Direct primary care and concierge medicine: They’re not the same

Physician
August 24, 2014

Direct primary care (DPC) and concierge medicine are rapidly growing models of primary care. Though the terms are used interchangeably, both are not the same. Such liberal use of terms, many times by even those within the industry, confuses those who are attempting to understand how these primary care models operate. As former concierge physician for the Pebble Beach Resorts, and subsequent founder of one of the nation’s largest direct …

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MKSAP: 59-year-old man with intermittent itching

Conditions
August 24, 2014

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

A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started …

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MKSAP: 21-year-old man with a heart murmur

Conditions
August 23, 2014

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

A 21-year-old man is evaluated during a medical examination for health insurance. The patient is a weight lifter. He has no medical problems and takes no medications or illicit drugs.

On physical examination, blood pressure is 128/73 mm Hg, pulse rate is 56/min, and respiration rate is 16/min; BMI is 30. Increased skeletal …

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Top 10 ways to know it’s time to quit your job as a doctor

Physician
August 21, 2014

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Attention all doctors: The first three are mine. The rest are from miserable colleagues. All true. And common. If you’re a doctor and you recognize anything on this list, please quit your job.

10. You feel nauseated when you see your clinic logo; you alter your commute to avoid streets with your clinic’s billboard.

9. Discouraged by the general despair among staff, you …

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Oncologist pay and chemotherapy: Buy and bill needs to stop

Physician
August 19, 2014

Today’s article highlights the lingering problem of physicians buying and selling prescription medications to patients — at a profit.

The medical profession has struggled with this controversial practice  for more than 150 years.

In George Eliot’s 1874 novel “Middlemarch,” an idealistic young doctor named Tertius Lydgate questions the ethics of fellow physicians who make handsome profits prescribing and dispensing their own remedies to the townsfolk. His medical colleagues shun him for it.

Around …

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Vaginal video games: What to make of mobile Kegel apps

Tech
August 18, 2014

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There are two new high-tech ways that aim to help you with Kegel exercises, both with Kickstarter campaigns. There is the Skea (Smart Kegel Exercise Aid), basically a video game that proposes controlling the avatar with a vaginal probe that uses the pelvic floor muscles and kGoal, a vaginal insert that is meant to connect wirelessly with your smart phone and measures your squeeze …

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The blonde minority: Sexism is alive in medicine

Physician
August 18, 2014

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While demographic data may suggest otherwise, I still consider myself a minority, albeit a less common one. I am a young woman in medicine, and I am a natural blonde.

I barely qualify for a prescription for eyeglasses, but I have found they give credence to my words and patients seem to take me more seriously. Perhaps three years of residency training …

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The unhealthy behaviors of physicians

Physician
August 17, 2014

As a fourth-year medical student, it was fairly easy to maintain a healthy lifestyle. When you have much leisure time and are relatively stress free, you can eat healthy, stay physically active and maintain quality mental health. However, as I begin the journey called residency, it is clear that the task of maintaining my own health will be much more difficult.

But the importance of this task should not be overlooked. …

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MKSAP: 57-year-old woman with decreased exercise tolerance

Conditions
August 16, 2014

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

A 57-year-old woman is evaluated for a 2-week history of decreased exercise tolerance and substernal chest pain on exertion. She also has an 8-month history of macrocytic anemia.

On physical examination, temperature is 36.7 °C (98.0 °F), blood pressure is 137/78 mm Hg, pulse rate is 104/min, and respiration rate is 17/min. BMI …

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Consider the messages that tattoos are sending

Physician
August 15, 2014

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Ink is everywhere these days, and I don’t mean on newspapers or in magazines. Tattoos are far more pervasive than I can ever recall in my fifty years. There was a time, when I was young, that boys were awestruck by the old Navy veterans, whose arms bore anchors, and the Marines with Semper Fi across their battle-scarred chests. Occasionally, when …

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A letter from a hospitalized patient to a hospital CEO

Physician
August 13, 2014

We are at a pivotal moment in health care. It’s changing so rapidly even the people leading the change can barely keep up. One of the biggest paradigm shifts over the last decade is the focus on quality over quantity. Improving the health care experience and patient satisfaction are also being talked about in boardrooms across the country (largely due to the link with reimbursements, but still unthinkable a few …

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At the hospital, I’m Dr. Nobody

Physician
August 12, 2014

Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital. Yay me.

I went to visit a patient who was admitted over the weekend to see what was going on.  She was a bit upset about the confusion of the hospitalist service and how orders apparently didn’t get written for her care by the admitting physician. …

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Are you a medical liberal or a conservative?

Meds
August 9, 2014

Our nation is highly polarized today, and often bitterly so.  Democrats rail against the GOP.  Pro-lifers face down pro-choicers.  Fox News disses MSNBC.  Isolationists push back against expansionists.  Traditionalists disdain the politically correct.  Free marketers duel against government advocates.  Carnivores deride the gluten-free crowd.  Martin Bashir trashes Sarah Palin, two proxies in a culture war.

There’s a philosophical divide among physicians also.  Would you prefer a liberal physician or a conservative …

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One more thing syndrome: 4 tips for doctors to stay on time

Physician
August 8, 2014

“Doc, can I ask you one more thing?”

These words are classic symptoms for those patients suffering from the “one more thing” syndrome. We’ve all been there. The visit has ended, your hand is on the doorknob, and you’re about to leave the room. Precisely at that moment, your patient stops you and says he has one more thing to discuss.

You think to yourself, “No! I almost made it out of …

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A letter to new medical students

Education
August 7, 2014

Dear new medical student:

Congratulations! You are about to embark upon an exciting, life-altering experience, one you will never forget. You are about to join an elite group of people who will now be your peers going forward.

You will be continually fascinated, and not a single day will go by from now until you retire that you aren’t challenged by something you have never encountered before. You will be solving problems …

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