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Doctor: You were strong. You are still strong today.

Physician

November 29, 2019

You were strong in college

You were strong enough to get through weed-out classes in undergrad. You were strong enough to balance the extra-curricular activities and clinical shadowing expected of you while crushing a 21-hour semester. You were strong enough to say, “no, I have to study” when friends wanted to go out because you had a dream of becoming a doctor someday.

You were strong enough to pay for the applications, …

The first lesson in medical school: Say you’re sorry

Jessica Stuart, MD

Physician

November 29, 2019

I paced in the hallway outside of the patient’s room, going over my mental checklist of items to do during the history and physical examination. Bringing in a paper list was discouraged; we were meant to “flow” through the exam “naturally.”

I stuffed my hands into the pockets of the white coat I’d received three weeks earlier, during the White Coat Ceremony for first-year medical students. Feeling around the deep pockets …

The secret to travel doctor success? Bring your family.

John Gallehr, MD

Physician

November 29, 2019

I recently returned from my second extended stay in New Zealand with my family. The entire experience was wonderful, but perhaps our most memorable day began with our three teenage sons waking up early to surf in the South Pacific Ocean. Once we had our fill of tropical paradise, we jumped in the car and drove a few hours to the local ski resort, where we found 10 feet of …

7 reasons why it’s hard to be kind

Jonathan Fisher, MD

Physician

November 28, 2019

Why do so many of us (meaning me) need to be reminded to act with kindness? Why can’t we “just do it”?

Yesterday, a friend asked me why we don’t celebrate World Kindness Day every day. I believe that’s a wonderful idea. But in practice, it’s not so easy. So, I got to thinking about why that is.

If we want to spread the ripple effects of kindness — to our families, …

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7 reasons why it’s hard to be kind

3 reasons why smart doctors fail big exams

Steve Blatt, MD

Education

November 27, 2019

OK, quick — word association time.

I say “doctor,” and you think what? “Smart,” right?

And it’s true. Doctors are smart. But before you buy into the myth that every doctor has breezed through school and could fall out of bed with a #2 pencil and crush an exam without thinking about it, consider that over 1,100 internal medicine doctors fail their board exam every year.

And that’s just one medical specialty. When …

The key to being an attending physician

Mary Braun, MD

Physician

November 26, 2019

When I graduated from residency, I was too worried about killing my first few patients to examine the meaning of being an attending physician. An early patient, a 97-year-old retired doc, brought it to my attention.

“Being an attending physician means you attend. When you attend me, all I want you to do is show up. You do not have to do anything. Keep the people with needles, knives, and nonsense away from …

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The key to being an attending physician

What to do when chronic illness is a source of embarrassment

Toni Bernhard, JD

Conditions

November 26, 2019

Embarrassment is a feeling of awkward self-consciousness or shame. It manifests as a sense of discomfort or even foolishness around others. Feeling embarrassed is emotionally painful because it means you feel uncomfortable with yourself.

The problem with embarrassment is that it adds a layer of mental suffering to the difficulties you’re already facing with your health. Here are four reasons why those of us who are chronically ill feel embarrassed at …

A brilliant song about the perils of texting and driving

Admin

Video

November 25, 2019

“Words Kill” is a brilliant song about the perils of texting and driving. Spread the message.

Courtesy of The Fever Breakers, a band made up of hospital employees. Their socially conscious songs are crafted in the basement of the hospital using a piano used for cancer patient music therapy and subsequently recorded in a studio.

A brilliant song about the perils of texting and driving

It’s OK to cry when a patient dies

Navpreet Sahsi, MD

Physician

November 23, 2019

As a young medical student, in my early 20s, I was still too inexperienced to know how a physician was “supposed to” act.

But I took the model of stoicism that I learned from my East Indian father and applied it to the medical model. Lectures on “professional detachment” reinforced this. I remember being told that it was the doctor’s job to keep a professional distance from a patient. By getting …

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It’s OK to cry when a patient dies

How studying abroad helped get me into medicine

Susan Muncner

Education

November 23, 2019

Think studying abroad doesn’t fit with your future plans? Think again.

Since the day I applied to university, I had been researching how I could incorporate global learning into my undergraduate degree program, while also thinking about my future goals for getting into medical school. When I was accepted to do a Bachelor of Science with a double major in chemistry and biology, I surprisingly still found time for extracurricular activities …

MKSAP: 67-year-old man with a carotid bruit

mksap

Conditions

November 23, 2019

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

A 67-year-old man is evaluated for a carotid bruit detected on routine medical examination. He reports no history of previous focal neurologic symptoms or visual loss. He has type 2 diabetes mellitus and hyperlipidemia treated with metformin, moderate-intensity pravastatin, and aspirin.

On physical examination, blood pressure is 128/64 mm Hg, …

Stop telling doctors what to do

Najma Hamdani, MD

Physician

November 22, 2019

I enjoy a fairly small private practice and a manageable telepsychiatry side job with good support staff. But even the small scale of my outpatient clinical practice doesn’t fully insulate me from the pain of unnecessary practices that I wish would become obsolete.

1. Preauthorization. The dance of preauthorization starts with the naivety on my part that I decide what medication my patient should be on. I spend precious time crafting …

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Stop telling doctors what to do

Medicine’s not what it used to be

Kerry Petsinger, DPT

Physician

November 22, 2019

When I was accepted to medical school, I debated — hard — whether or not to attend.

Out of the physicians I shadowed and interviewed, 19 out of 20 advised me not to become a physician.

Their dissatisfaction was rampant.

Over and over, I was told, “Don’t be a doctor. Medicine’s not what it used to be.”

They spoke of concerns ranging from unreasonable work expectations to inhumane conditions. They described insurmountable pressure, decreasing …

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Medicine’s not what it used to be

Are Americans really the worst patients?

Anupama Verma, MD

Physician

November 22, 2019

A recent article was published in the Atlantic about Americans being the worst patients.

Americans are part of a broken and dysfunctional health care system with exorbitant costs, a maelstrom of bureaucratic red tape, and insurance coverage that barely covers what most people need.

But are they contributing to this system by being such bad patients?

The article in the Atlantic seems to imply that this is the case. The …

What would an optimal libertarian health care system look like?

Taylor J. Christensen, MD

Policy

November 21, 2019

Next in a series.

In prior posts, I described my Healthcare Incentives Framework. If you haven’t read those, I recommend you check them out first to have the full context for this post. But here’s a refresher of the main points of the framework without re-explaining all the rationale:

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating …

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What would an optimal libertarian health care system look like?

Why choose a woman doctor?

Rada Jones, MD

Physician

November 20, 2019

Like all doctors, I’m a lousy patient. My doctor is a lovely man, but going to see him? That’s right there with weighing myself, getting a flu shot and doing my taxes, and behind celebrating Thanksgiving with the in-laws and getting a root canal.

And I’m not the only one. If I had a dollar for every patient who told me they hate doctors (no offense), I’d be long retired.

If you’re …

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Why choose a woman doctor?

A call to increase the availability of the Butrans patch

Cara Zimmerman, MD

Conditions

November 20, 2019

Janelle had overdosed 32 times.

Fentanyl coursed through her veins as she was given naloxone (Narcan) for the 32nd time in the ER, from the police, from a bystander. She could never get off of fentanyl. It had made her feel warm and numbed her from the trauma and horrors she had grown accustomed to. When she would wake up in the hospital, sore and discombobulated, she would beg for help. She …

Choosing family over medicine: Why I decided to leave clinical medicine

Kelli Randell, MD

Physician

November 19, 2019

When my obstetrician told me I was not going back to my clinic that afternoon due to severe preeclampsia, I was so indoctrinated that my first thought was of the inconvenience to my patients who would need to be rescheduled. Only a few minutes later did it register that I would be giving birth sooner than I had anticipated, and my new life as “working mother” would begin.

I was due …

The problem with reducing physician salaries

Smart Money, MD

Finance

November 18, 2019

Health care is big business, with medical practices vying for contracts, hospitals undergoing facelifts in order to cater to patient experiences, and insurance companies making deals with pharmacies. Some of these arrangements are negotiated in the name of reducing health care spending, but there has to be some skepticism when for-profit entities are implicated. Physician salaries aren’t exactly growing with inflation—some fields have had massive cuts in spending over the …

3 things every hospital should invest in

Christine Lau, MD

Physician

November 18, 2019

In the current health care system, patient outcomes, and patient satisfaction are increasingly important. With the hospital value-based purchasing program, Medicare adjusts payments to hospitals based on the quality of patient care they provide. Hospital consumer assessment of health care providers and systems scores are tied to Medicare reimbursements. Under the hospital-acquired condition reduction program, hospitals in the highest quartile of hospital-acquired conditions are subject to a 1 percent payment …

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