KevinMD.com

The financial disadvantages of being a doctor in California

Finance

May 20, 2019

Geographical arbitrage is a huge component to being able to build wealth in a timely manner. For doctors, the formula for rapid wealth accumulation calls for geographical arbitrage even more strongly as our salaries do not have wide ranges across the country. A doctor in Texas will probably command a similar salary in Arizona (maybe slightly less). A doctor in the midwest might earn more, spend less, and work less …

No, the HPV vaccine isn’t optional

Chad Hayes, MD

Meds

May 19, 2019

A lot of parents ask me about the HPV vaccine, “Isn’t that the optional one?” Well, let me walk you through why my answer to that question is a hard “no.”

Human papillomavirus (HPV) is a virus that causes warts and several types of cancer. There are over 200 different strains of HPV, some of which tend to cause warts on the hands, feet, or face. Other strains …

Read more…

No, the HPV vaccine isn’t optional

A medical student’s first patient presentation

Ton La, Jr., MD, JD

Education

May 18, 2019

In medical school, you’re not taught how to give stellar patient presentations. Yes, you’re shown the traditional order of things: “Give an effective one-liner first, then tell the HPI [history of present illness] but only give pertinent info, etc.” Just exactly how to deliver the punch that impresses your attending is an art. And it’s an art that takes some time to perfect.

My very first time presenting a patient was …

Private equity in gastroenterology: Is it the future?

Praveen Suthrum

Policy

May 18, 2019

An excerpt from Private Equity in Gastroenterology: Navigating the Next Wave.

A long time ago, gastroenterologists ran solo or small group practices. Despite the myriad challenges of running a medical business, doctors enjoyed the independence that private practices offered.

But over the years, everything got too complicated. From insurance reimbursements to …

Medicine was consuming this medical student. Was it worth it?

Sarah B. El Iskandarani

Education

May 18, 2019

For as long as I remember, studying medicine has always been the goal I focused on the most. For years, I thought that I knew the path I was taking, and that I calculated the benefits and drawbacks. However, with time, I learned that no matter how much one assesses his decisions, one cannot have a full grasp of it, until he/she “begins” to experience it.

I wasn’t aware how much …

Should we write that patients are “pleasant” in medical notes?

Paul Sax, MD

Physician

May 17, 2019

When writing medical notes, some clinicians include an appreciation of their patient’s personality and disposition in their opening line (the “chief complaint”), or when they’re wrapping up (in the “assessment and plan”), or in both locations.

You know — it goes like this:

“CC: Ms. Smith is a very pleasant 62-year-old woman admitted with …”

or:

“A/P: To summarize, Mr. Jones is a delightful 89-year-old man presenting with …”

or:

“CC: This lovely 74-year-old retired school teacher was in her usual state of health …

The simplest and most important question to ask in the exam room

Michael L. Millenson

Conditions

May 16, 2019

It was the first time the young woman had come to the health center in a suburb just north of Chicago. When the 26 year old walked into the exam room back in 2008. There was no paper chart or electronic health record (EHR) accompanying her, no background information — nothing to indicate anything but a routine annual gynecological exam.

She and her husband were about to try to have their …

The problem with burning health insurance down

Margalit Gur-Arie

Policy

May 16, 2019

Let’s burn health insurance down. Greedy corporate bastards should burn. Big Pharma and big hospitals should probably burn too. You know who else is really, really, bad? Wall Street. Let’s burn the banks. And let’s burn Big Tech and the entire Silicon Valley cartel. Let’s also burn Big Agribusiness that’s making us fat and sick. And let’s burn the Oil companies that are destroying the planet, and let’s burn the …

How a Minnesota Supreme Court decision could affect curbside consults

Christopher Johnson, MD

Physician

May 16, 2019

“In a case that could have wide-reaching implications for medical practice in Minnesota, the Minnesota Supreme Court issued a ruling on April 17 in the case of Warren v. Dinter holding that the existence of a physician-patient relationship is not a prerequisite for a medical malpractice action. Rather, a person may sue a physician for malpractice – even if that person was not a patient of the physician – if the harm …

Second victim syndrome: a doctor’s hidden struggle

Harry Karydes, DO

Physician

May 15, 2019

As physicians, we have embraced a calling where we help others. A commitment many of us fully relish. We are grateful for our patients and the families who put their trust in us as we diagnose and treat their sometimes incredibly complex illnesses. I have been genuinely inspired by the stories I have heard from patients and my colleagues on the work we do.

Yet, in spite of the incredible advancements …

The truth about Caribbean medical schools

Jessica K. Willett, MD

Education

May 15, 2019

I graduated from St. George’s University School of Medicine in Grenada and now work as an emergency medicine physician at a trauma center in Northern California. To some, that may seem like an extreme jump or a rare success story. The stigma of a Caribbean medical school education is built on rumors — and they’ve run their course. Let’s address some.

1. Students only go to Caribbean medical schools if they …

Treating a VIP benefactor of a hospital

Steven Reznick, MD

Physician

May 13, 2019

My local hospital has been petitioning the local city zoning board for permission to build an on-site parking garage for years now. The city zoning board is very strict about the height of buildings and has turned the requests down repeatedly.

This past fall, the hospital administration announced that it needed a capital partner to expand and stay solvent. Most of the members of the hospital medical staff have absolutely no …

Read more…

Treating a VIP benefactor of a hospital

Why would adult children disapprove of their parent’s happiness?

Anne Katz, RN, PhD

Physician

May 13, 2019

Going through the process of diagnosis, treatment decision making, and often lengthy treatment without a partner can be challenging. While children, friends, and other family members are supportive, for the single individual, there is no one to talk to in the middle of the night when fear and doubt often surface. I often counsel people who have finished treatment for their …

Physicians: Don’t let administration intimidate you

Suneel Dhand, MD

Physician

May 13, 2019

One of the things I am most grateful for, as a doctor who has worked in at least a dozen different hospitals over the last decade, is the broad range of experiences I’ve had and the variety of physicians I’ve met and gotten to know. I enjoy hearing experienced physicians’ perspectives on how the practice of medicine has changed from what it used to be in the 1970s to 1990s.

I …

Questions about physician disability insurance answered

Altelisha Taylor, MD, MPH

Finance

May 12, 2019

As resident physicians with a tight budget, one of the last things on our mind is paying for added insurance. Trust me; I get it. However, as a [future] high-income earners, long-term disability insurance is essential. It may not be at the top of our priority list, but it should be.

What is it and who needs it?

Unless you are already financially independent or were lucky enough to have a trust …

The brutal emotional challenge of medical training

Nyembezi L. Dhliwayo, MD

Physician

May 12, 2019

I can vividly remember the day the phone call came. My cousin screaming over the phone, trying to make out words but unable to speak, disbelief, horror, the fear in her voice palpable even though she was thousands of miles away. It was barely 5:30 a.m., I was frantically rushing out to beat traffic, hoping to get a head start on pre rounding since I was on call. Confused, I …

Want to create a review course? Here’s how this physician did it.

Mary Preisman, MD

Education

May 11, 2019

When I told my colleagues that I was going to try to create the first psychiatry review course at the University of Toronto, I received the same two responses: “It’s about time somebody did that!” and “What is wrong with you?” — sometimes from the same person!

The first reaction taps into the excellence of our department. With approximately 1,000 faculty with diverse expertise and the largest residency program in Canada, …

Nurses are striking. Where are the physicians?

Michael Pappas, MD

Policy

May 11, 2019

The U.S. health care “system” is completely and utterly broken. According to the World Health Organization (WHO), the U.S. system ranks 37th in the world, all while spending dramatically more on health care than other wealthy countries. Tens of millions remain without any health insurance coverage. For many, medical bills can mean economic ruin — some surveys show that up to Read more…

Nurses are striking. Where are the physicians?

The systemic poverty in Navajo Nation is a national travesty

Vincent DeGennaro, Jr., MD, MPH

Physician

May 10, 2019

“I have the CPAP machine. I’ve had it for a year, but I don’t have electricity in my house. I stayed with my aunt who has electricity but things didn’t work out,” said the young Navajo man, his massive belly protruding out from underneath the tray table.

The old Navajo man with Parkinson’s disease, unable to walk fast enough to make it to the outhouse in time, had started taking anti-diarrheal …

Should physicians lie when asked these questions?

Robyn Alley-Hay, MD

Physician

May 10, 2019

Dear colleagues, I know you have seen these questions:

Do you currently have any physical or mental impairment that could limit your clinical practice?
Are you currently taking any medication?
Have you ever been hospitalized for any reason?
Have you ever been hospitalized for, or diagnosed with, a psychiatric disorder to include substance abuse?

Ugh! I hate, hate, HATE these questions! “It is none of their business,” or at least that is what I told …