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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

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 …

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 …

Innovative approaches to solve physician burnout

Diane W. Shannon, MD, MPH

Physician

April 8, 2019

Health care organizations are moving to address clinician burnout with a real sense of urgency. It is now commonly accepted that burnout is widespread among health care professionals and has serious repercussions for patient safety and the quality of care. A report released by several major Massachusetts health care organizations labeled the situation “a public health crisis” and warned about the adverse impact “on the health and well-being …

Bias when treating supporters of President Trump

Anonymous

Education

April 7, 2019

President Donald Trump held a rally near my medical school last week.

While sitting in a small conference room during a lecture the morning of the event, my professor chuckled while clutching his phone. He looked up and around at all of us, remarking that his friend had texted him about the Trump supporters waiting outside for the rally to start; the message read, “Jesus, the maggots are already here!” My …

Should medical residents appear in reality TV shows?

Skeptical Scalpel, MD

Physician

April 6, 2019

This notice appeared on a general surgery news website in early February.

I don’t know who has been long anticipating this, but I’m pretty sure it’s not people on medical Twitter. My informal, nonscientific Twitter poll garnered 707 votes with 87 percent of those responding saying they would not allow their residents to participate in a reality television show.

Many of those who …

Regret medical school? Here are 3 things you can do.

Health eCareers

Physician

April 6, 2019

This article is sponsored by Careers by KevinMD.com.

It’s normal to daydream about living a life very different from our own:

“What would life be like if I were Beyonce?”
“Would I have the same worries if I were a trapeze artist?”
“Would I have been happier as a librarian?”

We all do it …

MKSAP: 52-year-old woman with shortness of breath

mksap

Conditions

April 6, 2019

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

A 52-year-old woman is evaluated during a follow-up visit. She was discharged from the hospital 3 weeks ago following a small non–ST-elevation myocardial infarction treated with drug-eluting stent placement in the right coronary artery. An echocardiogram obtained during hospitalization showed normal left ventricular function and normal valvular function. Her …

Can you put me to sleep? Why ER physicians have to say no.

Rada Jones, MD

Physician

April 2, 2019

The heavy young man curled on his left side is in the ER for a pain in his backside. The sweaty blue dragon on his chest smells like fear.

“It’s an abscess. I’ll have to open it. It’s gonna hurt.”

“Can you put me to sleep? I hate pain.”

I can. Should I? Remember Michael Jackson? I do.

His neck would make a Hereford bull proud; he’s missing a chin but he’s got a …

An emergency physician does a tooth extraction

Edwin Leap, MD

Conditions

April 2, 2019

I was working a few days ago and pulled a tooth. Mind you, it’s not something I do with any regularity. However, it was a very sweet little lady who was too weak and ill to get to the dentist and had other issues. That lower incisor was loose, and constantly in the way. Furthermore, it was painful.

I had seen her for something else in the emergency department. I took …

13 tips every pre-med student should know

Ton La, Jr., MD, JD

Education

April 2, 2019

If you’re reading this, you may have a son, a daughter, a family friend, or know of someone who is in college and considering medical school. As a medical student mentor, I share words of advice to my alma mater’s American Medical Student Association chapter and thought I would share them here.

1. When preparing for the MCAT, take a diagnostic test at the beginning of your study period, one in …

Appreciative and respectful of my privilege in caring for elderly patients

StorytellERdoc, MD

Physician

April 1, 2019

I dedicate this to each of you who have cared for or are currently caring for an ill parent or family member.

Recently, due to the stress that several of my dearest friends have been experiencing in caring for their elderly parents, I am even more appreciative and respectful of my privilege in caring for elderly patients who have attentive and loving adult children who accompany them to our ER.

Although this …

A tragic Fentanyl story without redemption

Marcia Glass, MD

Physician

April 1, 2019

Matt was 40, my sister’s age. He was training for a marathon and trying to talk his many friends into joining. He lay in bed with his three-year-old son every night to help him fall asleep. It’s hard to sleep train a toddler with a newborn to nurture at the same time, but he loved spending this time with his two kids and being the dad everyone counted on.

Matt’s best …

Real estate syndication 101: a physician’s guide

Cherry Chen, MD

Finance

April 1, 2019

Many physicians are looking for alternative sources of income and are looking for ways to diversify their investment portfolio from the volatility of the stock market. Some have heard of real estate syndications, but what exactly is a syndication? For those who have not heard of it, real estate syndications can be an attractive investment vehicle for busy professionals who do not have the time or experience to actively manage …

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