What personality type fits your medical specialty?

Physician
July 29, 2018

Both patients and providers realize that an internist is different from a surgeon, but specifically how they differ and how this affects their approaches to patient care is largely under-appreciated. Over the last four years, I have conducted over 250 interviews with physicians across specialties and institutions about what they do and why they do what they do. With each project, I continue finding remarkably distinct, specialty-specific values, perceptions, and …

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The other side of Suboxone

Meds
July 28, 2018

A lot has been written about Suboxone, the buprenorphine treatment drug. For many, Suboxone acts as an effective medication to treat opioid addiction. For others, it’s a highly-valued street drug that is commonly diverted and misused. To understand and acknowledge the darker side of Suboxone we have to look back at its history over the past 16 years.

History of Suboxone

Suboxone was first approved by the FDA in 2002 to treat …

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Tips for fellowship applicants from a program administrator

Education
July 27, 2018

The season has opened, and panic has spread among senior year residents, chief residents, and hospitalists out in the community. Fellowship applications are live and being viewed by the programs applicants think they want to rank one, two, and three. These incredibly intelligent physicians are refreshing student document network daily now and soon to be hourly as the weeks go on. The anxiety is building as people are waiting to …

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There’s a fine line between stupid and clever in medicine

Physician
July 26, 2018

In the 1984 rock mockumentary This is Spinal Tap, a fictional band discusses the controversy surrounding one of their album covers. “There’s such a fine line between stupid and …” the lead singer says, realizing where they’d crossed the line of tastefulness.

His guitarist finishes his thought, “… and clever,” he says. In life, in rock and roll and in medicine, there is indeed a fine line between stupid and clever.

During …

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NP/PA vs. physician: Why is there a productivity gap?

Physician
July 25, 2018

So out in the varied land of hospital medicine, I have noticed something that I have no clear explanation for. It turns out there is often a gap in productivity between that of NP/PA providers and physicians. The range of the gap varies wildly – I just got off the phone with a group leader who has observed a 50 percent difference to a smaller gap of perhaps 10 percent. …

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After you die, what will your legacy be?

Finance
July 24, 2018

As part of my job as an anesthesiologist, I get called to truly horrific airway events.  Sometimes they are down in the emergency department after a bad car accident, drowning, or burn.  Others are in ICU’s.  Sometimes they are even in hallways or bathrooms where people have stopped breathing or collapsed from cardiac arrest.  It’s part of the job.

Recently, I was called to an airway in an ICU in what …

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MKSAP: 55-year-old woman with an eating disorder

Conditions
July 23, 2018

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

A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to 19. She has otherwise …

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A return to the problem-oriented SOAP note

Physician
July 22, 2018

CMS is changing note requirements, among other changes.  Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.”

As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction.  To me the most important change is a focus on notes: “Allowing medical decision making to be …

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Who named our bones? And what were they thinking?

Conditions
July 21, 2018

All of our 200+ bones have names, which facilitates describing them when we cannot actually hold them or point directly at them. It might be easier to remember the names if they were familiar ones like Robert, Sally, and Kevin, but no such luck. Latin was the original language of science, so the bones received Latin names. Some of those were derived …

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Medical students: Welcome to the wards

Education
July 19, 2018

Dear third-year medical students,

Welcome to the wards.

I remember this stage — basking in the glory of completing pre-clinicals, in the excitement of finally switching heavy textbooks for living, breathing people, in the realization that medical education now lies in the hands of those I wanted to heal. I would be sleeping less, but living more, because this was my purpose.

Remember this moment because this will be the most difficult year …

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When attendings come to work rounds

Education
July 18, 2018

Learners value efficiency.  As I recall my residency, nothing caused more angst than unnecessarily long rounds.  In the 1970s just like in the 2010s, I had much to do after rounds ended.

As an attending physician, my responsibilities involve patient care and aiding learning.  I have always worked hard to do that within a time constraint.  The time constraint requires that rounds run efficiently.

Like many things in medicine, efficiency only works …

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How to thrive during your residency

Physician
July 16, 2018

Even though my own internship was a decade ago, I vividly remember the transition from student to resident. Residency was monumental in my path to becoming a physician. There were obvious changes: People now called me “doctor,” my misshapen short white coat was upgraded to a more comforting full length one, and I was often the first one paged to respond to patient problems. Coupled with the positive aspects though, …

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6 pieces of advice for graduating medical students and residents

Physician
July 13, 2018

My (sometimes solicited, but often unsolicited) advice for graduating medical students, residents, and fellows:

June is one of my favorite times of the year.  One, because it’s summer, but also because it’s graduation season.  I love seeing and hearing about everyone’s accomplishments, and seeing years of hard work come to fruition – although if I’m being honest, it’s bittersweet, because it’s also a reminder of how I’m getting older.

This year, I’ve …

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8 steps to have those difficult conversations

Physician
July 12, 2018


An excerpt from 7 Ways to Stop Drama in Your Healthcare Practice.

Although the ability to initiate difficult conversations is part of good leadership, I’ve never met a leader who enjoys it. Whether your conversation is about body odor, rude behavior, dress code, personal conduct or performance issues, difficult conversations are …

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A conversation with a doctor who was tired of feeling burned out

Physician
July 11, 2018

An excerpt from the Docs Outside the Box podcast, episode 1:  When the going gets tough… MOVE! 

Dr. Nii: All right, well thank you very much for joining us on the Doc’s Outside-the-Box podcast. You are our first guest — first victim, I guess. It’s the inaugural episode, so I just wanted to thank you for joining us. I know you are in New Zealand, which is roughly 18 hours away.

Dr. Brown: It’s …

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What’s better: mentorship or sponsorship?

Education
July 11, 2018

Literature coming from business and human resource management suggests that women are over-mentored and under-sponsored. However, if you have been reading reports about women in medicine, then you likely have heard that women are both over-mentored and under-mentored. Where does the truth lie? That depends on various factors including the definitions of these terms.

What exactly do these words mean? In the business sector, mentorship is …

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