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If you are a practicing physician, you need rest

Physician

January 23, 2018

“It is neither wealth nor splendor, but tranquility and occupation, which gives happiness.”
– Thomas Jefferson

If you are a practicing physician, you need rest.

Why do I say this? Because you have gone through an enculturation process which focuses on hyperactivity and super high-level achievement. In training programs and in practice, admitting that you are tired or needing a rest break is a sign of weakness and is discouraged, to say the …

A physician suicide: covered up with a tarp and silence

Pamela Wible, MD

Physician

January 22, 2018

Another young doctor recently jumped to her death in New York City. She landed at the entrance of the building where she lived.

Within less than an hour, I received the following emails about her. All published with permission.

Hello Pamela, I am not a doctor, but a mother of 3 and a wife of a resident physician. Tonight I watched AGAIN the police …

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A physician suicide: covered up with a tarp and silence

You can’t separate mind and body in medicine

Peggy A. Rothbaum, PhD

Physician

January 22, 2018

According to the American Psychological Association and the American Academy of Family Physicians, well over half of patient visits to primary care physicians are for mental health issues. So, as part of my book, I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship, I asked about mental health.

None of the doctor interviewees disagreed with the important role that …

Should the SOAP note be changed?

Jennifer Middleton, MD

Physician

January 22, 2018

Our hospital system’s IT department has recently encouraged us all to change our default encounter note template from the traditional “SOAP” format to the “APSO” format.

For those not familiar with those acronyms:

S: subjective — the patient’s story
O: objective — physical exam, labs, other data
A: assessment — the identified issues/diagnoses
P: plan — details of how to address issues/diagnoses in the assessment

The argument in favor of APSO, putting the assessment and plan …

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Should the SOAP note be changed?

When should physicians retire?

Wall Street Physician, MD

Finance

January 22, 2018

The decision to retire is a difficult one for anyone, including physicians.

However, with everyone’s investment accounts so flush with money because of the bull market, a lot of physicians younger than the traditional retirement age of 65 have enough money to retire early. Some have chosen to do so; others have chosen to continue to work even though they are financially ready for retirement.

So what …

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When should physicians retire?

13 things every doctor wants their patients to know

Joanne Jarrett, MD

Physician

January 21, 2018

1. We worry. We lie awake worried sick about you more often than you’d think. The stakes are so high, and we know it.

2. We wonder. I ran into a friend who’d met a patient I’d had sixteen years earlier. She gave me some follow-up, and it made my day — maybe my month. It was a year ago, and I’m still thinking about it. She’d had blood cancer. I referred her …

Young surgeons are learning robotic surgery in the shadows

Matt Beane, PhD

Physician

January 19, 2018

Artificial intelligence and robotics spell massive changes to the world of work. These technologies can automate new tasks, and we are making more of them, faster, better and cheaper than ever before.

Surgery was early to the robotics party: Over a third of U.S. hospitals have at least one surgical robot. Such robots have been in widespread use by a growing variety of surgical disciplines, including urology and …

The practice of emergency medicine is a team sport

Sandra Scott Simons, MD

Physician

January 18, 2018

“Same team!” bellowed all the frustrated parents from the sideline of a lacrosse game as we watched two teammates clash sticks while fighting to catch the same pass. Both players missed the ball, and the other team scooped it up and scored, perfectly illustrating to our kids what happens when they battle among themselves.

It’s easy to remind our kids that teammates shouldn’t fight, but it’s harder to remind each other …

A patient accused this doctor of sexual harassment

Thomas D. Guastavino, MD

Physician

January 17, 2018

It was a typical weekend on call. The usual number of surgeries, ER calls and consults. I was called to consult on 47-year-old female who had been admitted with four days of left shoulder pain. She had gone through a cardiac workup and was cleared by her internist. So now, a consult was called to see if there was an orthopedic cause for the patient’s pain — not an uncommon …

18 ways for physicians to invest $25,000

Passive Income, MD

Finance

January 17, 2018

So a new year is upon us! 2017 was a fantastic year for investors in general, so I hope it was a prosperous one for you. I believe that 2018 will be a great year as well and filled with multiple opportunities for everyone. A quick wish: May your 2018 be filled with much joy, great health, and hefty growth of your passive income streams.

Now back to the post – One …

Top 10 lies doctors tell themselves

Pamela Wible, MD

Physician

January 16, 2018

Pamela Wible: Today I’m sitting here with Sydney Ashland, an expert in physician mental health, who has worked with doctors for decades helping them overcome negative thinking patterns. And we’re going to dive into the top 10 lies that physician’s tell themselves. The number one thing that I hear over and over again from doctors is, “I’m stuck in assembly line medicine.”

Sydney Ashland: Yes. I …

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Top 10 lies doctors tell themselves

5 reasons to keep working after financial independence

Physician on FIRE, MD

Finance

January 16, 2018

I was browsing the Bogleheads forum last night, and my eyes naturally gravitated to the thread titled “What is FI if you love your job?”

The short answer is that FI is financial independence. Nothing more, nothing less, and it doesn’t look any different if you love, hate, or feel indifferent towards your job.

The long answer, after learning that the man asking the question is about ten …

A story of 2 torsions

Ronald Zacker, PA-C

Conditions

January 13, 2018

The kids were asleep, and I could hear a muted, distant moaning coming from our bedroom. It reminded me of labor pains, but there were three things making labor unlikely: my wife’s IUD, the absence of a gravid abdomen and the kind of unintentional celibacy that occurs between working parents raising two toddlers. I tried to ignore the moaning. In part, because it was a Sunday night, and the sound …

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A story of 2 torsions

Learn about Salter-Harris fractures with a Medcomic

Jorge Muniz, PA-C

Conditions

January 13, 2018

Pediatric physeal fractures have traditionally been described by the five-part Salter-Harris classification system.

Type I fractures occur through the growth plate. These injuries may present with normal radiographs, and the diagnosis is often made clinically when tenderness is palpated over the growth plate.

Type II fractures occur through the growth plate and metaphysis. Type II injuries are the most common physeal fractures.

Type III fractures occur through the …

20 anecdotes that describe the world of female medical students and physicians

Jamie Katuna

Education

January 13, 2018

I recently collected anecdotes from women in medicine who have noticed the same thing I’ve noticed: We’re not as comfortable here as our male counterparts. Despite progress, medicine remains a patriarchy — an “old boy’s club” — and the women in this world are frequently reminded of this status quo. In collecting these anecdotes, I’ve noticed two main themes for the type of advice and comments women receive.

The first one speaks …

Health care and the airline industry have a lot in common

Abraham Morse, MD, MBA

Policy

January 10, 2018

There are many apt comparisons to be made between aviation and health care. As a (lapsed) instrument-rated pilot, I may have some insight about the system in which planes function on a daily basis in the United States. It is truly an impressive system which is (to paraphrase Don Berwick) well-designed to achieve the safety results that it does. However, the kind of statement that some health care safety leaders …

A physician lurked on Facebook mom groups. Here’s what she found.

Audrey Nath, MD, PhD

Physician

January 9, 2018

In my off time, as a mom and a physician, I spend a decent amount of time lurking in a rather strange environment, even for the internet. A place so filled with anxiety, stories of ill-chosen spouses and little glimpses of unbridled joy, that you’d think you were somehow inside a taping of the Real Housewives of This-crying-baby-makes-me-hope-that-I-end-up-having-a-dissociative-fugue. You know, *that* place.

Online mommy groups on Facebook.

And, there I am, lurking …

15 minutes aren’t enough for a primary care visit

DrizzleMD

Physician

January 9, 2018

Have you bought a new memory foam mattress recently? Many come vacuumed in shrink bags. Once air gets in the bag, the mattress expands to its normal size. It is fascinating to watch how they expand.

It is not so fascinating to watch a patient expand to their actual size, when they are forcefully squeezed into an enclosed time space like an office …

A physician’s love-hate relationship with dividends. And what he does about it.

Physician on FIRE, MD

Finance

January 9, 2018

When I described my drawdown strategy in early retirement, I stated we will “sell from the taxable account first.” I also plan to collect quarterly dividends from my index funds, but if Vanguard were Burger King and I could have it my way, I’d hold the dividends and take bites out of my account only as needed.

When I discuss the downsides of dividends, note that I …

Learn about Clostridium difficile infection with a Medcomic

Jorge Muniz, PA-C

Conditions

January 8, 2018

Clostridium difficile is a gram-positive anaerobic bacillus which secretes toxins (A and B) that cause diarrhea and pseudomembranous colitis. C. difficile is the most common infectious cause of nosocomial diarrhea. Transmission of C. difficile can occur from contact with contaminated humans and fomites. The organism contains endospores that can survive the acidity of the stomach and reach the large intestine.

C. difficile colonizes the intestinal tract after the normal …