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Direct primary care physicians are not concierge doctors

Physician

February 1, 2019

I recently received a scathing email criticizing an article I wrote about the care of patients in underserved areas. “Should you really even get to write articles about poor, underserved populations when you run a concierge practice?” the author wrote. “This is called hypocrisy. You are what is wrong with the medical field.”

What the author of this email didn’t know was that I spent six years working for the underserved …

How to talk with a struggling physician colleague

Elisabeth Poorman, MD

Physician

February 1, 2019

My friend, Lello Tesema, and I were sitting in a restaurant in Harvard Square. It was the first, feverish bit of spring when it seems like the entire city has emerged en masse from their winter dens. We were sitting outside under patio lights, wearing regular clothes instead of our usual scrubs. I should have been happy.

As often happened in those days, I asked Lello if things were ever going …

Reflections after a medical student’s first code blue

Danielle Verghese

Education

February 1, 2019

We were in the middle of the morning routine – sign out between mouthfuls of eggs and homefries – when the call came in overhead, “Code Blue, 9 West. Code Blue, 9 West.” Just like that, our team snapped into action, the continued banter only thinly concealing a change in demeanor: backs straight, jaws set, we walked with a sense of purpose. There was a life on the line.

By the …

Why medical students should develop and increase self-awareness

Ton La, Jr., MD, JD

Education

January 31, 2019

The most important piece of advice I can give to incoming medical students is to be vigilant about how you are feeling day-to-day and to be aware of your actions. As is often said, our personalities, the distinctive makeup that makes us who we are, are set in stone. If you are a mindful person, you’ll stay that way even as you get older. If you are someone who likes …

The growing role of end-of-life activists

Jennifer Lynn

Conditions

January 31, 2019

Brittany Maynard was diagnosed with grade 2 astrocytoma, a form of brain cancer on January 1, 2014, her cancer also returned in April 2014, where her diagnosis was elevated to grade 4 astrocytoma, also known as glioblastoma, with a prognosis of just six months to live. She decided to take lethal drugs prescribed by her physician to end her life on November 1, 2014, at her home in Portland, Oregon. Under Oregon’s “Death …

The problem with abbreviations in the medical record

Fred N. Pelzman, MD

Physician

January 28, 2019

Several patients seen in our practice recently were significantly and dramatically transformed by the electronic health record (EHR). And not in a good way.

Take, for instance, the patient whose outside chart was reviewed when she showed up in our office for a follow-up appointment after an emergency department visit.

The notes from the emergency department providers, including a scribe and the …

6 things learned from being rejected from medical school

Anonymous

Education

January 26, 2019

I have spent the greater portion of my 20s enduring a premature quarter-life crisis. Patterns of self-doubt and debilitating anxiety became my new normal.

I was rejected from medical school — again.

After taking time to process the reality that I would have to wait another year to re-apply, I fervently journeyed through a messy jungle of introspection that led me to these six lessons. Although I learned more than I could …

Do smaller, independent practices have happier doctors?

Health eCareers

Physician

January 26, 2019

This article is sponsored by Careers by KevinMD.com.

Physician burnout is not a novel topic within the health care industry. Numerous studies have been done on the increasing prevalence of its symptoms — from emotional exhaustion and loss of empathy to doubt that one’s work even makes a difference — among today’s practitioners. In fact, a recent …

The conflict between pharmacists and their corporate superiors

Vamsi Aribindi, MD

Meds

January 24, 2019

Pharmacists play an essential role in today’s ever-expanding health care system today. They check for drug interactions, watch for signs of opioid overprescribing and try to determine whether a drug for one condition prescribed by one doctor will negatively impact the patient because of another diagnosis the patient has. In hospital units, their roles have become yet more complex — often serving on various quality committees, managing daily dosages of …

Treat your family like you treat your patients

Doctormom_andmore, MD

Physician

January 24, 2019

Many times during difficult patient interactions — when I am not sure about the right thing to do — I let myself be guided by the question: “What would I do if it was my family member?” This internal dialogue usually cuts the clutter and lets me focus on the most important thing: the well-being of my patient. I can step away from the behavioral chaos and guide them in …

This physician chose not to do a triathlon. Here’s why.

Dora C. Rodriguez, MD

Physician

January 24, 2019

I posted on social media that in 2019, I would compete in Ironman. I wanted to hold myself accountable and was announcing “I could do this.” My primary reason, so I thought, was that “I wanted to grow mentally and physically.”

Since then, I have been training six hours per week on top of my usual daily routine. I have been mentally and physically challenged in ways I didn’t think possible. …

My garden has taught me a lot about health care

Jeffrey A. Oster, DPM

Physician

January 24, 2019

Sustainability is a bit of a buzz word these days. To be sustainable means that you only use what you need, leaving the rest to be used by you or others in the future. Sustainability is a popular topic in environmental sciences and refers to renewable agriculture, good stewardship of natural resources and recycling of waste. What about sustainability in health care?

In health care, we often describe The United States …

What clothing choice says about a patient

Anne Katz, RN, PhD

Conditions

January 23, 2019

The woman waiting to see me looked every inch a lawyer or accountant in her black pencil skirt, pink shirt, and a Chanel-style houndstooth jacket. Her ankle boots were reminiscent of those worn by women in Victorian times with a row of small buttons up the side. She had a scarf loosely knotted around her shoulders, and her hair was …

Must-have medical apps for primary care

Douglas Maurer, DO, MPH

Tech

January 23, 2019

Earlier this year, we put together a list of what we thought were the best medical apps for health care providers. Now at the end of 2018, we’re augmenting that list to give you a full picture of what we think are must-haves medical apps for those in primary care.

Safe Motherhood Initiative: ACOG DII SMI

Quick reference for common obstetric emergencies

Many of us in family medicine practice full-scope …

Read more…

Must-have medical apps for primary care

A stage IV lung cancer survivor story

Jennifer Lycette, MD

Conditions

January 23, 2019

I want to share how the era of immunotherapy, specifically immune-checkpoint-inhibitors, has changed the landscape of community oncology practice in metastatic non-small-cell lung cancer, for oncologists and, more importantly, patients.

I want to tell you the story of Joe. A stage IV lung cancer survivor story. (Name and details changed to protect anonymity.)

In 2015, Joe was diagnosed with stage IV non-small-cell lung cancer (NSCLC), adenocarcinoma. He had multiple metastases to other organs. …

Read more…

A stage IV lung cancer survivor story

To my mentor: Thank you. I didn’t know how much I needed you.

Elizabeth Rubin Ribak, MD

Physician

January 23, 2019

I never really had a true mentor. Or role model. I wasn’t sure if they were the same thing, or what the difference was, so I gave up. Sometime in middle school, I remember a teacher encouraging us to find someone we looked up to and develop a mentor relationship. I was 12, looked at my teachers who I thought were old, and ignored that advice.

In high school, I thought …

How this student took care of his severe depression in medical school

Anonymous

Education

January 22, 2019

We learn about it in school as a formula. There is a checklist that we are given, and we ask our patients these eight questions and then calculate whether or not they have depression. It’s so simple. Anyone can do it! I never once thought that I would be calculating my own score at the prime of my education.

I entered medical school full of hope after years of failures and …

I had just witnessed my first patient die

Jenny Hartsock, MD

Physician

January 22, 2019

Stepping into a hospital for the first time as a clinical medical student is a strange dichotomy. There is still so much you have to learn before you will become a physician, but you are quickly thrust into life-and-death situations. One of my early rotations was in the emergency room. As a student, you have no actual authority and must be closely monitored at all times. Many times you will …

Why did it take over a week for doctors to initiate treatment?

Iris Kulbatski, PhD

Conditions

January 22, 2019

Part 3 of a series.

Patients with advanced cancer are particularly vulnerable to infection due to a compromised immune system. Moreover, the typical symptoms of serious infection, such as fever and chills, may be absent in cancer patients. If not identified and treated early, infection can lead to sepsis, a life-threatening reaction of the immune system that causes organ failure, shock, and death, as …

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