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5 challenges of working in a county hospital

Policy

December 6, 2017

As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas. After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have …

10 surprising things you need to know about the emergency department

Irene Tien, MD

Physician

December 5, 2017

Despite the fact that most people will have had the misfortune of visiting the emergency department (ED) at some point in their life, I find that many folks do not really understand what happens in the ED.

1. Emergency medicine is a specialty. Yes, we actually did residency training to learn how to work in the ED. This training lasted three to four years after medical school and is sometimes followed …

Is MRI contrast a dangerous threat?

Karen Tran-Harding, MD

Conditions

December 5, 2017

In early November, Chuck Norris filed a lawsuit against medical device manufacturers involving gadolinium-based contrast media, a chemical used in MRI imaging scans. The lawsuit stated that the gadolinium that doctors injected into his wife Gena to improve the clarity of her MRIs have left her “weak and tired and with debilitating bouts of pain and a burning sensation.”

As with any adverse effects involving medical procedures in the news, it …

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Is MRI contrast a dangerous threat?

Can universal health care and capitalism coexist? Yes, here’s how.

Catherine Cheng, MD

Policy

December 4, 2017

Eat what you kill.

Sounds like a mantra from a survival reality show, right? Akin to “eat or be eaten,” “kill or be killed.” It’s also a common reference to the prevailing business model in our American scarcity-minded, competition-driven, fee-for-service health care culture. How ironic, the application of these words to this profession. It was explained to me essentially as: “Every man for himself, and you’re a minion. You are expected …

Is there ever a right time for a doctor to have a baby?

Gillian Mueller Goddard, MD

Physician

December 4, 2017

When is the right time to have a baby? This question plagues professional women across industries. It takes on more significant importance for women training as physicians. Medical training is long and coincides with a woman’s late 20s, often stretching into her 30s. Waiting to have children until completing training is not always biologically feasible.

Medical schools and residency training programs still lag behind in developing formal parental leave policies. Outside …

To survive in medicine, compartmentalize your patients

Andrea Eisenberg, MD

Physician

December 4, 2017

“Breathe in slowly, deeply, giving fresh energy to your body.

Breathe out, releasing any tension from your day.

In … 1 … 2 … 3 … 4 …

Out … 4 … 3 … 2 … 1 …”

I try to follow the yoga instructor, but in my post-call fog, I struggle to let go of the last 24 hours. We begin by sitting poses to stretch our necks. But my neck is so …

How being an immigrant shaped the way I treat patients

Saisai Chen

Education

November 30, 2017

I was born in Shanghai, China. In September 2000, my parents and I left behind our family and friends, a language and culture dear to our hearts and social and financial stability to immigrate to the United States. I was six at the time. Although I don’t claim to have fully understood the weight of their decision to start a new life, I knew that my parents were making a …

Make more than your spouse? Here’s how to save money on taxes.

Foreign BornMD

Finance

November 30, 2017

The only time my husband outearned me was during our first three years of marriage when I was still in residency and working 80-plus hours per week earning less than minimum wage per hour. Since then, despite graduating in a professional degree, we have made relocation moves that primarily help with my career growth, to the detriment of his.

In 2015, an NPR article quoted statistics showing that 38 percent of …

5 shifts to move health care in the right direction

Halee Fischer-Wright, MD

Policy

November 29, 2017

The truth about change in health care was never more perfectly captured than in an episode of Sex and the City, when Carrie Bradshaw lamented that we keep “should-ing all over ourselves.”

In the past decade, those of us on the front lines of health care have seen the passage of nine major pieces of federal legislation that, combined, have profoundly affected how they work. We’ve seen the number of people …

How to inspire medical students to pursue primary care

Natalia Maria Calderón

Education

November 29, 2017

I distinctly remember the excitement I felt during my first year of medical school when exposed to the breadth of general and specialty fields that seemed all so equally rewarding and medically influential. I envisioned myself holistically understanding my patient, seeing the problem in the context of her other medical issues, her personality, her family and her environment — an approach I considered at the heart of the oath we …

The hidden threat of the 80-hour resident workweek

Anonymous

Education

November 27, 2017

In an article published by the Atlantic earlier this year, Ryan Park writes that neither truck drivers nor bankers work the kind of gruelingly long hours that doctors — particularly young doctors in their residency programs — do. It is no secret that residency life is demanding and exhausting. Over the last decade, it has also become controversial. Almost a test in itself, as if gauging doctors’ …

It’s time to stop prejudging your patients

Melissa Welby, MD

Physician

November 27, 2017

Recently I had an interaction online with a physician regarding his thoughts on ADHD treatment. (Let’s call him Dr. Stigma). This post is not about doctor-bashing but more to point out the prevalence of stigma against those with a psychiatric diagnosis even from within the medical community. Stigma, unfortunately, is so indoctrinated into our culture that sometimes people don’t recognize the pure ugliness of their words.

Dr. Stigma’s comments:

Many patients use …

Physicians must embrace the business side of medicine

Davis Liu, MD

Physician

November 26, 2017

“Does physician leadership matter?” asks cardiologist and author Dr. Sandeep Jauhar in his New York Times opinion piece “Shouldn’t Doctors Control Hospital Care?” He opens his piece with the termination of the elected leaders of the medical staff office at the Tulare Regional Medical Center due to poor performance. He answers his rhetorical question with the obvious and simple response that doctors should control hospital …

Picking up the pieces of a broken medical dream

Marteney Jacobs

Education

November 25, 2017

I was in the midst of my family medicine clinical rotation when my world came crashing down. I had failed my Step 1 boards. I would never be a doctor. It was a nightmare that unfolded over three failed attempts, from which I awoke in a new reality where I was no longer a medical student — and there was absolutely nothing I could do to change that.

I poured everything …

The lessons of Harry Potter and the Deathly Hallows

Divya Yerramilli, MD

Physician

November 24, 2017

Harry understood at last that he was not supposed to survive. His job was to walk calmly into Death’s welcoming arms … All those times he had thought that it was about to happen and escaped, he had never really thought of the thing itself: His will to live had always been so much stronger than his fear of death … It was over, he knew it, and all that …

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The lessons of Harry Potter and the Deathly Hallows

The worst-case scenario question you must ask patients: even healthy ones

Sarah Fraser, MD

Physician

November 24, 2017

The last few passengers filter in and buckle themselves up before takeoff. The emergency exit row is occupied by an elderly couple, and I am seated behind them. The flight attendant asks whether they are comfortable in those seats, given that they’d have to respond in the case of an emergency.

“Not that I expect anything bad to happen,” the flight attendant adds with a smile.

I, too, am familiar with discussing …

4 problems with the Joint Commission

Anonymous

Physician

November 24, 2017

I’m passionate about patient safety. In no small part because I was raised to be. My mom has a lot of letters behind her name (RN, BSN, MSN), and she’s dedicated her career to the field.

Before I was accepted into medical school, I knew about “six sigma,” the “Swiss cheese model” and root-cause analysis. I’d been taught about creating a culture of safety and the example of the airline industry. …

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4 problems with the Joint Commission

I’ll never forget the eyes of a 6-year-old sexual assault victim

Debbie Moore-Black, RN

Conditions

November 23, 2017

Patsy loved playing bingo every Wednesday night. Her boyfriend of three years loved watching her daughter Jenna who was a tiny and pretty six-year-old her momma called “princess.”

Even though they weren’t related, Jenna called Patsy’s boyfriend “Uncle Billy” at her mother’s behest.

And Uncle Billy made Jenna shyer and quieter than she usually was. He’d walk in on those Wednesday nights and demand a big hug and kiss on the cheek …

The doctor-patient relationship is everything

Peggy A. Rothbaum, PhD

Physician

November 22, 2017

While doing my doctoral dissertation research at a clinic for kids with diabetes, I observed the attachment that some of them had to the physician faculty member who directed the clinic. I particularly remember one teenager who complained that this doctor “did not care” about her, as he sent “fake doctors” (residents) to take care of her, not coming himself. She was refusing to cooperate. When I suggested to the …

The case of a fish hook in the eye

Raj Waghmare, MD

Conditions

November 22, 2017

Triage Note: Fish hook in eye. No bleeding. Tetanus up to date.

It’s a sunny weekend during cottage season. A young woman is rushed into the ER as she cups both hands over her left eye. She’s in shorts, and flip-flops, and she’s hyperventilating. Her friends follow, hands similarly cupped over their mouths. I read the triage note. I’ve never seen this before. I’ve removed dozens of fish hooks — it’s …

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The case of a fish hook in the eye

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