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MKSAP: 55-year-old woman with an eating disorder

mksap

Conditions

July 23, 2018

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

A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to 19. She has otherwise …

A return to the problem-oriented SOAP note

Robert Centor, MD

Physician

July 22, 2018

CMS is changing note requirements, among other changes. Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.”

As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction. To me the most important change is a focus on notes: “Allowing medical decision making to be …

What is proper work attire in medicine?

Michael Edmond, MD, MPH

Physician

July 22, 2018

I’m a creature of habit. My first activity every day is to read the New York Times. Depending on my schedule, some days I read more articles than others. This week I was away at a conference and found myself with some early morning extra time before the first meeting session, so I delved into the Arts section. I began to read the first article: “Women …

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What is proper work attire in medicine?

Who named our bones? And what were they thinking?

Roy A. Meals, MD

Conditions

July 21, 2018

All of our 200+ bones have names, which facilitates describing them when we cannot actually hold them or point directly at them. It might be easier to remember the names if they were familiar ones like Robert, Sally, and Kevin, but no such luck. Latin was the original language of science, so the bones received Latin names. Some of those were derived …

Medical students: Welcome to the wards

Zainab Mabizari

Education

July 19, 2018

Dear third-year medical students,

Welcome to the wards.

I remember this stage — basking in the glory of completing pre-clinicals, in the excitement of finally switching heavy textbooks for living, breathing people, in the realization that medical education now lies in the hands of those I wanted to heal. I would be sleeping less, but living more, because this was my purpose.

Remember this moment because this will be the most difficult year …

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Medical students: Welcome to the wards

When attendings come to work rounds

Robert Centor, MD

Education

July 18, 2018

Learners value efficiency. As I recall my residency, nothing caused more angst than unnecessarily long rounds. In the 1970s just like in the 2010s, I had much to do after rounds ended.

As an attending physician, my responsibilities involve patient care and aiding learning. I have always worked hard to do that within a time constraint. The time constraint requires that rounds run efficiently.

Like many things in medicine, efficiency only works …

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When attendings come to work rounds

Reading the body language of your patients

Suneel Dhand, MD

Physician

July 16, 2018

When a patient is unwell and seeking help, a vast number of emotions could be going through their mind. Their whole life could have been turned upside down, they may have been fearing this moment for a while, and stressing over the implications of their illness. To physicians, it may sometimes feel like just another name on our list or almost become a routine mechanical interaction, but for …

How to thrive during your residency

Varun Verma, MD

Physician

July 16, 2018

Even though my own internship was a decade ago, I vividly remember the transition from student to resident. Residency was monumental in my path to becoming a physician. There were obvious changes: People now called me “doctor,” my misshapen short white coat was upgraded to a more comforting full length one, and I was often the first one paged to respond to patient problems. Coupled with the positive aspects though, …

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How to thrive during your residency

Restoring the trust in the medical profession

Philip A. Masters, MD

Policy

July 13, 2018

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Trust is the belief that another person or entity will act in your best interest, and it serves as the foundation upon which the doctor-patient relationship and our health care system are built.

But we have a significant trust paradox in American medicine. As …

6 pieces of advice for graduating medical students and residents

Nisha Mehta, MD

Physician

July 13, 2018

My (sometimes solicited, but often unsolicited) advice for graduating medical students, residents, and fellows:

June is one of my favorite times of the year. One, because it’s summer, but also because it’s graduation season. I love seeing and hearing about everyone’s accomplishments, and seeing years of hard work come to fruition – although if I’m being honest, it’s bittersweet, because it’s also a reminder of how I’m getting older.

This year, I’ve …

8 steps to have those difficult conversations

Marlene Chism

Physician

July 12, 2018

An excerpt from 7 Ways to Stop Drama in Your Healthcare Practice.

Although the ability to initiate difficult conversations is part of good leadership, I’ve never met a leader who enjoys it. Whether your conversation is about body odor, rude behavior, dress code, personal conduct or performance issues, difficult conversations are …

10 ways to stay out of the DEA’s crosshairs

Dennis Wichern

Physician

July 12, 2018

No news attracts attention like a physician who’s in trouble with DEA or their state medical board. So, how does it happen, what are the common issues and what can a physician do to safeguard themselves?

First, let’s look at what the numbers and the research tell us.

The Federation of State Medical Boards (FSMB) tells us that 4,091 physicians were disciplined during …

A conversation with a doctor who was tired of feeling burned out

Nii-Daako Darko, MD, MBA

Physician

July 11, 2018

An excerpt from the Docs Outside the Box podcast, episode 1: When the going gets tough… MOVE!

Dr. Nii: All right, well thank you very much for joining us on the Doc’s Outside-the-Box podcast. You are our first guest — first victim, I guess. It’s the inaugural episode, so I just wanted to thank you for joining us. I know you are in New Zealand, which is roughly 18 hours away.

Dr. Brown: It’s …

What’s better: mentorship or sponsorship?

Julie Silver, MD

Education

July 11, 2018

Literature coming from business and human resource management suggests that women are over-mentored and under-sponsored. However, if you have been reading reports about women in medicine, then you likely have heard that women are both over-mentored and under-mentored. Where does the truth lie? That depends on various factors including the definitions of these terms.

What exactly do these words mean? In the business sector, mentorship is …

Prescription drugs are killing students and the educational system

Yasir Khan, MD

Meds

July 11, 2018

The Centers for Disease Control and Prevention reports that 63,632 individuals died in 2016 as a result of drug overdose. Among these, 66 percent died from opioid overdose. The statistics are derived from in-depth research that was carried out by the research institute in 2016. The Centers for Disease Control and Prevention warns that cases of drug abuse are swiftly spreading geographically and increasing demographically. The …

A physician’s warning on the keto diet

Shivam Joshi, MD

Conditions

July 11, 2018

The keto diet has recently garnered much fame for its apparent ability to improve diabetes and obesity – results so impressive the Journal of the American Medical Association recently highlighted the diet and thereby christened it as something more than a low-carb craze. However, not all the evidence supports such a positive outlook, leading the diet to straddle the increasingly blurred lines between faddist snake …

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A physician’s warning on the keto diet

3 steps for doctors to move into the next level of career growth

Stephanie Wellington, MD

Physician

July 10, 2018

In medicine, this is the time when one season ends and another begins. New doctors graduate from medical school. They are excited and, at the same time, scared as they enter into residency training. Interns become residents. Senior residents celebrate moving into attending positions or look forward to subspecialty training in fellowship programs. It’s the excitement of completion combined with the uncertainty of charting a new course in medicine. Each …

Sleeping with your baby: Mainstream media gets it wrong

Karen Allen, MD

Conditions

July 9, 2018

Recently, a journalist with NPR asked her audience if sleeping with your baby is as dangerous as doctors say. In short, yes, it is very dangerous.

In the article, Michaeleen Doucleff repeatedly trivializes the danger of parents co-sleeping with their baby. She uses anthropological evidence to reassure parents that sleeping with their infant is safe if parents don’t drink, smoke, or use illicit drugs. She makes light …

The hidden issues of the “dancing doctor”

Joshua D. Zuckerman, MD

Physician

July 9, 2018

Over the last month, a dermatologist practicing in Georgia known as the “dancing doctor” was suspended by the Georgia Medical Board, which said she posed a “threat to public health, safety, and welfare.” At least ten patients have sued this physician with complications including disfigurement and brain damage, and reportedly there are another 100 former patients who …

What I wish my family had known about medical residency

Elisabeth Poorman, MD

Physician

July 9, 2018

I sometimes get messages from people who have lost physician colleagues and loved ones to suicide. It’s the specifics of these stories that wound me: a note left for an unexpected person; an insignificant fight at sign-out that in retrospect is full of meaning; the white coat that a woman wore when she jumped to her death. Each of these lives is complex, and each of these deaths …

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