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MKSAP: 79-year-old man with a sacral ulcer

mksap

Conditions

November 3, 2018

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

A 79-year-old man is evaluated for pain in the buttocks region. He was diagnosed with non-Hodgkin large B-cell lymphoma 6 months ago. Although his lymphoma has responded well to therapy and he is without evidence of active disease, he required hospitalization three times for chemotherapy-associated complications during his treatment course. He has been …

It’s time we start voting at our local hospitals

Stephen Haff and Hussain Lalani, MD

Policy

November 2, 2018

Early voting began recently in Texas with unprecedented excitement, as a record 15 million registered voters made their way to the polls. Reports say polls are looking more like Black Friday shopping lines than early voting locations. Although we cannot predict the results of the election, one thing is clear: healthcare is the top issue. This is hardly surprising given …

Being a physician was never the objective. The goal was becoming one.

Yoo Jung Kim, MD

Education

November 2, 2018

There is a saying among students that medical education is like “taking a drink out of a fire hydrant.” The simile evokes the torrent of information and the impossibility of taking it all in.

The type of people who are admitted to medical school aren’t used to being wrong; to call them perfectionists wouldn’t be too far from the truth. Many secured a seat in medical school because they had made …

Why demanding a randomized controlled trial for vaccines is disingenuous

Christopher Johnson, MD

Physician

November 1, 2018

I swiped this editorial cartoon by Steve Sack from the redoubtable Dr. David Gorski’s blog, who goes by the nom-de-web of Orac. Recent epidemiology shows reducing the fraction of vaccinated children in the population rather promptly leads to a resurgence of the diseases vaccines protect against. This is the concept of community or herd immunity. …

Why medical students should not let medicine define them

King Pascual

Education

October 31, 2018

Sanjay Gupta. John Locke. Jill Stein. Charles Krauthammer. What do they all have in common?

If you guessed that they are all physicians, then you’re right.

Less salient, however, is the fact that all of them pursued passions outside of medicine. (Dr. Gupta is an Emmy Award-winning medical reporter. John Locke was a physician-philosopher. Stein and Krauthammer both made their mark in politics.) In doing so, they avoided an existential trap that …

You shouldn’t worry about public service loan forgiveness

Rishi Thaker, DO

Finance

October 31, 2018

Anger. Jealousy. Envy. Frustration. I was feeling all the emotions when NYU announced in August that their incoming and subsequent classes would be tuition-free into perpetuity. One consolation: at least I wasn’t one of the chronologically unfortunate that graduated from the school just months, or a year, before that announcement. For them, the time difference was small, but the difference in loans was vast — one year of tuition costs …

5 lessons on doing research as a resident

Kathryn Jobbins, DO

Physician

October 29, 2018

I remember sitting in my residency academic adviser’s office as I was discussing the plans I had designed for my community project at the end of my intern year. I can only imagine what she thought as I looked at her with a blank stare when she had suggested I should create an original research project around this. “What?” was all I had managed to mumble out of my mouth. …

The gift of suffering in medicine

Kristine Tatosyan-Jones, MD, MBA

Physician

October 29, 2018

“There will always be suffering. It flows through life like water …”

Those famous lyrics sung by Nick Cave in his Lime-Tree Arbour ring true for many of us. They take on an entirely different layer of meaning for physicians.

Even the very journey of becoming a physician is marked by suffering. While many of our classmates frequented football games, nightclubs, and social events, most of us were studying day and night …

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The gift of suffering in medicine

What I wish I knew on the residency interview trail

Amanda Xi, MD

Education

October 28, 2018

I still remember the warm, fuzzy feeling of receiving my first few interview invitations. Unlike medical school, I received much more “love” from residency programs. Since I was part of the inaugural class of a new medical school, I interviewed for a lot of programs: 16 anesthesiology, six transitional years, and three preliminary medicine programs. After my first few interviews, it became apparent that most residency interviews tend to be …

What we can learn from the tragic deaths of CEOs

Joel Kahn, MD

Conditions

October 26, 2018

An excerpt from Dead Execs Don’t Get Bonuse$: The Ultimate Guide to Surviving Your Career With a Healthy Heart.

The details of the careers and tragic deaths of these CEOs are a matter of public record, and the disruption that followed their deaths was enormous. Take Ranjan Das, for example. …

It’s better to not go into medicine than try to get out of it

David Beran, DO

Physician

October 26, 2018

“Passion isn’t a path in the woods. It is the woods.”
-Tom Robbins, “Half Asleep in Frog Pajamas”

I’ve met plenty of accidental physicians. These have been photographers, travel writers, artists, outdoor guides and chefs who awoke one day to find themselves doctoring. Their passions didn’t die — they were just delayed by lifestyle choices. By the time they recognized a need to follow their passion, they were at least partially through …

There’s no textbook for when your father is dying

Jeremy Pivor

Education

October 26, 2018

On my first day of medical school, my father, a dentist, told me he’d just been diagnosed with stage four pancreatic cancer. Cancer had crept back into my life — except this time not into my body.

At age 12, I was diagnosed with brain cancer. After an aggressive surgery, I was tumor-free for 10 years. Then, at 23, I received the news of an inoperable recurrence.

While going through radiation and …

A physician loves the adrenaline surge

Alexandra Novitsky, MD

Physician

October 25, 2018

Have you ever felt so cold? I mean bone-chilling cold. I don’t mean the same kind of cold that northern winters can leave you feeling. I am talking about working in a hospital that is climate-controlled, and you are undoubtedly shivering.

I still remember my first day on the job as a neonatology fellow. I was anxiously walking to the operating room to attend the delivery of a 25-week infant. As …

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A physician loves the adrenaline surge

When physicians order tests: a tale of 2 patients

Fred N. Pelzman, MD

Physician

October 25, 2018

Sometimes things go just the way you want them to, and sometimes they don’t.

Compare and contrast the case of two different patients, and how things went trying to get them the care they needed.

The first patient, let’s call him Mr. Smith, called up one day last week with a brand-new symptom, which after a phone call was ultimately determined to be disturbing enough that he was offered a same-day appointment.

After …

Physicians have the skills to be entrepreneurs

Passive Income, MD

Finance

October 24, 2018

Within the medical community, there seems to be a prevailing belief that when it comes to business and finance: Well, we’re just not very good at it. Some chalk it up to the lack of financial training we received in medical school. Others say it’s simply not in the physician’s DNA – that our brains are wired differently.

I would disagree.

In reality, I’ve seen many, many physicians become successful …

The phone calls physicians make in the middle of the night

Maria Yang, MD

Physician

October 23, 2018

I don’t miss making the phone calls in the middle of the night.

“Hi, this is Dr. Yang calling from the psychiatric emergency service. May I speak to Mr. or Mrs. Doe?”

“Yeah, this is Mr. Doe,” he’d reply, his voice thick and slow with sleep.

“I’m sorry to call so late. Your son is here at the hospital.” Take a breath and slow down for the next part. “He’s alive and doing OK at …

Don’t watch too much financial news

Wall Street Physician, MD

Finance

October 23, 2018

There’s a lot of financial information out there. Some of it is helpful, and some of it is unhelpful.

I’m sure many of you take notice when the Dow Jones falls 1,000 points in two days.

And even if you don’t usually follow the stock market on a daily basis, when the stock market is dropping, the financial news media will let you know about it.

Because when the stock market is crashing, …

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Don’t watch too much financial news

We can do a better job with hospital discharge paperwork

Suneel Dhand, MD

Physician

October 23, 2018

The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20 percent for Medicare patients (higher for certain patients, with up to a third of these occurring in the first 7 days), there is an …

Why physicians should embrace failure

Jason Chesney, MD

Physician

October 22, 2018

Failure is a guarantee. “Success” assumes that certain metrics have been set and that the words used to describe those metrics are understood in the exact same way by all parties involved. One patient with parotid cancer and given facial paralysis after surgery was thrilled to be alive. Another is furious about a widened scar.

The brain, primed to act on behalf of the organism, works at times without our input …

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Why physicians should embrace failure