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Borderline personality disorder in medical practice

Conditions

June 6, 2018

What is borderline personality disorder (BPD)? According to the National Institute of Mental Health, unstable moods; impulsive and reckless behavior, and unstable or volatile relationships may be indicative of BPD. People with BPD often have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides. They often make poor life choices and take unwise risks. Thus, adults with …

The questionable ethics of ultrasound in pregnancy

Cory Michael, MD

Conditions

June 6, 2018

Having worked at both community hospitals and major medical centers, the issue of ultrasound in pregnancy has revealed itself to be more complex over the years. As a resident, I worked with an obstetrics office that only scanned their own patients who had private insurance and would send uninsured or Medicaid patients (often with a high risk of inadequate prenatal care) to the hospital late in the day to be …

What you need to hear at your medical school graduation

Pranay Sinha, MD

Education

June 5, 2018

Well done! Strong work! You’ve done it!

Four years (often more) of perspiration have earned you two extra letters (often more) in your name. You should be proud. Nothing should get between you and a gigantic glass of bubbly today. The world feels different. You feel different. But are you?

The thing about ceremonies that feature costumes, protocols and rituals is that they confer upon participants a sense of change. Just look …

Cyberbullying and mental illness in kids

Nils Westfall, MD and Samantha Saltz, MD

Conditions

June 5, 2018

Cyberbullying is a major and growing public health problem associated with increased risk of greater psychiatric morbidity and mortality among children and adolescents. Its prevalence, varieties, associations with other forms of maltreatment, risk factors and deleterious effects in different populations are poorly understood.

Furthermore, effective, evidence-based approaches to screening and prevention in different populations are lacking. Developing such approaches is challenged by the rapidity and unpredictability with which electronic social media …

Here’s why I left nursing

Sarah E. Jorgensen, RN

Conditions

June 5, 2018

Leaving the nursing profession is bittersweet. My heart left nursing a while ago when I came to the realization that nursing left me first. It never was a two-way relationship. The profession left me without acknowledgment of work-related stress, specifically post-traumatic stress (PTS).

First responders and emergency workers often hear the phrase, “It’s just part of the job.” So we all just deal with it — or not. I’ve heard this …

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Here’s why I left nursing

The caste system is thriving in medicine in the U.S.

Pramod Theetha Kariyanna, MD

Policy

June 4, 2018

On my morning commute as I read this NPR article, memories started flooding my brain. I could not control myself and had to write this.

My last name “Theetha Kariyanna” has its origin from a small village Theetha and added to it is my dad’s name Kariyanna (a local folk god). Back in my school days, the name was weird to my friends as the name …

Pregnant and in medical training? Here’s how to do it.

Arti Thangudu, MD

Physician

June 4, 2018

We hear all the time that maternity leave in the U.S. is in shambles. Let’s clarify: There’s no such thing as guaranteed maternity leave. Some companies are obligated to give some leave to some employees — that’s as good as it gets. No companies are obligated to give paid leave.

Medical training adds complexity to parental leave. Residents and fellows are expected to be deferential, the lowest on the totem pole …

Physicians have become devalued in modern health care

Anonymous

Policy

June 2, 2018

I’m writing this piece because I’m finally at the point that I am truly angry. I am angry at how physicians have become devalued in modern health care. I’m angry at how systems of care have participated in this by replacing physicians with lesser trained mid-level practitioners. I’m angry at how our title “doctor” has been hijacked to allow patients to be misled or, in many cases, deceived.

It wasn’t that …

The painfully fine line of pain management

Michelle Dang, MD

Conditions

June 2, 2018

I’ve been practicing as an interventional pain management physician for over six years. It was a long road to get here — four years of medical school, four years of residency in anesthesiology and one year of fellowship (in addition to the four years of undergraduate education). So people say, “You must really love what you do.” Sure, during residency there was light at the end of the grueling tunnel …

It’s time to recognize the rights of medical students and residents

Thad Salmon, MD

Education

June 1, 2018

Goodbyes were confusing during my third and fourth years of medical school. Even on my way to a 28-hour labor and delivery call, I tended to say, “I’m leaving for school.” Rather quickly, my wife trained me to say, “I’m leaving for work.” I was never quite reconciled to this, as I couldn’t forget the upcoming exams and tuition costs around $30,000 per year.

For the uninitiated, “work” as a medical …

Life on the night shift at the hospital

Torree McGowan, MD

Physician

June 1, 2018

It’s 7 a.m. The hospital is just starting to wake up from its slumber, stretching arms and blinking eyes. I’m 54 minutes away from the end of another night shift.

Night shifts are curious creatures. They are a part of the fabric of emergency medicine life — one of the often hated aspects of our jobs. They steal us away from our families, cutting short bedtime snuggles and picture books so …

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Life on the night shift at the hospital

When private physician groups get acquired: Who loses?

Bimal Massand, MD, MBA

Policy

June 1, 2018

In the recent years, there is a growing trend in the health care industry whereby private practitioners and independent groups are being acquired by larger companies. This trend is a result of growing complexities of running a private practice and increased expectations of hospital administrators from hospital-based specialists such as anesthesiologists, radiologists and pathologists.

I will concentrate on anesthesia as it is my area of specialization, and I have some relevant …

This doctor retired from clinical medicine. Here are his tax surprises.

Cory Fawcett, MD

Finance

June 1, 2018

Upon retiring from clinical medicine and becoming a full-time author/coach (I like to say I’m repurposed), I was uncertain as to the amount of taxes I needed to pay. I have a complicated tax return with several K-1s that don’t surface until March. My final return totals 32 pages for federal and 5 pages for state. After making an estimate of my tax bill at year end, I figured I …

Residents should not be mandated to do research

Skeptical Scalpel, MD

Physician

May 29, 2018

In a 2012 blog post called “Things that puzzle me about surgical education,” I wrote the following:

There was the emphasis that still exists today on making sure every resident did research. At last, some are questioning the value of this for the average clinical surgeon. Contrary to the prevailing wisdom, there is no evidence that a resident who is dragged kicking and screaming through a clinical research project or …

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Residents should not be mandated to do research

Cross-coverage has made me aware of the art in medicine

Don S. Dizon, MD

Physician

May 28, 2018

Perhaps one of the hardest things about medicine is cross-coverage, that is, to be the covering doctor for your partners, whether for the occasional night, weekend, or longer. It’s not something done only in oncology. All specialties in medicine have this system, which allows us to have lives outside of our hospitals and clinics. What’s …

The Medicare merry-go-round in geriatric psychiatry

Katherine Gantz Pannel, DO

Physician

May 28, 2018

Martha (not her real name) was not an overly complex case in my field of geriatric psychology. But the case was complex enough to require multiple approaches and reliable follow up. And in rural Mississippi, follow up can be elusive. Soon it occurred to me that Martha’s case is emblematic of how caring for this vulnerable population often runs up against a huge problem — the Medicare merry-go-round.

A 78-eight-year-old with …

We are sorry, you did not match to any position

John Brewer Eberly, Jr., MD

Education

May 27, 2018

When I was in fourth grade, I won our school’s spelling bee. This meant that I went on to the next tier of the local spelling world — the sort of prestigious competition that takes place in a gymnasium somewhere with a makeshift stage and a bunch of flags.

I was the first kid disqualified. I misspelled veterinarian “veterenarian” and battlement “battlemint.” I remember feeling, in the moment the announcer said, …

Your first meeting with a mentor

Joannie Yeh, MD

Physician

May 26, 2018

You extend a firm handshake and get ready to sit down at the table across from your mentor for the first time.

Woah, wait. Let’s back up to the legwork that should have happened prior to this meeting. First step, you found the mentor (see this post for practical ideas on how to find a mentor). Neither you nor the mentor have a lot of time — a frequent obstacle often …

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Your first meeting with a mentor

How to ask for a great letter of recommendation for residency

Ted O’Connell, MD

Education

May 25, 2018

Strong letters of recommendation are essential for supporting your residency application and matching well. This article details how to ensure you get great letters of recommendation.

Knowing what constitutes a great letter of recommendation is crucial to obtaining outstanding letters. A strong letter of recommendation clearly conveys knowledge of the medical student, how that student performed and qualities that predict excellent performance in residency. Strong letters of recommendation include the following:

What to do if you want to be a cruise ship doctor

Cory Fawcett, MD

Physician

May 25, 2018

In 2013 I began searching for ways I could change my career to reduce my workload, but not give up medicine altogether. During that time I took a cruise and looked at various jobs I could do on a cruise ship. One of the jobs I was qualified for, I thought, was to be a Cruise Ship Doctor.

After talking with the ship’s doctor to find out what it was like …