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 …

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A framework for understanding health care systems

The Resident and Fellow Bill of Rights

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

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 …

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Why electronic medical records should be standardized

Why this physician never tells anyone she’s a doctor

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 …

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Why this physician never tells anyone she’s a doctor

4 significant misconceptions about universal health care systems

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 …

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4 significant misconceptions about universal health care systems

How internal medicine got its name

Physician
October 21, 2019

acp new logoA 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

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, …

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

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

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 …

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

Why this medical student chose to pursue medicine

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, …

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Why this medical student chose to pursue medicine

How “Joker” gets mental illness wrong

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)

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 …

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

Physicians explain Sia’s chronic pain

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 tweet, 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.

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 …

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

Changing the habit of physician drinking

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 …

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Changing the habit of physician drinking

5 hidden symptoms of physician burnout

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

The medical illiteracy epidemic

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

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 …

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A cardiologist’s take on red meat consumption

Physicians need moments of reflection throughout their days

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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Physicians need moments of reflection throughout their days

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