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An American physician in Sweden. Here’s what he thought about its health care.

Policy

July 14, 2019

I had the distinct pleasure working with family physician colleagues in Sweden recently. It was a similar experience to a trip I made to Britain about five years ago that I also wrote about. I got to spend some time watching one of my colleagues care for her patients in her surgery (they use the same description of a clinic as the British).

I got to spend some time watching …

Why you’re an unhappy physician

Suneel Dhand, MD

Physician

July 13, 2019

Health care is a tough job to work in — whether you are a doctor, nurse or any other professional. We are dealing with matters of life and death, our patients expect (and deserve) the best from us, and we always have a hundred-and-one things to do at the frontlines of medicine. I remember reading somewhere when I was a teenager that a career in medicine would be a “mentally, …

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Why you’re an unhappy physician

MKSAP: 23-year-old woman with painful lumps on her legs

mksap

Conditions

July 13, 2019

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

A 23-year-old woman is evaluated for 2 weeks of painful lumps on her legs. The lumps persist for several days and make it difficult for her to go to work as a waitress. She is a college student in Ohio where she has lived her whole life. She has …

The line between family member and personal doctor

Brian Vukelic, MD

Physician

July 12, 2019

I, like many physicians, am the only doctor in my extended family. To say that they are proud is probably an understatement. I’ve been a practicing physician for seven years now and yet my grandmother each time I see her greets me with, “There’s my doctor grandson.” I have worked quite hard to get to where I am, and I enjoy what I do. I, too, am proud to be the …

The pros and cons of being a part-time physician

Passive Income, MD

Finance

July 12, 2019

“Burnout” has been a buzzword circulating in the medical community quite a bit lately. The World Health Organization has just recognized the term as an official medical diagnosis as part of ICD-11.

One moment you’re graduating medical school, full of hope and excitement for residency. The next moment, you’re overly stressed and working insane hours every week. Honestly, it isn’t a huge surprise that nearly half of all physicians …

The art of off-label prescribing

Hans Duvefelt, MD

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 …