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 …
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 …
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 myths and truths about med-peds physicians
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 …
The generational differences of physicians
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 …
Not all pathologists are created equal
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. …
MKSAP: 55-year-old man with severe COPD
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 …
What physicians should know about umbrella insurance
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 …
Does coffee lead to cardiac arrhythmias?
Physicians receive rigorous medical training for the better part of a decade. However, we emerge unprepared for the real-world job application process to which our friends in other professions are accustomed. One of these logistics includes credentialing and verification for hospitals and clinics where your group intends to practice — a process that can take up to three months.
There are a number of items that are requested during the credentialing …
12 things you’ll need for a smooth credentialing process
A lot has been spoken and written about clinical documentation already. In spite of that, many hospitals still struggle in getting the best out of their doctors when it comes to documentation quality. And although we can cite various reasons for this, we can all safely agree that the hospital EMR is the single biggest influence when outcomes to efficiency and quality of documentation — both in terms of compliance …
The 3 goals of clinical documentation
A New Mexico woman, suffering from Dercum’s disease (adiposis dolorosa) which causes painful fatty tumors, is suing a Santa Fe hospital and an emergency physician claiming she was the victim of two negligent acts in 2016.
One, according to the Albuquerque Journal, she told hospital personnel she was allergic to Dilaudid but went into cardiac arrest after receiving an injection of the drug.
Two, despite the presence of a lawfully …
A patient sues when a DNR is ignored
On one of my first days on the labor and delivery ward, one of the attending obstetricians asked me what area of medicine I was interested in. When I said that I was applying into neurology this year, she said, “Ah! The other end of the body!” After a pause, she continued, “Well, this rotation will be … different.”
It wasn’t the first, or last, time I had heard a similar refrain during …
A medical student after an OB/GYN rotation: Here’s what he learned
5,177.
That’s the current number of “cc’ed charts” as of this morning in my electronic health record in-basket.
While it might sound like a lot, this is not at all an unusual accumulation, partly due to the fact that I receive a notation every time a patient at our practice gets a flu shot, and also every time one of my patients or …
Electronic health records: Separating the signal from the noise
This article is sponsored by Careers by KevinMD.com.
How satisfied are you in your current health care position? According to the Conference Board, a global, independent business membership and research organization, only 51 percent of employees report overall satisfaction with their current job. In the survey, conducted earlier this year, respondents reported that the job factors …
What to know before moving for a health care job
For the last 25 years, I have had the privilege of being a designated airman medical examiner by the Federal Aviation Administration. To earn that privilege, it required flying to FAA headquarters and taking a one-week training course followed by refresher training material every three years.
The FAA grades medical examiners annually by our judgment and decision-making. The nature of the questions we are required to ask the pilot candidates, and …
The rewards of being a designated airman medical examiner
Prostate cancer often presents unique challenges to patients and physicians alike. It can be indolent and non-aggressive — or life-threatening and everything in between. Unlike most cancers that have a dedicated roadmap for treatment for prostate cancer revolves around opinions and biases.
To help patients navigate the landmine of prostate cancer, I’ve compiled a list of 10 basic questions to ask when diagnosed with prostate cancer. Here they are:
1. “What is …
Diagnosed with prostate cancer? You must ask these 10 questions.
We’ve all heard about credit card points and miles by now—put enough of your expenses on plastic and you’ll be flying first class airlines all the time, right? We are actually fortunate in American (sorry for those of you residing in, let’s say Japan, who still are stuck in a mostly cash-based society) to be able to have incredible amount of credit card options to squeeze out every penny.
While the …
How physicians can play the credit card reward game
The intestinal microbiota, also commonly known as the ‘‘gut microbiome’’ is integral to human physiology and has wide-ranging effects on the development and function of the immune system, energy metabolism and even nervous system activity. There is a lot of excitement around the potential of targeting the microbiome therapeutically to promote health and to prevent or treat medical conditions. Further, as DNA sequencing technologies and computational methods …
A clinician’s guide to microbiome testing
I just had a conversation with a physician and faculty member at my school. He started the conversation like this: “It’s alright if you disagree with me, and I can disagree with you too. Good academic discourse should allow people to disagree with each other.”
He then allowed me to question him and explain my perspectives for over an hour as he explained his answers, helped clarify some points, and gave …
How to foster and encourage genuine, curious learning in a medical student
A wonderful senior resident helped me understand the goal of rounding. Rounds should focus primarily on understanding the key problems and the diagnostic and therapeutic approaches to those problems. She suggested that some rounds spend too much time on “minutia” that the resident could handle, and not enough on understanding the big issues. According to her, rounds work best when we spend our time addressing the problems that the patient …
The key to successful rounding
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