office visit

Fred N. Pelzman, MD

Physician

October 3, 2019

As many of you know, if you’ve read my columns regularly, once a year the whole family escapes from the city, and we travel up to New Hampshire to stay at the lake house that’s been in my wife’s family for over 100 years.

A modest wooden house perched out over the water, situated just right for sunset viewing, for a few …

Using low-dose naltrexone to treat pain

Alex Smith

Meds

October 2, 2019

Lori Pinkley, a 50-year-old from Kansas City, Mo., has struggled with puzzling chronic pain since she was 15.

She has had countless disappointing visits with doctors. Some said they couldn’t help her. Others diagnosed her with everything from fibromyalgia to lipedema to the rare Ehlers-Danlos syndrome.

Pinkley has taken opioids a few times after surgeries, but they never helped her underlying pain, she said.

“I hate …

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Using low-dose naltrexone to treat pain

How we got from 18th-century tinctures to the opioid crisis

Mike Magee, MD

Meds

October 2, 2019

Americans have always loved their medicines and sought them out actively to cure whatever ailed them. Their interest ranged all the way from “staying well” to “feeling better.” Productivity in this hard-charging, pull yourself up by the bootstraps society required activity, and it’s hard to be active when you’re sick.

In the 18th-century in Germany, England, France, and Switzerland, men practicing pharmacy saw their retail operations as the …

An expensive treatment may be a victim of its own widening use

Julie Appleby

Meds

October 1, 2019

Medical treatment has knocked down tumors in 6-year-old Easton Daniels’ brain, but the drug used also wiped out his immune system.

To bolster his immune function and help keep him healthy, he has visited a hospital for intravenous infusions of immune globulin about every month for the past year and a half.

But in early July, his family was stunned by a letter from Cincinnati Children’s Hospital: “All of Easton’s appointments canceled …