I shared my assessment and plan with the preceptor as she walked into the room. She cut me off, “You think this patient needs surgery?” she smirked. “He has no idea what he is talking about, don’t mind him,” she whispered loudly to the patient. I kept quiet until the patient left, and my preceptor began writing her note. I pulled up a recent research article I had found prior …
Who are the best educators for medical students?
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
For years, research and common belief have supported the concept that patient education alters patient behavior and improves patient outcomes. For instance, lifestyle changes, implemented after improved physician-patient engagement and education, have demonstrated clinical benefits in a wide range of chronic illnesses, …
The importance of patient education before surgery
Falling through the cracks, when it comes to health care, is a bad thing, but the way things are going, it’s getting harder and harder to avoid.
Providers in every setting are bombarded on all sides with data, results, messages, and things crying out — screaming — for our attention. Take, for instance, the conundrum that appears when a patient is …
How to prevent patients from falling through the cracks
I have always felt lucky and relieved when a cardiologist told me I seemed to be fine despite my heart condition. My condition, referred to as congenital, complete AV block, is estimated to affect between 1 in 15,000 to 22,000 live-born infants. The electrical block is more commonly seen among older, adult patients where it presents an acute pacemaker indication.
Researchers do not know very much about what causes the condition …
UpToDate? Information my cardiologists didn’t have.
“Planned death.”
When you put it like that, this can only mean one of two things: suicide or murder. For most of us in medicine, the very idea of “planned death” seems safely outside our purview. After all, the bulk of medicine is concerned with staving off death. And the very nature of death’s uncertain timing enables practitioners of everyday medicine to take refuge in its mystery.
When necessary, we prognosticate. But …
A critical discussion is needed about planned death
On July 8, 2019, the American Academy of Emergency Medicine wrote a letter to the American Medical Association, asking the organization to create a public campaign to support physician-led care.
Noting concerns over the recent media crusade to promote nurse practitioner care to patients, including the American Association of Nurse Practitioners “We Choose NPs” campaign, the letter asks the American Medical Association to combat the …
“The Big Sick” is an intimidating name for a movie. I never know what to think when “sick” is used as a noun. Does it mean vomit? Are we referring to ailing people? Just as the name doesn’t give you much insight, neither does the beginning of the film. It has nothing to do with illness. It’s about a Pakistani standup comedian/Uber driver who starts dating a white girl, but …
What The Big Sick says about our profession
“What’s the most common missed fracture?” my supervising PA asked during my clinical rotation in the emergency department. “The second one,” I answered confidently. It was the right answer, and I surprised him by knowing it. He had previously given a lecture to my class and had emphasized this clinical pearl in such a way that I knew it was one of his favorite trick questions.
Unfortunately, I didn’t always know …
Roundsmanship: the skill you didn’t know you needed
Many consider the novel the House of God, written by Samuel Shem (pen name for Stephen Bergman), to be a must-read for any physician or soon-to-be physician. A fictionalized account of his internship year, the book details how the accumulated stress, fatigue, and powerlessness of being a first-year doctor inexorably accumulates during that year — with sometimes hilarious, and but also disastrous, results.
The survival strategies of the interns in …
When should physicians read the House of God?
Something I’ve been thinking about lately is the path that we’ve all been somewhat conditioned to take. And that is working really hard now so we can reap the rewards later. If you don’t work really hard now, you risk not being able to enjoy life when “later” finally comes.
Does that sound familiar to you? Well, it should, because that’s the exact path we took to become successful in our careers. …
Work hard now, enjoy later. Is it time to rethink that?
It took me decades of studying, training, hard work, and sleepless nights to become a doctor. In approximately five years, I became a successful writer, editor, columnist, and a whole array of other titles assigned to that type of work. In under 3 seconds, I became a chronic pain patient for the rest of my life.
Around this time last year, I was taking my two dogs outdoors when they spotted …
The physician who became a chronic pain patient in seconds
I’m sorry you are sick. I’m sorry you had to wait a long time in the waiting room. I’m sorry you haven’t gotten your pain medications. I’m sorry I don’t have an answer. I’m sorry the department is busy. I’m sorry it’s loud. I’m sorry I don’t know why it smells in here. I’m sorry your neighbor is screaming. I’m sorry you are in pain. I’m sorry you are uncomfortable. …
I’m sorry: Why I lost my love for medicine
Some hospitals are trying a curious new tactic to attract patients: free hernia screenings.
One Illinois hospital raffled off tickets for a smart speaker to entice people to get their abdomens checked by a surgeon, while an Indiana hospital offered a chance to win dinner at a chophouse.
Announcements for screening events in Colorado and Maryland warned about “life-threatening” complications that could arise if hernias are left untreated. And hospitals in Read more…
Beware the hidden agenda of free hernia screenings
An excerpt from Understanding Medicines for Anxiety.
In addition to medicines with FDA indications for anxiety, such as benzodiazepines and some antidepressants, a number of drugs are frequently prescribed off-label. Among these are gabapentin and the related compound pregabalin, collectively known as gabapentinoids. Their popularity is remarkable: gabapentin has been …
Off-label use of gabapentin and pregabalin for anxiety
Many people use reviews to help decide how to choose products and services. However, it is not widely known that an online physician review may not reflect what we think it does.
I thought about sharing this information before — but now it is time.
Recently, a frustrated patient called my office to schedule an appointment.
She simply wanted a doctor who did not have awful online reviews.
Seriously?
This is truly a sad state …
How online physician reviews can be fake news
Whether you are starting a new job, like me, or extending the contract at your current one, part of the process may involve signing up for retirement accounts. Most people have heard of a 401(k), but you may have other options available to you such as a 403(b) and Roth IRA. Let me breakdown the pros and cons of each account, so you can better determine which one is best …
Which retirement account is best for physicians?
It is no secret that health care providers shoulder a lot of responsibility. As a whole, they take this on with both competence and kindness. Sacrificially, they go above and beyond in order to provide patients with the highest of quality care. They juggle a multitude of professional and personal responsibilities in creative and admirable ways. Meanwhile, each health care provider learns to adopt a unique combination of coping mechanisms …
How physicians become medical narcissists
Although pediatric (children’s) hospitals are not yet mandated (as are their general population counterparts) to participate in value-based contracts (VBCs), as competitive medical institutions they are very cognizant of the market changes toward value-based payment models while tirelessly seeking to increase value in pediatric health care delivery.
The push towards better alignment of payers and hospital systems continues to change the landscape of competitive health care. Children’s hospitals “are the backbone …
Are pediatric hospitals ready to embrace value-based payment models?
As Wei Wei Lee sat with her doctor to discuss starting a family, she felt a “distance” between them. The physician was busy on the computer and focused on the screen.
“It just didn’t feel very personal,” Lee said. “I didn’t feel heard.”
It seemed as though keeping a record of the conversation was more important to the doctor than making a connection with Lee.
It wasn’t the experience she wanted, but she …
When physicians focus more on screens than patients
You’re a clinician. You had a patient die under your care, and now your hospital is being sued. You are not named in the lawsuit, but you are being asked to give a deposition. How much of your time is this going to take? If some lawyer sends you thousands of pages to review before scheduling multiple phone calls …
What to do when physicians get subpoenaed as witnesses
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