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Residency training, and training in residency

Education

January 8, 2019

Exhausted. Aching. Hungry. Slightly delirious.

Mile twenty-four of a marathon? Or hour twenty-four of a twenty-eight-hour shift?

I am a resident. I am a runner. I am also a rather tired human since, as I type these words, I’m both post-call and post-run. However, this post-call/run state of body and mind is one I have learned to love and embrace during this residency whirlwind.

I’m not myself unless I’m wearing scrubs or running clothes. …

How near-death experiences profoundly change lives

Raymond Moody, MD, PhD

Conditions

January 7, 2019

An excerpt from The Science of Near-Death Experiences.

Near-death experiences are an ancient and very common phenomenon that spans from ancient philosophy, religion, and healing to the most modern clinical practice of medicine.

Modern advances in medical knowledge make it possible to revive patients from increasingly severe, life-threatening injuries and illnesses, including cardiac arrest. Upon being revived, …

A medical student’s letter to her parents

Hillary McKinley

Education

January 7, 2019

Dear Mom and Dad,

I love you, and thank you. The rest of this letter is an attempt to write something more eloquent and thoughtful, but those are the best and truest words I can ever speak to you. I made the decision to enter the medical field when the rest of our family is from a business and finance background. Despite being unfamiliar with the different hurdles of application cycles, …

Physician gives in to police pressure to conduct a forced invasive rectal exam

Kyle Varner, MD

Physician

January 7, 2019

Recently, news broke about a disturbing act of medical battery carried out by doctors at St. Joe’s Medical Center in Syracuse, New York. The case began when police officers conducted a pretext stop and elected to harass their victim about a small amount of marijuana.

As the situation escalated, the cops took the man to St. Joe’s Medical Center for him to be searched for …

Net promoter scoring needs to be tweaked for medicine

Philip DeGaetano, MD

Physician

January 6, 2019

Net promoter scoring (NPS) measures customer experience and predicts business growth. Recently it is becoming more common for health networks to adopt NPS. The word “customer” should be a red flag. In medicine, we do not have customers; we have patients.

It is common practice for a patient to receive a text message after they leave an office asking them to rate their experience. It generally looks something like this, “How likely …

An approach to prior authorization insurance denials

Debraj Mukherjee, MD and Chaim B. Colen, MD

Policy

January 6, 2019

Patient access to care is a high priority for all neurosurgeons. Unfortunately, many of our practices are thwarted in these efforts from unwarranted insurance denials. Know, you are not alone. Take this common scenario:

When Ms. Mary Smith (not the patient’s real name) started her new job several years ago, she purchased the premium insurance policy that her company provided. Recently, she developed severe neck and left arm pain. Imaging of …

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An approach to prior authorization insurance denials

How to transfer residency programs

Michael Grzeskowiak, MD

Physician

January 6, 2019

Even though physicians do not talk about transferring residencies, it is more common than is often believed. According to the AAMC website, about 30 percent of residents do not finish the initial program they started. Quantifying that number further, the ACGME recently reported 1,044 residents transferring from their program.

There are a variety of reasons for transferring residencies: A spouse being accepted for …

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How to transfer residency programs

Stop shoving metrics down nurses’ throats

Sarah E. Jorgensen, RN

Policy

January 5, 2019

One time, I applied for an emergency department (ED) nurse manager position. I thought I had the job locked up until I was asked during the interview how I would “enforce metrics.”

“Enforce.”

My holistic, qualitative research-based response to this authoritarian-style question was: “I’ll find more organic ways to achieve your metrics without shoving numbers down their throats.”

I didn’t get the job. Someone told me I wasn’t “MBA enough.”

Yet, I stand by …

The pros and cons of practicing medicine in a rural setting

Health eCareers

Physician

January 5, 2019

This article is sponsored by Careers by KevinMD.com.

Wide open spaces. Fresh, clean air. No people for miles around.

The advantages of rural living are plentiful, but there are disadvantages, too, especially when it comes to health care; being way out in the country likely means the choices for doctors, clinics and hospitals are severely limited.

According to the …

Non-therapeutic relationship or human kindness?

Anonymous

Physician

January 4, 2019

About two months ago, a 15-year-old Native American male was riding around in a stolen car on the reservation. “M” and the driver were drinking. And somehow, after he exited the vehicle at 4 a.m., the car struck him. Hours later, it became clear that something was wrong. M was transferred to our pediatric hospital as a trauma and was found to have an unstable vertebral fracture. Conservative treatment with …

What’s the biggest problem with medical education?

The Curious Radiologist, MD

Education

January 4, 2019

There has been a profound deterioration in the education of our medical students. I only make this contention after having taught over a hundred medical students across five continents, often one-on-one and for extended periods. Although the majority of those I’ve taught have been students educated at international medical institutions, a substantial number have been those from U.S. medical schools. While I do recognize that those that find their way …

What’s barbaric in medicine?

Lisa Masson, MD, MBA

Education

January 3, 2019

Late one evening, I received a text from my oldest daughter.

“What in medicine, that we do now, will we think is barbaric in 50 years?”

Wow. They play more provocative bar games now than they played when I was in my 20s.

I promptly texted back my knee-jerk response: “chemotherapy.” As we are on the brink of precision medicine, what will the next generation think of our “slash, burn and poison” paradigm …

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What’s barbaric in medicine?

68 laws of the ER

Rada Jones, MD

Physician

January 3, 2019

1. Murphy’s Law as it applies to the ER: If something can go bad, it will do so in a hurry. If it can’t possibly go bad, it will still find a way.

2. Clock’s First Rule: All the patients will crash at the same time. Usually when the computer system goes down.

3. Clock’s Second Rule: The sickest patients will come just before the shift change.

4. Haste’s Theorem: The healthier the …

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68 laws of the ER

Go quiet into the night

Debbie Moore-Black, RN

Conditions

January 2, 2019

I know what you’re thinking: She’s cold-hearted, cruel, and unkind.

But am I? Or are you?

Grandma Lilly is 87-years-old and in the ICU. She’s on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats per minute. Her blood pressure is low and Levophed and vasopressin drips are ordered.

Her family can’t talk …

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Go quiet into the night

The myths and truths about med-peds physicians

Andrea Lauffer, MD

Physician

January 2, 2019

Yes, med-peds is a real residency! It is a real specialty! And it is a practicing profession by many physicians today! It can open doors for so many wonderful professional opportunities. It is a discipline that can provide patients and communities extremely comprehensive medical care. People need to know more about this unique and sometimes under-recognized field. And here is why:

Like many people today, I didn’t even know what med-peds …

The generational differences of physicians

Xrayvsn, MD

Physician

January 2, 2019

It is a known fact, but every generation feels that they had it worst and that other generations have it made.

“When I went to school we had to walk uphill in the snow both ways!” says every grandparent

I identify myself with the Generation X physicians, finishing medical school in 1997 and my radiology residency and fellowship training in 2003.

During this time I have seen quite a change in the medical …

Not all pathologists are created equal

Celina Nadelman, MD

Conditions

January 2, 2019

Pathology and laboratory medicine services play a vital role in global health care and continuously improve patient care around the world. When it comes to your medical care, you have many options, and choosing the right professional could improve your health. So what exactly does a pathologist do, and do I have the power to choose my own pathologist?

The pathologist’s role

A pathologist is a medical doctor who studies the causes …

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Not all pathologists are created equal

MKSAP: 55-year-old man with severe COPD

mksap

Conditions

December 29, 2018

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

A 55-year-old man is evaluated in follow-up for severe COPD, which was diagnosed 2 years ago. He has had two exacerbations in the past year requiring hospitalization, and his baseline exercise tolerance is low. He completed pulmonary rehabilitation 3 months ago without much improvement in exercise capacity. He quit smoking 1 year ago. …

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MKSAP: 55-year-old man with severe COPD

What physicians should know about umbrella insurance

Smart Money, MD

Finance

December 28, 2018

Asset protection is a term that gets tossed around quite a bit when we discuss how long and difficult the journey is for doctors to establish their careers. You always want to protect what you’ve worked hard for, right? The principles for asset protection apply not only to doctors but essentially anyone who wishes to have some sort of security for their assets. The key is to make sure you don’t over …

Does coffee lead to cardiac arrhythmias?

Larry Istrail, MD

Conditions

December 26, 2018

Coffee —”because of the caffeine which it holds,” described Dr. Henry Elsner in a 1911 review article in the journal of Hypertension and Arteriosclerosis — causes “increased rapidity of the heart’s action. It makes the heart irritable, it increases the power of the heart’s contractions, it places an extra load upon the kidneys, increasing the urine flow. Because of these effects, I have for some time …

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