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A patient that reminded me of the first man I ever witnessed dying

Conditions

April 24, 2019

He struggled to breathe, progressing from deep breaths with wet sounds reverberating in his lungs, to guppy breathing — opening the mouth like a fish, contorting the entire face. His heart rate slowly decreased, from 150 beats a minute — a pace attempting to keep up with the oxygen demands of the body — to 50 beats, to 40 beats, to that which is incompatible with life. The nurse pushed …

USMLE Step 1 tips that may surprise you

Jason Ryan, MD

Education

April 21, 2019

To reach my current position as a general cardiologist, I have taken nine board exams. I have also been teaching medical students for over ten years with several colleagues who write questions for the USMLE Step 1 exam. Through this experience, I have observed a number of themes about what works and does not work for board preparation. I share these with you now in the hopes they may help …

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USMLE Step 1 tips that may surprise you

A nurse’s downfall was telling the truth

Debbie Moore-Black, RN

Conditions

April 21, 2019

These events happened over 18 years ago. Some content has been changed to protect the innocent and the guilty. Searching for positive changes in the health care industry. We are not a number, and the patients are not a number.

I’m not good at lying. My eyes go to the left or look downward, and I start to stutter and pause. There is no eye contact, and I fall deep into …

The powerful phrase that’s ruining medicine

Jackson B. Salvant, Jr., MD

Physician

April 20, 2019

Within the clinics, hospital corridors, and halls of medicine, a new phrase has emerged and taken hold of the practice of medicine. Whenever confronted with the challenging, inconvenient, undesirable, underinsured or maybe when just overwhelmed, health care personnel have begun to utter the phrase “I’m not comfortable with …”

Upon the utterance, all responsibility to the patient, institution or the honorable practice of medicine is immediately and completely discharged until the …

MKSAP: 39-year-old woman with fatigue, intermittent rectal bleeding, and abdominal pain

mksap

Conditions

April 20, 2019

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

A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or …

What physicians should know about investing in real estate

Passive Income, MD

Finance

April 19, 2019

As someone who can’t stop talking about passive income investments, I inevitably end up having a lot of conversations about investing in real estate.

I’ve heard countless stories of how real estate investing has helped people achieve their goals, but from those who don’t invest, I often hear this objection commonly voiced, “I don’t want to be called in the middle of the night to unclog a toilet.”

What I …

8 things to watch for if you, or a family member, is hospitalized

Suneel Dhand, MD

Physician

April 18, 2019

Hospitals are busy, hectic, and unpredictable places. Professionals who work in health care are highly trained and competent individuals, and if you are receiving acute care in America — the standard of your treatment and access to high-quality tests and an array of specialists, is unparalleled (take it from someone who has worked in different countries). Nevertheless, the hospital experience itself, despite our best efforts, often falls short. Here are …

What distinguishes good physicians from truly seasoned medical professionals?

Michael Kirsch, MD

Physician

April 17, 2019

One thing that gastroenterologists know about is stool. But, I’m not referring to that kind of stool in this post. Follow along.

When we do a colonoscopy, for example, we are relying upon stool, or more accurately a stool, as in a three-legged stool. This metaphor illustrates that the three legs must be equally strong or the stool will not stand. The three pillars of support that a colonoscopist needs include:

How physicians and administrators can get to a place of greater trust

Leslie Flores

Policy

April 16, 2019

Recently, I wrote about some key findings from a 2018 survey of U.S. physicians by The Physicians Foundation. It’s no surprise to anyone working in health care today that the survey found alarming levels of professional dissatisfaction, burnout, and pessimism about the future of medicine among respondent physicians. Sadly, it appears that much of that pessimism is directed toward hospitals and their leaders: 46 percent of survey respondents viewed …

Was she a doctor? Or was she a hack?

Dana Canfield, MD

Physician

April 14, 2019

Separating fact from fiction had once been her favorite activity. Going over research with a fine-toothed comb, she caught the inaccuracies that riddled popular culture like unruly strands of hair. It came down to this simple algorithm: there were things that could be proven and things that could not. In other words, there were things that would happen consistently given the same set of conditions, while other things were random. …

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Was she a doctor? Or was she a hack?

What are the top non-clinical physician jobs and salaries?

Health eCareers

Physician

April 13, 2019

This article is sponsored by Careers by KevinMD.com.

When considering a career in the medical field, many people only think of physicians and nurses who work in clinics, give shots, and diagnose patients. However, there’s …

MKSAP: 62-year-old woman with a sun allergy

mksap

Conditions

April 13, 2019

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

A 62-year-old woman is evaluated for a “sun allergy,” manifesting as a rash on her scalp, eyelids, upper back, and knuckles. This started 2 years ago, but is less pronounced over the winter months. Medical history is unremarkable. Her only medication is hydrocortisone cream.

On physical examination, vital signs are …

A medical student grew up without health insurance. Here’s why that matters.

Yoo Jung Kim, MD

Education

April 12, 2019

I’m constantly awed by the fact that I get to be part of one of the best hospitals in the world, especially because as a kid, I grew up without health insurance.

These were the days before the Affordable Care Act; there was no penalty for going without health coverage. As a non-citizen, I was ineligible for Medicaid, and private health care was prohibitively expensive for my family. Fortunately, I was …

These are the only 3 reasons to file a tax extension

Cory Fawcett, MD

Finance

April 12, 2019

There are only three valid reasons to file an extension on your taxes, which changes your required filing date from April 15th to October 15th. Unfortunately, I see many people who have filed an extension incorrectly or for the wrong reason that end up getting billed by the IRS for interest and penalties. There is no reason anyone should have to pay penalties for late tax filing since correctly filing for …

Fleece pajama bottoms in the ER

StorytellERdoc, MD

Physician

April 12, 2019

Can someone please tell me the exact moment when fleece pajama bottoms became the fashion sensibility of America?

I can’t pinpoint the moment exactly, but several years ago I began to notice that many of our ER patients were presenting for treatment wearing nice fluffy fleece bottoms. Men. Women. Old. Young. These fleece bottoms seemed to be enjoyed by a variety of the population. Most of these earlier bottoms for the …

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Fleece pajama bottoms in the ER

Screening elderly men for prostate cancer: More harm than good?

Peter Ubel, MD

Conditions

April 10, 2019

Most men diagnosed with prostate cancer don’t die of the disease. Between 2011 and 2015, 112.6 per 100,000 men per year were diagnosed with prostate cancer in the U.S., but only 19.5 per 100,000 men per year died of the disease over that same period of time. That is still far too many deaths. But the huge disparity between deaths and diagnoses arises in large part from overdiagnosis of prostate …

How to study smarter for USMLE Step 1: 5 tips for success

Jason Ryan, MD

Education

April 10, 2019

Important new information in the tragic cases of child abuse

Christopher Johnson, MD

Conditions

April 9, 2019

Like many pediatric intensivists, I care from time to time for victims of child abuse in the form of what is often called “shaken baby syndrome.” This syndrome is a characteristic constellation of finds that happen when a strong person grasps a child around the chest and aggressively shakes the infant. It was first described by Caffey, a pediatric radiologist, fifty years ago. The baby may have …

It’s important to understand the money trail in medicine

Smart Money, MD

Finance

April 9, 2019

There was a recent news brief stating that the average internist generates about $2.4 million annually for the hospitals that they work for. While it’s no surprise that doctors help others make money, seeing a figure to your worth hammers home how much we sustain the health care system, often at our own expense.

This means that a hospitalist making $240,000 …

Work-life balance is hard. Here’s how this physician does it.

Erin McAdams, MD

Physician

April 8, 2019

Work-life balance is hard, and that’s true for so many career options both in and out of the medical field. The topic is something that you consider as you choose a career path. It’s something that you struggle to achieve and maintain as you train for your job, and as I have found out over the past eight months, something that you have to invest energy into after finishing training …

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