A surprising cause of rectal bleeding

Conditions
May 2, 2018

“I can’t stand the site of blood!”

We’ve all heard that adage. Blood can provoke emotional reactions from even steely muscle-bound bodybuilders. We gastroenterologists routinely receive fearful phone calls from patients who have observed even minor rectal bleeding. Fortunately, in most of these cases, there is a benign explanation for the sanguinary seepage.

If blood repels you, then gastroenterology should not be on your short, or even long list of professions under …

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How to give patients bad news

Physician
April 30, 2018

I would like to give some tips to younger doctors regarding how to tell your patient that he is going to die. Your approach should also incorporate your unique personality, as well as published literature and other resources.

For your first case, watch someone more senior tell the patient. See what you think worked and what could be improved. When it is your turn, make sure to have …

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Why is it difficult to be a doctor?

Physician
April 30, 2018

As part of the interview for my book, I asked why it is difficult to be a doctor. Some of it has to do with integrating information and making decisions.

“The public thinks that we know more or can do more than we can. Ultrasounds don’t mean it’s a perfect baby. All of the tests and technology moves so fast that we don’t know what we see.” A doctor explained, “You cannot know …

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Are you an artisan or just a medical professional?

Physician
April 28, 2018

Take a moment to ask yourself the following:

1. Did I come to practice medicine because it was a calling, rather than a possibly lucrative career path?
2. Do I consider the practice of medicine primarily an art, a craft and the consistent application of evidence-based care?
3. Do I respond to inner measures of prideful work more than the appeal of external motivators?
4. Are there lines that cannot be crossed, even if …

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A pulmonary physician’s take on vaping

Conditions
April 27, 2018

Walking down the street, I sometimes see people who appear to be strolling in a cloud. These folks are wrapped in vapor they inhale from e-cigarettes — a practice called vaping.

Vaping devices first emerged in the late 1990s. They feature a battery-powered heating element that heats up liquid nicotine to create an aerosol, which is free from the toxic byproducts of cigarette combustion. In theory, this device …

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How to match into a fellowship

Education
April 27, 2018

Residency training is an opportunity to get a good feeling of the specialty that interested you when thinking about what to pursue in the future. You may think that after applying for premed college, medical school and residency, applying for fellowship would be a piece of cake for you. Let me tell you: applying for fellowship is probably the hardest one among all other applications you went through so far. …

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I’m retiring my first stethoscope

Physician
April 26, 2018

I retired my first stethoscope today. I bought my Littmann Cardiology III during my first term of medical school in 1999. It came with a penlight, otoscope, ophthalmoscope, manual blood pressure cuff, tuning forks and reflex hammer, all contained within a traditional black leather physician’s bag with my initials in gold. Receiving your medical student diagnostic kit is one of the rites …

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Oh, are you a nurse? The physician gender bias

Physician
April 26, 2018

A man and a woman step into an elevator wearing the exact same hospital scrub uniforms. The man’s pager suddenly starts beeping, and the stranger in the elevator says to him, “Do you doctors really still use pagers?” The stranger then notices the women next to him and asks her, “Oh, are you a nurse?”

It’s something that has happened to every female physician. It’s not that we mind getting mistaken …

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Moonlighting is the side hustle for the not so lazy

Finance
April 26, 2018

Physicians-in-training make a pittance when one looks at the hourly rate,  Especially when I was residency, in the early 2000’s.  I often worked upwards of 100 hrs per week and made $30,000 per year.  The first year, called internship, is replete with long hours and crushing responsibilities.  Opportunities to make an extra buck are all but impossible.  In the second and third years, however, there is much more elective time.  During these …

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Taking risks and the costs of inaction

Finance
April 25, 2018

Every day, we’re presented with choices. Some are larger than others, and though some make little difference in the grand scheme of things, some choices can be life-altering. In life and in business, when we have a big decision to make, it’s all too easy to err on the side of caution–sometimes to our personal or financial detriment. It’s human nature.

But what is it that keeps us from making tough …

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My first objective structured clinical examination

Education
April 20, 2018

After a semester of studying and taking written exams, we had our first OSCE in medical school. An OSCE — or an objective structured clinical examination — is the real deal. Instead of filling out multiple choice boxes, we instead work with a real human being, which for me is a welcome change.

The actor is given a script with their unique condition and story — it’s a simulation of what …

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6 things this physician learned after retiring

Finance
April 20, 2018

In February 2017, I saw my last patient and left clinical medicine. Most people would say I retired. I have chosen to say I have repurposed. I no longer see patients, but I still work. I am writing the Doctors Guide series of books, keeping up a blog and working with physicians who need help with a financial makeover, usually to eliminate their debt, set themselves up for retirement or …

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A medical intern’s 3 greatest fears

Education
April 19, 2018

A 76-year-old gentleman with a history of kidney failure, myasthenia gravis and recently diagnosed with esophageal cancer presented for evaluation of melena and hypotension.

The patient was my first admission to the medicine team as an intern, and he was as near to an ICU admission without actually being admitted to the ICU as one could come. After examining the patient, I briefly staffed with the busy attending physician, placed the …

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How physicians can start lazy side hustles

Finance
April 19, 2018

How do I start a side hustle?

I have heard this plea so often, It is no wonder there are many how to blog posts trying to answer this exact question.  As helpful as they may be, most of the ideas espoused are both time and energy-consuming.  For instance, starting a blog is great!  But if you want to truly make money, be prepared to put in full-time hours.  Or Read more…

An awkward encounter with a hypochondriac

Video
April 18, 2018

A warning about examining your friend’s medical condition. Brad Nieder is a physician and comedian and can be reached at the Healthy Humorist.

Here’s what’s wrong with time-based billing in the hospital

Physician
April 17, 2018

Consider this hypothetical addendum to a hospital discharge summary:

”ADDENDUM @10:56 a.m: In considering the accurate billable discharge time involved in this case (as I have recently been instructed by hospital coders that I must record the exact time required for a patient discharge, rather than simply “greater than 30 minutes” or “less than 30 minutes”), I feel I have stumbled upon a troubling quandary, having failed to note the exact …

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Independent practice: Nurse practitioners respond

Policy
April 17, 2018

Shortly after the publication of “Independent practice: Both nurse practitioners and physicians should be outraged,” the nurse practitioner (NP) leadership responded with a press release, denouncing the concerns that were cited, calling them “rhetoric.”

But in contrast to this criticism from the political end of the NP spectrum, I was inundated by emails from working NPs across the country in support …

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The human touch in medicine: good or bad?

Physician
April 17, 2018

Humans need human touch

Patients sometimes need a shoulder to cry on. When I say that, I normally mean it on a completely figurative level.

However, at times, it needs to be interpreted differently. There are instances in a medical encounter where an actual shoulder could be of service — a physical crutch that takes off an emotional load — and that’s when the popular adage can be beneficially carried out in …

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The fall of the digital rectal exam

Conditions
April 16, 2018

For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.

As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable …

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