Discussing the side effects of medications: How can doctors do better?

Meds
September 9, 2015

While studying for a certification exam, I came across a question that stayed with me well after taking the practice test. The case discussed a patient who was prescribed antibiotics by his physician for a presumed bacterial illness and then returned the following week with an antibiotic-associated diarrheal infection. The test question then asked what could be concluded from this case. The answer: informed consent (i.e., patient permission for a …

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4 ways to improve the lives of doctors and their patients

Policy
September 8, 2015

Ask physicians across the country what problems they want solved, and they won’t hesitate to tell you. They worry about the growing health risks they observe in patients based on lifestyle choices, obesity and a variety of social factors that they feel powerless to change. Ask what they would modify if they had a magic wand, and they’ll point to the illogical, problematic and increasingly complex reimbursement schemes still favored …

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How can we measure the doctor-patient relationship?

Policy
September 6, 2015

Sixty years ago, before he became a controversial figure in the field of psychiatry, Dr. Thomas S. Szasz co-authored an article for the Archives of Internal Medicine (now JAMA Internal Medicine) on “The Basic Models of the Doctor-Patient Relationship,” which is well worth reading today, particularly for those who believe that patient empowerment/engagement is a novel and disruptive innovation of our digital times.

The paper is describing …

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Why physician burnout and work-life balance is a first-world problem

Physician
September 5, 2015

Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”?

Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white?

Every day, I go to work and see the example of the …

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Kim Kardashian’s first trimester nausea: The truth behind Diclegis

Meds
September 2, 2015

It was only a matter of time before Kim Kardashian posted a picture on her Instagram account with a bottle of Diclegis, basically announcing her brand partnership with Duchesnay, the manufacturer of the prescription medication for nausea and vomiting in pregnancy. Duchesnay had been tweeting for ages that they were so relieved Kim had found help with Diclegis — so much so that I was wondering if Ms. …

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When doctors pass the buck: The ugly side of a shift-work mentality

Physician
September 1, 2015

“I’m just the night doc,” you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was “just the patient,” who lay suffering hours before her death and the RN was “just the nurse” withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to …

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A physician’s ode to nurses

Physician
September 1, 2015

A few weeks ago, after feeding my face with rich, dense chocolate cake brought by a truly awesome nurse (for no particular reason other than a warm and generous spirit), I walked back into a room to check on a post-cardiac arrest patient.

After surveying his vitals on the monitor, I turned my attention to two nurses and a pharmacist who were discussing the management of his six drips. He was …

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So doctor, who’s your boss?

Physician
August 31, 2015

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As a relatively young physician, I always enjoy my conversations with the older members of our profession, who’ve seen so much change over the last few decades. I’m fascinated with their stories about how different the medical world was when they were residents, how treatments were so novel, and how they used solid clinical skills to get to the diagnosis.

Those were the …

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A patient presents with painless diarrhea. What should you do next?

Conditions
August 29, 2015

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

A 67-year-old woman is evaluated for a 1-year history of loose stools. She reports approximately four episodes per day without abdominal pain. She has not had nausea, vomiting, weight loss, bright red blood per rectum, or melena.

On physical examination, temperature is 36.7 °C (98.1 °F), blood pressure is 115/85 mm Hg, pulse …

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The story of a boy who liked to draw

Physician
August 27, 2015

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There was once a little boy who loved to draw.  He would wake up every morning, pull out his box of colored pencils, and let his hands explore the promise of a pristine sheet of blank paper.  For him, the canvas was anything but empty,  images and ideas exploded out of his mind and magically appeared on the pages in front of …

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What doctors can learn from a professional photo shoot

Physician
August 26, 2015

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Have you ever had a professional photo shoot? I have had many, but not because I particularly enjoy being photographed. Actually, it is quite the contrary.

Photo shoots have always been a traumatic experience for me. You see, for some reason, likely as a creative form of cruel parenting punishment, my family of five siblings had a photo taken every year while growing up. …

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So you had a bad day: 3 reasons why doctors should have some perspective

Physician
August 25, 2015

Being a doctor is one of the most emotionally and physically demanding professions out there. The health care landscape may have changed a lot over the last decade, but the basic unavoidable grueling nature of medical practice has been the same for time immemorial. I remember reading a careers advice book when I was a teenager telling me just that being a doctor was “the most challenging of jobs,” and …

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How to perform a stool transplant

Conditions
August 25, 2015

Fecal microbiota transplantation (FMT) is the process of administering a preparation of healthy donor stool to a patient with a certain disease, usually Clostridium difficile colitis, in an attempt to treat the disease.  I covered some of the basics about the microbiome and FMT in a previous article, so this will just be a cookbook-style post on how we do FMT with colonoscopy.

First, a healthy donor must be identified.  The donor …

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What is a 5-star hospital? The answer may surprise you.

Policy
August 24, 2015

Now we’re giving star ratings to hospitals? Does anyone think this is a good idea? Actually, I do. Hospital rating schemes have cropped up all over the place, and sorting out what’s important and what isn’t is difficult and time consuming. The Centers for Medicare & Medicaid Services (CMS) runs the best known and most comprehensive hospital rating website, Hospital Compare. But, unlike most “rating” systems, Hospital Compare …

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What does Sir William Osler think about physician burnout?

Physician
August 22, 2015

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Sir William Osler (1849-1919) is universally considered the father of modern medicine.

“He belongs to medical students of all time, as Lincoln belongs to the common man everywhere.”
– Wilder Penfield, eminent Canadian neurosurgeon, who met Osler while at Oxford

“His energy, productivity, and humanity blossomed out of a deep vulnerability. Between the pages of his books, we can still encounter an Osler who is … …

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What causes toxic stress in medical school and how to fix it

Education
August 20, 2015

For two years, I served as a representative to my medical school’s student affairs committee.  My job was to convey medical student concerns and problems.  As part of that role, I had a lot of time to think about how and why many medical students experience depression and stress. Two recent articles have led me to write about the issue now: “10 simple solutions to stop medical student suicide,” …

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The truth behind why doctors don’t tell the truth

Physician
August 20, 2015

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There are two key scenarios when doctors fail to tell “the whole truth and nothing but the truth so help me God.”

Sometimes doctors give a diagnosis we’re not 100 percent sure of and other times we don’t diagnose something we’re almost 100 percent sure of. The truth is complicated and often more gray than black and white.

Scenario #1: “You have [insert diagnosis …

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You won’t necessarily be admitted to the hospital. Here’s why.

Physician
August 19, 2015

When we take our sick or injured loved ones to the hospital, we often hope that they will be admitted. In many instances, this is a very reasonable request. When heart or lung disease are at work, when severe infections, dehydration, fractures or strokes occur, admission may well be the only option. However, sometimes our desire to admit our family members is a throwback to a simpler time in medicine; …

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