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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 …

12 things you’ll need for a smooth credentialing process

Aalap Shah, MD

Physician

December 25, 2018

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 …

The 3 goals of clinical documentation

Nagendra Gupta, MD

Physician

December 25, 2018

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 …

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The 3 goals of clinical documentation

A patient sues when a DNR is ignored

Skeptical Scalpel, MD

Physician

December 23, 2018

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 …

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A patient sues when a DNR is ignored

A medical student after an OB/GYN rotation: Here’s what he learned

Nathaniel Fleming

Education

December 23, 2018

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 …

Electronic health records: Separating the signal from the noise

Fred N. Pelzman, MD

Physician

December 23, 2018

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 …

What to know before moving for a health care job

Health eCareers

Physician

December 22, 2018

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 …

The rewards of being a designated airman medical examiner

Steven Reznick, MD

Physician

December 21, 2018

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 …

Diagnosed with prostate cancer? You must ask these 10 questions.

Naeem Rahman, MD

Conditions

December 20, 2018

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 …

How physicians can play the credit card reward game

Smart Money, MD

Finance

December 19, 2018

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 …

A clinician’s guide to microbiome testing

Alexander Khoruts, MD

Conditions

December 17, 2018

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 …

How to foster and encourage genuine, curious learning in a medical student

Jamie Katuna

Education

December 16, 2018

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 …

The key to successful rounding

Robert Centor, MD

Physician

December 15, 2018

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 …

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The key to successful rounding

6 ways to ensure you’re not accepting a terrible health care job

Health eCareers

Physician

December 15, 2018

This article is sponsored by Careers by KevinMD.com.

What makes any particular job a “bad” one? Maybe the pay is too low. Perhaps the hours don’t work with your other commitments. It could be the commute is too long, or the opportunity for advancement is too little. A job might be bad because it has a poor …

The fight to save Howard University College of Medicine

Vicky Li and Naveen Balakrishnan

Education

December 13, 2018

Our country is at risk of losing an iconic institution that has played a pivotal role in the history of medical education. A school, which has produced some of the boldest pioneers in medicine, could lose accreditation upon the opening of a new hospital that will shunt away 40 percent of their current patients. Scores of our brightest potential medical students will be ripped away from the communities that desperately …

How social media leads to a loss of creativity

Edwin Leap, MD

Social media

December 12, 2018

I use social media. Specifically, I use Facebook, Twitter, and LinkedIn. In the beginning, I did so for utilitarian purposes. As a columnist and aspiring writer of books, these were (and indeed are) useful marketing tools.

I have, in the past, carried around a note-pad to jot down ideas. I was never without my note-pad. I always wanted a small legal-pad with a blue or black gel-ink pen. It was my …

The day when the white coat can be worn with no hesitation at all

Shadi Ahmadmehrabi

Education

December 11, 2018

It was my first day of orientation at medical school. In a hallway stood a coat rack overflowing with white garments. I set down my accumulated papers, reached for a hanger and — for the first time ever — shrugged first one arm and then the other into a white coat.

It was too large, but I had no other options. The unisex coats ran from XXS to XXL, but the …

The Wild West approach to PICU practice

Christopher Johnson, MD

Policy

December 10, 2018

I spent my early and mid-career years working in a pediatric intensive care unit (PICU) at a large academic center. We did almost everything except for a few things esoteric at the time — small bowel transplants, a few kinds of experimental surgery. I’m now in my late career (but have no plans to quit anytime soon!) and work in a smaller PICU. I am frequently confronted with the issue …

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The Wild West approach to PICU practice

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