The obscene price of insulin: This is what happens when health care is for profit

Meds
April 25, 2019

I recently had a patient whose blood sugar was well controlled until he lost his health insurance. He purchased his diabetes pills because they’re cheap, but he couldn’t afford the insulin. His diabetes had been well controlled. Now, almost a year later, his hemoglobin A1C was 14, or double what it should be. The HbA1C measures sugar control over the last three months.

The bee sting kit or EpiPen cost hike …

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The obscene price of insulin: This is what happens when health care is for profit

Medical workplace bullying: We just want it to stop

Physician
April 25, 2019

Health care is increasingly complex. Objective peer review, constructive feedback, and robust debate are essential to continually improve the quality of patient care.

But doctors don’t always disagree well. One of the contributing factors to bullying in medicine is the complex interplay of different personality types in very stressful situations. Some doctors have personality traits that predispose them to have interpersonal conflict and being unable to see the view from the …

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Medical workplace bullying: We just want it to stop

Why didn’t your doctors tell you the truth?

Conditions
April 24, 2019

Here’s what they should have told you: “We found cancer in your lymph nodes, your liver, your lungs, and your brain. It explains your weight loss, your difficulty breathing and your loss of appetite. This wasn’t just your depression like you thought. It started in your lungs, and now it’s everywhere. This cancer has been growing for quite some time. You cannot, even with the strongest medications and the longest …

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Why didn’t your doctors tell you the truth?

A medical student’s first day. The memories last forever.

Education
April 24, 2019

On an early August morning in 2010, my alarm clock went off. The day had finally arrived. Today was my first day as a medical student at the university I had always wanted to attend. High school had ended just a couple of months before, and today I felt completely different. After years in the same school with the same friends, today I was going to be all by myself. …

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A medical student’s first day. The memories last forever.

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 …

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

USMLE Step 1 tips that may surprise you

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

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 …

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A nurse’s downfall was telling the truth

The powerful phrase that’s ruining medicine

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 …

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The powerful phrase that’s ruining medicine

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

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 …

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

What physicians should know about investing in real estate

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 …

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What physicians should know about investing in real estate

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

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 …

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

What distinguishes good physicians from truly seasoned medical professionals?

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:

What distinguishes good physicians from truly seasoned medical professionals?

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

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 …

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

Was she a doctor? Or was she a hack?

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?

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

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 …

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

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

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 …

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

These are the only 3 reasons to file a tax extension

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 …

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These are the only 3 reasons to file a tax extension

Fleece pajama bottoms in the ER

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?

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 …

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

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