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The art of off-label prescribing

Meds

July 10, 2019

Some drugs are used for indications beyond their original FDA approved ones that make complete sense. I mean, if old seizure medications help nerve pain, it might be reasonable to try new ones for the same purpose if everything else fails.

Sometimes the broader use of a medication leads to additional FDA approved indications. One good example is bupropion, Wellbutrin, for smoking cessation. It even got a new name for that indication, Zyban, …

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The art of off-label prescribing

The conundrum of dual physician households

Smart Money, MD

Finance

July 10, 2019

Two incomes are better than one, right? As we all know, the answer isn’t clear cut. If we have to actively “work” to generate income, we have to balance exchanging time for money. Nothing comes for free. When you throw in a tax system to convolute matters, certain households are actually punished for going into the workforce. There is a delicate balance between each income-earning member and what each profession …

Before starting your own practice, do these 3 things first

Frederick Gandolfo, MD

Physician

July 10, 2019

If you’re a young doctor reading this, chances are you are employed by someone else. Your paycheck may come from a hospital system or a group of other doctors, but you’re not your own boss. This may be working out just fine for you: I hope you are happy and have a well-balanced work and personal life, and are getting a fair paycheck. I hope you have a sense of …

After cancer treatment: It’s time to reconsider the ringing of the bell

Anne Katz, RN, PhD

Conditions

July 8, 2019

It’s become a common practice in oncology institutions across North America: A patient completes their prescribed course of treatment and they ring a bell. Usually, it’s a large bell, like one that used to be rung in schools signaling the end of recess. Or it’s a ship’s bell, attached to a wall outside the radiation department or the chemotherapy unit. …

The truth behind the care at a skilled nursing facility

Steven Reznick, MD

Physician

July 7, 2019

Reuters recently published an article on skilled nursing facilities and post-hospital stays. They discussed the often-lengthy time between hospital discharge and the patient being seen by a physician or “an advanced care practitioner.”

Older, more infirm and cognitively impaired patients tend to be seen later than other patients. The later you are seen, the more likely it is that you will be sent back to the acute care …

MKSAP: 69-year-old man with chest pressure and dyspnea

mksap

Conditions

July 6, 2019

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

A 69-year-old man is evaluated during a follow-up visit. He initially presented with a 3-month history of chest pressure and dyspnea that occurred primarily with exertion. Despite maximal medical therapy, his symptoms have not abated and adversely affect his quality of life. Medical history is significant for type 2 …

Thinking about changing jobs? Here’s what physicians should consider.

Smart Money, MD

Finance

July 5, 2019

A large percentage of doctors end up switching jobs within the first five years of practice. This really isn’t surprising given that the medical training experience doesn’t necessarily correlate with the medical practice experience. Many doctors work hard throughout their entire training only to realize that their expectations do not necessarily align with reality. Is it our fault that we don’t really know what we got ourselves into?

Perhaps taking q3 …

8 incredible side effects of being debt free

Cory Fawcett, MD

Finance

July 5, 2019

Most Americans live their lives on borrowed money, constantly spending a little more than they make, leaving them with a growing debt. These debt payments, and the added interest they must pay on their debt, decreases the amount of money that they have available to spend on future needs. Paradoxically, borrowing to buy depreciating items, decreases one’s net worth.

Stop the madness this year. No more spending more than you make. …

What to do with disparaging doctors

Christopher Johnson, MD

Physician

July 5, 2019

Doctors who disparage, or even ridicule, what parents tell them are, fortunately, rare. Nevertheless, sometimes parents may infer from what the doctor says or how he acts that he does not value what they are telling him, even though he did not mean to imply such a thing. All physicians have had the experience of overly touchy parents inappropriately assuming from our questions that we do not respect their ability …

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What to do with disparaging doctors

Understanding the distinction between universal health care and a single-payer system is critical

Niran S. Al-Agba, MD

Policy

July 4, 2019

The World Health Organization describes universal health coverage — a system coupling health care access with financial protection for all residents — as the “single most powerful concept that public health has to offer.” The goal of universal care is to give all people the equal opportunity to enjoy the best health possible.

I wholeheartedly endorse universal health care, though not a single-payer system like “Medicare for all” because there is …

Practicing medicine full-time in America is very difficult. It’s time to think outside the box.

Suneel Dhand, MD

Physician

July 4, 2019

Talk about physician burnout and job dissatisfaction is everywhere right now. If you are a doctor, you cannot escape the news. Within the last couple of weeks, organizations in Massachusetts (a mecca of healthcare and hospitals) declared physician burnout a “major public health crisis.” This all sounds rather dramatic. On the surface, physicians are reasonably well paid, still enjoy a good degree of autonomy (certainly compared with many other …

Why is it so difficult for Americans to make doctors’ appointments?

Peter Ubel, MD

Policy

July 3, 2019

Jill Ladkin was already having a terrible autumn. It began with a seizure that put her in the hospital with what seemed like scores of unfamiliar physicians attending to her state of health. The brain scan revealed a mass in the lining of her brain, a location usually signifying a benign tumor; but, given her seizure, the tumor was hardly what you would call a harmless growth. The surgeon had a theory of what …

In the age of EHRs, why are we still asking patients to fill out paper forms?

Fred N. Pelzman, MD

Physician

July 3, 2019

From the sublime to the ridiculous.

That’s sort of how my day went yesterday.

It started out with an early morning meeting with a colleague who has been implementing a telehealth program at one of our institution’s practices, learning about how they have been using this technology, some of the bumps in the road they’d hit, and how they’d been able to …

You’re lucky to have a medical student in the family

Nathaniel Fleming

Education

July 2, 2019

One of the most common experiences faced by a medical student is being asked for health care advice from a friend or family member. My initial reaction to these questions is usually something along the lines of, “Are you sure you want to be asking me that? I’m not even a doctor yet!” This is especially true when the question is about something that I’m not particularly experienced in (which, …

A key strategy to use for difficult conversations: Ask questions

Suneel Dhand, MD

Physician

July 2, 2019

No matter what profession you are in, having uncomfortable and difficult conversations is something you have to get used to. Tim Ferris said in his bestselling book, The 4-Hour Workweek (which I’d highly recommend), “A person’s success in life can usually be measured by the number of uncomfortable conversations he or she is willing to have.”

It could be with another colleague, a client or customer. Even in your personal …

Physicians are problem solvers and artists

Hans Duvefelt, MD

Physician

July 1, 2019

I keep thinking about the dichotomy between covering a lot of ground and getting to the point.

The other day I saw my bosses at one of my clinics stop in their tracks when I suggested that a lot of the things we are measured on as physicians could be turned into standing orders and simply get shifted off my plate. I have just created a letter that anybody can send …

What to do with physicians who don’t explain

Christopher Johnson, MD

Physician

June 29, 2019

How doctors treat patients’ need for information has changed significantly over the past decades. Sixty years ago medical practice was much more paternalistic than it is now, although some would say it continues to be so in important ways. Still, not too long ago it was common for doctors to tell patients or their families next to nothing about what was going on. The presumption always was: the doctor knows …

A diagnosis of pneumonia in a rehab facility: We can do better

Hans Duvefelt, MD

Physician

June 28, 2019

I’ve known Pat McCann (identifying information changed) for many years. He carries a diagnosis of COPD and has a preventative and a rescue inhaler, but he has never really had any serious flare-ups.

He fell and broke his hip. Then he went to skilled rehab, one of a half dozen near Cityside Hospital. His stay turned longer than expected because he fell, luckily didn’t break anything, but had to go back …

10 tips for success after you finish residency

Michael Javid, DO

Physician

June 28, 2019

If you’re done with your residency or fellowship, you’ve paid your dues. And I am excited for you. Life is about to get better. A lot better.

If you read my prior article about going unmatched, you know that things have not always gone smoothly for me. But now, after a reasonably good first year out of training, I feel compelled to reflect on why things are going well, and also—to offer any …

Physicians: Do not be intimidated by administrators

Suneel Dhand, MD

Physician

June 28, 2019

A piece of advice I would give to any younger physician, especially one who is just graduating residency, would be to expect a whirlwind ride into the realities of frontline medical practice. It’s something that you are totally not prepared for in the controlled environment of education and residency training. A steep learning curve awaits you once you start practicing medicine. And one of the biggest things you will have …

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