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Why this anesthesiologist says “no” to fentanyl

Meds

October 26, 2017

No, I’m not talking about putting fentanyl into my own veins — a remarkably bad idea. I’m questioning the habitual, reflex use of fentanyl, a synthetic opioid, in clinical anesthesiology practice.

I’ve been teaching clinical anesthesiology, supervising residents and medical students, in the operating rooms of academic hospitals for the past 18 years. Anesthesiology residents often ask if I “like” fentanyl, wanting to know if we’ll plan to use it in …

An interview with an American doctor working in Canada

Suneel Dhand, MD

Physician

October 24, 2017

A couple of weeks ago I visited Canada. It was my first visit in a very long time. We were in Ontario, spending most of the time in the Toronto area, and also getting to visit the majestic Niagara Falls for the day. I’ve heard so much over the years about the differences between neighbors USA and Canada, and in even just a few days there, agreed that there are …

Beware of online retailers selling designer benzodiazepines

Abraham M. Nussbaum, MD

Meds

October 24, 2017

One of Max’s friends taught him an easy way to buy shady drugs. What he learned almost killed him, and it opened my eyes to a hiding-in-plain-sight source of dangerous drugs that is amplifying the opioid epidemic.

When Max (not his real name) developed pancreatitis a decade ago, his physicians prescribed opioids to ease his extreme …

Are we medicalizing everything?

Kjell Benson, MD

Physician

October 24, 2017

“A condition counts as a disease independently of whether there is safe and effective treatment.”
– Journal of Medicine & Philosophy, August 2017

What is a disease anyway? Mrs. Jones is 90 years old and frequently experiences episodes of chest pain. She has numerous partially blocked coronary arteries, and her physician has told her to come to the emergency room because she might be having a “heart attack.” …

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Are we medicalizing everything?

A place for music in the emergency department

Thomas Scary

Education

October 23, 2017

The emergency department is a place of unpredictability. Some days are a whirlwind, others drag, but both can be interesting. On a calmer day, I found myself, a fourth-year medical student, working with a physician I will call Dr. Smith. We discovered that we shared a common love for music, and between patients, we discussed everything from opera, to banjo, to Indian music. I am a composer and amateur classical …

Different perspectives but the same goal: providing the best possible care to patients

Yul Ejnes, MD

Physician

October 21, 2017

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

For this column, my 61st for the American College of Physicians (ACP), I thought it would be interesting to look back at the first 60 and review the trends and topics that inspired me to write 800 to 900 words every month. Rather …

MKSAP: 32-year-old woman with weight loss, abdominal cramping, and loose stools

mksap

Conditions

October 21, 2017

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

A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has an 8-year history of diffuse …

An open apology to medical students from a resident

Karen Tran-Harding, MD

Education

October 20, 2017

Dear medical student, I’m sorry.

You had just finished two years of didactic learning and couldn’t wait to feel like a “real” doctor. You finally were starting your clerkships, that is, ultimately working with patients and getting deep in the trenches.

You were bright-eyed as you pulled on your pristine short white coat. You got to the hospital at 5:15 a.m., 15-minutes early for the first day of your very first third-year …

The high cost of hospitalists

Richard Young, MD

Physician

October 18, 2017

Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with …

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The high cost of hospitalists

A letter to my sister (and all other first-year medical students)

Misha Armstrong

Education

October 16, 2017

Congratulations! At this point, you are almost halfway done with your first year of medical school. Either you have finally figured out what’s going on, or if you’re like me, you are still trying to figure it out. Relax, take a few deep breaths. Medical school is unlike anything you have ever done. The volume of information, constant testing, and overwhelming need to keep up with your peers is an …

This psychiatrist does most of her work outside of the traditional system

Maria Yang, MD

Physician

October 15, 2017

Every now and then, when some people learn what kind of work I do, they say, “You’re doing God’s work. Thank you.”

They mean well, so I accept the compliment, though I also tack on, “I also like what I do. It’s meaningful work for me.”

So many of the people I see, whether in my current job or in my past jobs working in other underserved communities, have a lot going …

Emergency medicine can be exhausting. Here’s what this doctor does to unwind.

Edwin Leap, MD

Physician

October 15, 2017

So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of …

Why veterans deserve special recognition

Jarret Patton, MD

Physician

October 14, 2017

November brings fall weather, raking leaves and one of my favorite holidays. No, not Thanksgiving, it is Veteran’s Day. Veteran’s Day is a day reserved to celebrate members of the U.S. armed forces for their service. Thank you, veterans. Veterans are found in all segments of our society. Some are retired, some have started second careers, and some are struggling with health issues as a result of their service. They …

A story from a physician’s journey to burnout

Franklin Warsh, MD, MPH

Physician

October 13, 2017

An excerpt from The Flame Broiled Doctor: From Boyhood to Burnout in Medicine.

“So what did my bloodwork show, Doctor?” asked Liz. Liz was friendly and polite, but a textbook example of the Worried Well … healthy but neurotic patients I didn’t need to see as often as …

4 ways doctors put themselves last

Maiysha Clairborne, MD

Physician

October 12, 2017

As physicians, we are conditioned to put ourselves last. This long-standing tendency likely began way before we hit medical school. But certainly, our training reinforces it. Think about it: the personality type that goes into medicine is typically a caretaker. And while medical school reinforces this personality pitfall, It doesn’t end there. Residency brings a whole other dimension of self-neglect. We think, “If I can just get out of residency …

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4 ways doctors put themselves last

3 signs that you’re ready to leave your job

Ben Levin, MD

Physician

October 12, 2017

Medicine is a calling. And almost all of us went into this profession for altruistic reasons. Unfortunately, it’s no secret that the health care landscape has changed dramatically over the last couple of decades, and practicing medicine is undoubtedly getting more difficult for most doctors.

Fortunately, I’ve found myself in a better place than most. But after hearing feedback from physicians at various stages of their career, there are a number …

A medical student in therapy

Kristen Lee

Education

October 11, 2017

On TV shows, therapists decorate their rooms with leather lounge chairs, throw pillows and organza curtains that let in the light.

But Dr. Hassan’s office is in the clinic basement. The fluorescent lighting is sterile. She has a gray metal desk — I think every doctor I’ve shadowed as a medical student has had that same desk.

But I’m not here as a student.

I’ve been anticipating this appointment for a month. In …

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A medical student in therapy

The problem with prescribing sleeping pills for older patients

Lea C. Watson, MD, MPH

Conditions

October 11, 2017

It seems that everyone has advice about sleep these days, and we have become immune to it. “Avoid naps, caffeine and alcohol close to bedtime. Get exercise. Get out of bed if you can’t sleep. Turn off the TV and any electronic devices hours before bedtime. Enjoy a relaxing ritual. Keep to a routine.”

Please do all of these, because they actually work! Shifting your bedtime later to achieve sleep consolidation …

This is who’s to blame for the opioid crisis

Steven Reznick, MD

Physician

October 11, 2017

“Do not get caught” seems to be the real rule of the law in South Florida, where I live.

I was trained to limit the use of controlled substances, narcotics, hypnotics and sedatives. Their use can affect consciousness, ability to drive a car and work. More severe consequences include respiratory depression and overdose from too high of a dosage or mixing too many medications and over the counter items.

The Joint Commission, …

A missed diagnosis haunts this physician

Anonymous

Conditions

October 10, 2017

Eighty percent of diagnoses can be made based on the history and physical. Take the subjective and objective; throw in some medical history, family history, social history and you can figure out your assessment and plan. Doctors are the detectives of the body and the more facts, the easier it is to solve the mystery.

This is the fictional note that I wrote in my head concerning a fellow physician friend …