Better paid, better utilized physicians can transform the VA

Policy
November 2, 2017

It’s a tale of two health systems: the VA and Kaiser Permanente.

The U.S. Department of Veterans Affairs, Veterans Health Administration (VA) is a mission-driven health organization, serving our nation’s veterans. A patient population of 8.9 million, led by David Shulkin, MD. An early leader in health technology adoption. The VA has faced serious issues; however: long patient wait times (deadly long in some cases) and high physician turnover rates.

Kaiser Permanente …

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Want to slow cognitive decline? Here’s how.

Conditions
November 1, 2017

Part of a series.

Cognitive decline is a normal process of aging; Alzheimer’s is a disease.

Cognitive decline due to aging can be slowed but not halted with appropriate lifestyle approaches. The “big four” are equally important to slow cognitive decline: Don’t smoke. Reduce stress. Exercise often. And eat a quality diet in moderation.

Good sleep and brain stimulation need to be added for maintaining good cognition. Some form of …

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I was attacked by a patient and want my fear to help others

Physician
November 1, 2017

I have been working with psychiatric patients for the better part of 30 years. During this time, I have worked in psychiatric emergency rooms, prison wards, substance abuse treatment centers and inpatient psychiatric units. I have been proud of the fact that, despite working in some dangerous areas, I have never been harmed by a patient. I have been threatened, swung at — but never injured. Once a patient decided …

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Don’t be so rigid in your thinking

Physician
October 30, 2017

“She doesn’t look like a person with an addiction problem to me,” replied the physician to the psychiatrist, referring to a patient who was admitted to the hospital for confusion. She was found at home amidst an array of bottles containing various controlled substances, and a toxicology screen positive for cannabis. She was in a higher socioeconomic bracket having retired from a professional job. The psychiatrist explained that addiction crosses …

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10 golden communication tips for doctors. And 3 things they shouldn’t do.

Physician
October 28, 2017

It’s something that’s not taught anywhere near enough as it should be in medical school, but every practicing physician quickly realizes that communication is everything in health care. It’s the foundation of the doctor-patient relationship, and what patients will judge you on. Sure, doctors are among the busiest professionals out there. We do an incredibly hectic job. But it’s so imperative to remember the importance of that interaction with your …

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Does how women dress matter?

Physician
October 27, 2017

I am going to discuss something that is really important for women. It’s going to get a lot of criticism, and it’s OK. I can take it.

Your clothing.

That’s right. I am here to tell you that what you wear, and how you dress, matters.

Why? Because how you feel in your clothes affects the way you walk, talk, smile, interact, and well, lead.

Don’t mistake what I am saying. I am not going …

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Why this anesthesiologist says “no” to fentanyl

Meds
October 26, 2017

No, I’m not talking about putting fentanyl into my own veins — a remarkably bad idea. I’m questioning the habitual, reflex use of fentanyl, a synthetic opioid, in clinical anesthesiology practice.

I’ve been teaching clinical anesthesiology, supervising residents and medical students, in the operating rooms of academic hospitals for the past 18 years. Anesthesiology residents often ask if I “like” fentanyl, wanting to know if we’ll plan to use it in …

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An interview with an American doctor working in Canada

Physician
October 24, 2017

A couple of weeks ago I visited Canada. It was my first visit in a very long time. We were in Ontario, spending most of the time in the Toronto area, and also getting to visit the majestic Niagara Falls for the day. I’ve heard so much over the years about the differences between neighbors USA and Canada, and in even just a few days there, agreed that there are …

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Are we medicalizing everything?

Physician
October 24, 2017

“A condition counts as a disease independently of whether there is safe and effective treatment.”
– Journal of Medicine & Philosophy, August 2017

What is a disease anyway? Mrs. Jones is 90 years old and frequently experiences episodes of chest pain. She has numerous partially blocked coronary arteries, and her physician has told her to come to the emergency room because she might be having a “heart attack.” …

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A place for music in the emergency department

Education
October 23, 2017

The emergency department is a place of unpredictability. Some days are a whirlwind, others drag, but both can be interesting. On a calmer day, I found myself, a fourth-year medical student, working with a physician I will call Dr. Smith. We discovered that we shared a common love for music, and between patients, we discussed everything from opera, to banjo, to Indian music. I am a composer and amateur classical …

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MKSAP: 32-year-old woman with weight loss, abdominal cramping, and loose stools

Conditions
October 21, 2017

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

A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has an 8-year history of diffuse …

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An open apology to medical students from a resident

Education
October 20, 2017

Dear medical student, I’m sorry.

You had just finished two years of didactic learning and couldn’t wait to feel like a “real” doctor. You finally were starting your clerkships, that is, ultimately working with patients and getting deep in the trenches.

You were bright-eyed as you pulled on your pristine short white coat. You got to the hospital at 5:15 a.m., 15-minutes early for the first day of your very first third-year …

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The high cost of hospitalists

Physician
October 18, 2017

Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with …

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A letter to my sister (and all other first-year medical students)

Education
October 16, 2017

Congratulations! At this point, you are almost halfway done with your first year of medical school. Either you have finally figured out what’s going on, or if you’re like me, you are still trying to figure it out. Relax, take a few deep breaths. Medical school is unlike anything you have ever done. The volume of information, constant testing, and overwhelming need to keep up with your peers is an …

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This psychiatrist does most of her work outside of the traditional system

Physician
October 15, 2017

Every now and then, when some people learn what kind of work I do, they say, “You’re doing God’s work. Thank you.”

They mean well, so I accept the compliment, though I also tack on, “I also like what I do. It’s meaningful work for me.”

So many of the people I see, whether in my current job or in my past jobs working in other underserved communities, have a lot going …

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Why veterans deserve special recognition

Physician
October 14, 2017

November brings fall weather, raking leaves and one of my favorite holidays.  No, not Thanksgiving, it is Veteran’s Day.  Veteran’s Day is a day reserved to celebrate members of the U.S. armed forces for their service.  Thank you, veterans.  Veterans are found in all segments of our society.  Some are retired, some have started second careers, and some are struggling with health issues as a result of their service.  They …

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