Dos and don’ts for your residency interview

Education
October 6, 2016

It’s that time again — time to dust off your nicest suit and prepare for either residency or fellowship interviews. Being knee-deep in interview season for infectious diseases fellowships, my interview days bear some resemblance to my residency interviews, yet also are quite different. I have a unique opportunity this year to be a part of the recruitment and decision process for our internal medicine residency program, in addition to being a fellowship applicant.

I was visiting …

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The day that the pediatricians quit

Physician
October 5, 2016

Once upon a time, there was a land where parents were anxious, information was pervasive, and trust was hard to come by. Misinformed celebrities with impressive influence (despite minimal education) were spouting ideas that provided concrete solutions to poorly understood situations, and parents were clinging to them as if their (child’s) life depended upon it.

Pediatricians everywhere were scratching their heads, wondering, what has happened? Why are our patients doubting us? …

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A physician experiences a medical error. Here’s her story.

Physician
October 4, 2016

As a physician, I knew exactly what was happening when I walked into the emergency room. My eyes were nearly swollen shut. My throat was closing. I was in the midst of a severe allergic reaction known as anaphylaxis. I urgently needed epinephrine, a potent medicine that could halt my life-threatening symptoms. When I told the nurse what was happening, she rushed me to the trauma room where doctors and nurses encircled …

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I don’t apologize for being a fast doctor

Physician
September 30, 2016

When we think about the technology revolution, we often get excited at the thought of getting what we want instantly. We wait in line for new smartphones. We instant message. We love fast. Getting something done faster, with as good a result, is usually seen as a virtue — unless one is a doctor.

In these times of fast information, we find ourselves bombarded with surveys. Part of the downside of …

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Patients want to make their own informed choices. We need to let them.

Physician
September 30, 2016

Growing up during the 1970’s and 80’s, Little House on the Prairie was an iconic part of my childhood.  Doc Baker was the physician and veterinarian for all of Walnut Grove, in spite of limited resources.  Medical lessons were everywhere in the beloved television series:  Mary experiencing onset of blindness (most recently attributed to viral meningoencephalitis, likely from measles), the death of Laura’s infant son by unknown cause, and Rose’s …

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When EMTALA forms meet EMRs, chaos can ensue

Physician
September 28, 2016

Ah, EMTALA! The revered Emergency Medical Treatment and Active Labor Act! It’s one of those things which is like a nursery rhyme to emergency medicine folks like me. We’ve heard about it from the infancy of our training.  “And then the bad doctor sent the poor lady to another hospital because she couldn’t pay!  And the King came and crucified him for doing it!”  The end.

EMTALA, for the uninitiated, is …

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This doctor is against medical marijuana. Here’s why.

Meds
September 26, 2016

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio.  Once of my points in that piece is that I did not want legislators making medical decisions for us.  They can’t even do their own jobs.

I am not against medical marijuana; I am for science.  The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, …

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Captain Sully and the human factor in health care

Physician
September 25, 2016

I recently watched the movie Sully. It was the first time I’d ever watched a movie on its actual release date. Knowing what a legendary actor Tom Hanks is, and what a fascinating and near-tragic story unfolded on January 15, 2009, I felt confident that my choice to venture out to the cinema on a beautiful Boston September evening, would be a good one.

The movie sure didn’t disappoint. Brilliantly directed …

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Physician parents, physician children. Why?

Education
September 25, 2016

Upon starting medical school, I remember feeling amazed to learn just how many of my classmates had physician parents. I felt like I was in the minority, not having any family members of my own who were doctors. This made me realize: Physician parents tend to breed physician children. But why? I soon discovered that the answer may lie in the genetics of personality.

The academic study of personality has grown extensively over …

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The yoga of surgery

Physician
September 24, 2016

Early on a random Tuesday morning, I walked into the burn unit and found my 87-year-old patient, Mr. Gray, in septic shock. While Mr. Gray’s burn injury was small by our standards, it appeared that the sequelae of the injury might prove fatal. I called Mr. Gray’s wife to obtain consent for a vascular catheter through which I planned to begin continuous dialysis and was surprised when she declared, “No …

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I question the ethics of any doctor who sells supplements to patients

Physician
September 20, 2016

I was seeing a patient who brought me a bag of supplements she bought from another specialist. I looked skeptical and then she pulled out the list of lab results the other doctor ordered on her. I reviewed the results with her and asked why all these tests were ordered in the first place, some of which I had never ordered in my life. She said she told the specialist …

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If doctors wanted to be wealthy, they would have become UPS truck drivers

Physician
September 19, 2016

figure-1-for-kevin-pho

Do doctors make too much money?

I don’t think so. I read with great interest the blog by Dr. Michael Kirsch defending physicians’ salaries: “If you think doctors make too much money, think about this.” Unfortunately, the public’s perception of physicians’ incomes has been that physicians make too much money.

Whenever I hear this remark from patients or even non-physicians, I show …

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Reflecting on sepsis: Definitions, new ideas, and a continued commitment to patient care

Conditions
September 19, 2016

sepsis-blog-9-2016

CHEST_sig_horiz_PMS-TMSeptember is Sepsis Awareness Month, a month which aims to raise awareness of sepsis and strategies for prevention and treatment. Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when the body’s response to infection becomes dysregulated and white blood cells and chemicals cause injury to organs throughout the body.

Earlier this …

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Pain patients are being cut off from their drugs. Here’s why.

Meds
September 18, 2016

In March, 2016, the CDC released guidelines for prescribing opioids.  The guidelines were a response to a serious and growing problem: millions of pain patients became addicted to prescribed opioids, and hundreds of thousands died as a result.

Since the guidelines were released, reports of pain patients being abruptly cut off of their medication or having their medication abruptly reduced have become rampant. These patients report they were using opioids long …

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When treating chronic pain, don’t compromise your principles

Meds
September 17, 2016

One of the most difficult things I deal with as a physician is patients’ demands for pain medications. I treat patients with cystic fibrosis, a genetic disease present at birth with no cure, and its issues are indeed complex. There are legitimate causes for misery from the chronic coughing, abdominal pain, and joint pain recognized as common symptoms of the disease.

But the associated issues of depression, stress with family, and …

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A medical student’s struggle with continuity of care

Education
September 16, 2016

“I can’t find the fetal heart tones.” The nurse states with a tone of underlying panic as she exits the patient room.

It’s around 7 a.m., and those of us working the night shift are getting ready for morning sign out before we can head home and get some much-needed sleep after a crazy 14 hours shift.

“Tessa, go scan her” the resident nods towards the ultrasound machine, and I cheerfully follow …

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The social history: Our patients are more than their diseases

Physician
September 15, 2016

“Any alcohol use? Any tobacco use? Any other drugs?”

These are the three main questions that most health care providers ask their patients when documenting a social history on a note.

“What stressors do you have in your life? What social support do you have? What is your home life like? What do you do for fun? Do you wear a helmet when you ride a bike? Do you wear a seatbelt?”

I …

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The inhumanity of medical residency programs

Physician
September 13, 2016

My mother-in-law died last week.

She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now …

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Medical eponyms: Where women are clearly underrepresented

Physician
September 13, 2016

The month of September has been Women In Medicine Month (according to the AMA) since 1989.

Statistics are always telling:

  • Currently 65 percent of practicing physicians are men, and 35 percent women.

You can’t prepare for a rotation in the pediatric ER

Education
September 12, 2016

Walking into Riley Pediatrics Hospital in Indianapolis, Indiana, and having just completed two prior rotations in emergency medicine at two different level 1 trauma centers, I thought I would be able to easily fit in with pediatric population here. I thought I would be able to slide fluidly from patient to patient, oral reports to consults, while staying connected with the rest of the team. I thought I would be …

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