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The old days of medicine are gone

Physician

January 17, 2019

In the last decade, specifically in the last five to six years, we have seen the gradual disempowerment of America’s physicians as well as their unfortunate patients.

Starting with health management organizations, managed care, all the way to the insurance exchange, doctoring has been forcefully wrestled away from physicians only to be placed into the hands of large insurers, administrators and the United States government.

The common denominator was never about improving …

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The old days of medicine are gone

For residents unsure about their choice of specialty

Abeer Arain, MD, MPH

Physician

January 16, 2019

About halfway through the internal medicine residency, there comes a time when a resident must decide on what he or she plans to do after three years of training. We may come across a second-year resident saying: What should I do next? Should I become a hospitalist or plan for a fellowship? But in what? Cardiology and gastroenterology are fascinating careers, but is my resume ready for a competitive match? …

10 tips for non-traditional medical school applicants

Joe Bardinelli, DO

Education

January 16, 2019

I would like to offer some words of encouragement to what many call the “non-traditional” students pursuing medicine.

The term encompasses people in different aspects in their lives. It may be someone in a different line of work looking at medicine as a second career or another just getting started that didn’t take the traditional path in undergrad.

My own journey

I started medical school at 28 after spending six years as a …

Why is Medicaid reimbursement below sustainability?

Niran S. Al-Agba, MD

Policy

January 15, 2019

Recently, a child was on a waitlist for five months to get into my practice. For this article, I will call him Tiny Tim.

Tiny Tim, now five years old, has a skin condition known as eczema or atopic dermatitis. When we first met, virtuously every area of his body was covered with wounds from constant scratching. Skin that breaks easily and heals poorly can give bacteria access to other parts …

A divided house always falls: Why doctors lost control of health care

Suneel Dhand, MD

Physician

January 15, 2019

I recently met an old friend of mine for the evening in New York City. He’s a talented young orthopedic surgeon, who has already, in the short amount of time since finishing residency, experienced so many of the problems our health care system faces.

The topic of conversation quickly turned to the current state of medical practice, the dramatic swing to corporate medicine, and the consequential loss of autonomy suffered by …

A call for the end of routine opioid use after wisdom tooth removal

Amy Ma and Susan Sutherland, DDS

Meds

January 15, 2019

We are writing as a parent and a dentist to spread a message to parents and dental health care providers across Canada: there are alternatives to prescribing opioids after wisdom tooth removal.

Removing wisdom teeth is considered by many as a rite of passage for teenagers. It is one of the most common surgical procedures done in young people aged 16 to 24.

Amy’s 16-year-old son, Felix recently had his wisdom teeth …

The fallacy of work-life balance in medicine

Ellen Poulose Redger, MD

Physician

January 15, 2019

Physician well-being, burnout, and “work-life balance” are pretty common topics in training. We start at intern orientation, discussing how to work 80 hours a week, eat, sleep, exercise, and still have some semblance of social life. It’s like we’ve forgotten the origins of our job title: “resident” or “house staff” — implying that, until recently (and even now, in places outside of North America), we, the physicians-in-training, lived at the hospital. …

Peanut allergies: What is the best policy for schools?

Roy Benaroch, MD

Conditions

January 14, 2019

Peanut allergies can be a serious problem, and many exposures happen when our kids are at school. On average, there are probably about 5 peanut-allergic children in each of our nation’s 100,000 school buildings. What’s the best policy for schools to use to help protect these kids from potentially fatal reactions?

Different schools have taken different approaches, and as far as I can tell there is no authoritative national guideline …

How physicians can successfully wind down their practice

Smart Money, MD

Finance

January 14, 2019

A retirement plan isn’t usually a top priority for fresh doctors looking for their first jobs, whether that final date is in five years or thirty. Perhaps knowing when to hang up your hat is immaterial so early in your career since most doctors will end up leaving their first job within the first five years anyway. However, I do wish that I had some inkling about the career paths …

How carefully do most patients or doctors read medical forms?

Michael Kirsch, MD

Physician

January 14, 2019

Does any living, breathing human believe that there is not enough paperwork in our lives? While we are all burdened, I believe that the medical profession is uniquely deluged with an absurd volume of documentation requirements, most of which should be filed under “N” for nonsense. Ask any physician or nurse about this and have antacids on hand as you will soon see some sizzling smoke emerging from the medical …

Patient care suffers when you squeeze patients into a tight schedule

Fred N. Pelzman, MD

Physician

January 13, 2019

86 minutes.

That’s what I found when I added up how late patients were through a single practice session earlier in the week.

Some patients arrived on time, and some a few minutes early, but the average was about 8 minutes late, ranging up to one patient who showed up an hour and 12 minutes after their scheduled appointment time.

The reason I …

Investing in the stock market is like playing that game of rock-paper-scissors

Wall Street Physician, MD

Finance

January 11, 2019

Rock-paper-scissors is a game that nearly all of us played as children.

It is a game with incredible opportunities to play mind games with your opponent.

There is no luck in rock-paper-scissors as with card games.

The game does not have complex rules like chess.

You simply have to figure out the patterns of your opponent (or induce patterns into them) and take advantage accordingly.

Can you beat the New York Times computer bot?

Back in …

A financial checklist for the pregnant woman physician

Bonnie Koo, MD

Finance

January 11, 2019

Women physicians are disheartened when they discover the financial implications of having children. Most of us will not get paid leave. Many of us are the breadwinning partner. And most of us will not become stay at home moms so we will need to pay for high-quality childcare or have a stay at home spouse.

Certain things should be in place prior to becoming pregnant. So even if you’re single, I …

10 surprising things you need to know about the hospital

Kevin Tolliver, MD, MBA

Physician

January 11, 2019

1. Very little revolves around the patient. For a place dedicated to healing, the hospital does a poor job accommodating patients. Labs are drawn in the middle of the night, so the doctor has them early in the morning. There is no standard rounding time, so the patient is constantly awakened throughout the day. Vitals must be measured every few hours. Patients often comment about being happy to be discharged …

Treating sleep apnea without CPAP

Joi Freemont, DDS

Conditions

January 11, 2019

It was 4:00 a.m. when I made it to my parents’ home. My mother called me to say that my father was having a hard time breathing. I could hear him struggling in the background. I ran inside to see my mother cradling my father on the floor — not breathing. I performed CPR on the man that gave me life! CPR on the person who just three months earlier …

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Treating sleep apnea without CPAP

The discrimination against nurse practitioners must stop

Cristina Carballo-Perelman, MD

Physician

January 10, 2019

I have been a neonatologist for 30-plus years. Throughout my career, nurses and neonatal nurse practitioners (NNPs) have guided me, assisted me and comforted me through difficult patient care issues that arose. Even more importantly, they allowed me to leave the neonatal intensive care unit (NICU) without worrying about how my patients were being taken care of.

I am writing this because our profession (MDs and DOs) continue to devalue these …

Your first 24-hour shift

Joseph Shapiro, MD

Physician

January 10, 2019

How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the ordeal.

When I get to work, full of nervous energy, I am relieved to find out …

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Your first 24-hour shift

10 essential questions to ask when diagnosed with bladder cancer

Naeem Rahman, MD

Conditions

January 9, 2019

Over 80,000 new cases of bladder cancer are diagnosed every year. Of the new cases, over 62,000 are men, and over 18,000 are women. Whites have higher incidence rates than blacks, although black patients have higher mortality rates, particularly black women. The majority of cases are found with painless gross hematuria (although most patients with gross painless hematuria don’t have bladder cancer). Nearly 80 percent of patients diagnosed with bladder …

Here’s what caregiving taught me

Ajay Dave

Conditions

January 9, 2019

Caregiving is often described as a sacrifice. One individual bears a burden to care for another. There’s a connotation of drainage, evocations of burned-out batteries and tired limbs.

I was a premedical student. I was aggressive in pursuing an MD. I wanted to be the best doctor I could be. I did not realize that required me to become a much a better person.

I left school to care for my grandmother. …

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Here’s what caregiving taught me

Residency training, and training in residency

Michelle Meyer, MD

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. …