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Paging the surgeon general: America needs you

Policy

November 14, 2017

The Office of the Surgeon General existed since 1871 when Dr. John Woodworth was appointed the first supervising surgeon of the national hospital system. In the previous year, the Marine Hospital was reorganized into the national hospital system. On January 4, 1889, Congress formally recognized the new personnel system as the Commissioned Corps. The Corps was established along military lines and initially consisted of only physicians. They …

Want to make meaningful connections with patients? Here’s how.

Gil C. Grimes, MD

Physician

November 14, 2017

“How did you know what to say to her?” asked the resident, “We have been trying to figure her out all morning and have gotten nowhere.” An expression of mixed curiosity and frustration crossed her face.

“I try not to focus on how she is acting, as much as I try to talk to the part of her Jesus would love,” I found myself answering. This catchphrase would find its way …

Physicians: Be nice to your pregnant colleagues

Avani Trivedi, DO

Physician

November 14, 2017

After about the first week of anesthesia residency, I was told, “Don’t get pregnant, you are going to ruin the call schedule.” Initially, I took it as a joke because I was getting married that year and I wasn’t thinking of having children yet, but I did think, “what if it happened accidentally?”

After it’s told to you over and over again by your male co-residents and even some of my …

Let’s get one thing clear: pre-op comments from primary care

Fred N. Pelzman, MD

Physician

November 13, 2017

Earlier this week, one of the residents and I saw a new patient who apparently had been sent in to see us for a pre-op visit, an evaluation to make sure that her medical conditions were well controlled and that the surgery was safe for the surgeons to proceed with. She reported that she forgot the paperwork they gave her. All she knew was that whatever we wrote had to …

Have you been reported under the Sunshine Act?

Another Second Opinion, MD

Policy

November 11, 2017

The Sunshine Act is part of the Patient Protection and Affordable Care Act passed in 2010. This act went into effect in August of 2013 and requires the full disclosure of any payments (or transfers of value, i.e., lunches and dinners) made to physicians from pharmaceutical and medical device manufacturers.

The spirit of the act is to have more transparency with regards to potential conflicts of interest created when physicians receive …

We all treat the whole patient. We must avoid tunnel vision at all costs.

Sara Scarlet, MD

Physician

November 10, 2017

In loving memory of my grandfather, my first physician mentor.

Earlier this year, my 90-year-old grandfather passed away unexpectedly after undergoing transcatheter aortic valve replacement (TAVR). Similar to many elderly patients who die each year in the United States, his death was preceded by a litany of costly and time-consuming tests and treatments. Despite this extensive workup, the end of his life was shadowed by suffering left unaddressed. But, unlike the …

Burnout during residency? Yep, and here’s what it taught me.

Saba Mann, MD

Physician

November 9, 2017

You’ve probably heard this story before: a young physician, who has spent all of his or her life succeeding and building goals, stumbles into a career without meaning or enthusiasm. Indeed, my story about burnout is much like the rest.

Like so many before me, I entered into a career in medicine motivated and eager to change the world through the care of my patients. I grew up in a family …

10 rules to keep physicians on time

DrizzleMD

Physician

November 8, 2017

The key to staying on time in a busy clinic and to finish the day unscathed is to be in battle mode from the get go. The ten rules outlined below will help you to achieve that goal.

1. Make sure your bladder is empty, and that you are well hydrated. This goes without saying. You don’t want to finish the day with …

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10 rules to keep physicians on time

Thank you for performing CPR on my child

Mick Connors, MD

Physician

November 7, 2017

I wonder what the best thank you any physician has ever received? I think this one is mine. This recent thank you was for our efforts to not save a child but for simply allowing this family to have a few more days with their infant who ultimately passed away. This amazing thank you has deeply and positively affected me so much …

For an anesthesiologist, this is the hardest part of medicine

Sasha K. Shillcutt, MD

Physician

November 6, 2017

As a cardiac anesthesiologist, there are times I care for patients who are faced with a tough decision: to take their chance on a very high-risk surgery, or let nature take its course. It is in these times I feel most humble and most human, as I may be the last one to hear the last words they speak.

Recently I was at a social event and introducing myself to some …

Here’s what death really sounds like

Molly M. Murray, PA-C

Physician

November 6, 2017

7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel.

“He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, …

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Here’s what death really sounds like

Medical students must have this mindset

Manisha Ravi

Education

November 6, 2017

It is early on a Saturday morning when I walk out of the elevator of Doan Hall looking for a nursing desk to call the fourth-year anesthesiology resident I am supposed to be shadowing. Instead, I am met with a set of double doors and a staff-only sign.

Before walking through the doors, I decided to read the placard placed on the wall next to them. As I begin to read, …

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Medical students must have this mindset

Take it from this physician: Beware the dangers of benzodiazepines

Christy Huff, MD

Physician

November 6, 2017

It’s 3 a.m., and I wake with a jolt. My heart is pounding out of my chest. I stumble out of bed to take a beta blocker hoping it’s enough to quiet my heart so I can doze off again. I sleep fitfully the next three hours, experiencing weird dreams and terrifying nightmares.

At 6 a.m., I take my Valium. Nauseated, I lie in bed for 30 minutes, so I keep …

Is assembly line surgery better for the patient?

Thomas D. Guastavino, MD

Physician

November 3, 2017

A friend of mine recently underwent a total knee replacement. Although he did well and was pain-free, he did say that he felt he was on an assembly line. I asked him what he meant. As he was talking, I flashed back 30 years, back to a time when by today’s standards I would be considered a “good old country orthopedist.”

Thirty years ago, I moved to a small community to …

Never forget to consider the number needed to treat

Hans Duvefelt, MD

Conditions

November 3, 2017

How would you like to double your chances of winning the lottery? Just buy two tickets!

Statistically, this is true, but is that a reason to spend more money on something that most likely offers no return on investment?

Yet, in medical research, study after study shows impressive improvement in relative risk for this, that and the other intervention but a small or even negligible effect on absolute risk.

For example, I just …

“My mom is a doctor; my dad is a dad.”

Jennifer Lycette, MD

Physician

November 2, 2017

So stated one of our children in their autobiography assignment for school. I kept reading, curious what would come next.

“My dad usually stays home and cleans up, and takes care of the pets.”

I thought for a moment. “That’s very good, honey, but do you think you could write something else about Dad?” I suggested. “He does other stuff too, add some more nice things.”

“OK, how about … ‘And he takes …

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“My mom is a doctor; my dad is a dad.”

Seeds, popcorn, and nuts in diverticulitis: fact and fiction

Frederick Gandolfo, MD

Conditions

November 2, 2017

Diverticulitis is a common and sometimes serious problem that affects several hundred thousand people each year. Diverticulitis is the condition where small outpouchings or “pockets” in the wall of the large intestine called diverticula become inflamed and infected, and typically presents as a constant lower abdominal pain, associated with fever or chills, and often bloating or constipation symptoms. Despite becoming even more common in recent years, not much is understood …

Technology is not friendly to the elderly

Janice Boughton, MD

Tech

November 2, 2017

In about 1990 we got our first computer. I say “we” because my husband and I shared a desktop which I used infrequently. I mostly used it for word processing, and the Internet was very young. At the turn of the millennium, my children were using computers, and they were limited to 1 hour of computer time a day, which was on a shared desktop. By 2001, I was communicating …

Better paid, better utilized physicians can transform the VA

Suvas Vajracharya, PhD

Policy

November 2, 2017

It’s a tale of two health systems: the VA and Kaiser Permanente.

The U.S. Department of Veterans Affairs, Veterans Health Administration (VA) is a mission-driven health organization, serving our nation’s veterans. A patient population of 8.9 million, led by David Shulkin, MD. An early leader in health technology adoption. The VA has faced serious issues; however: long patient wait times (deadly long in some cases) and high physician turnover rates.

Kaiser Permanente …

Want to slow cognitive decline? Here’s how.

Stephen C. Schimpff, MD

Conditions

November 1, 2017

Part of a series.

Cognitive decline is a normal process of aging; Alzheimer’s is a disease.

Cognitive decline due to aging can be slowed but not halted with appropriate lifestyle approaches. The “big four” are equally important to slow cognitive decline: Don’t smoke. Reduce stress. Exercise often. And eat a quality diet in moderation.

Good sleep and brain stimulation need to be added for maintaining good cognition. Some form of …