How to respond to physician burnout in a colleague

Physician
June 25, 2017

Two hours of administrative tasks for every hour with patients. A proliferation of non-physician administrators deciding how the day is going to run. Little in our training about how to cope with uncertainty and change. It’s no surprise that burnout rates are approaching 60 percent. Despite being so common, when we see a colleague struggling with physician burnout, we may not know what to say. Responding appropriately can bring someone …

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How to respond to physician burnout in a colleague

The striking parallels between doctors and journalists

Physician
June 24, 2017

Once during my TV news days, I was feeling pretty good about myself during a three-hour drive to the Mayo Clinic. “I am so glad I don’t practice!” I crowed to my photographer. “Practicing physicians are so sad. They’ve lost their income, their autonomy, and the public’s respect.”

My photographer didn’t miss a beat. “Yeah,” he replied. “They sound just like you.”

By which he meant that as a journalist, I’d lost …

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The striking parallels between doctors and journalists

How to maintain a sense of accomplishment as a physician

Physician
June 24, 2017

In my last year of training, I came to realize the difference between doctors who felt successful and those who didn’t. From the beginning, I had always been hard on myself. I always thought about the decisions I made for every patient in detail, played them over and over in my head, and wondered what I could have done differently for each one. Whether or not their outcome was satisfactory, …

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How to maintain a sense of accomplishment as a physician

How do we fix the apathy in nursing home staffs?

Conditions
June 22, 2017

My grandmother’s room is silent, save for the plucks of sitar strings and Pixar movie soundtracks I try to stimulate her with. Instead of books, we fill the shelves around her bed with mouth swabs, drab hospital gowns and vials of baby powder. My grandmother — who walked an hour every day, who thrashed me in gin rummy, who rose before sunrise every morning to read — now lies bedridden …

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How do we fix the apathy in nursing home staffs?

Before my first job, I wish someone had told me a few things

Physician
June 21, 2017

I remember one sunny day in Chicago, in June 2011, when my husband and I packed up our two young children, aged 2 and 5 months.  Professional movers had collected our belongings and had driven off a day prior.  We were headed out of state, to my first job at an academic hospital.  It had been a rather hectic few months for me, having just had a baby 5 months …

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Before my first job, I wish someone had told me a few things

Doctors will inevitably make mistakes because they are also human

Education
June 20, 2017

Every time I walk into a bookstore, I pass Paul Kalanithi’s When Breath Becomes Air and am reminded of a specific anecdote he shared.

Kalanithi, MD, was a seventh-year neurosurgery resident and his lung cancer had metastasized – a process which was only being controlled by a new drug his oncologist had decided to try. But one day, Kalanithi had severe nausea and had to be hospitalized to stay hydrated. A …

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Doctors will inevitably make mistakes because they are also human

Transition from memorizing physical exam techniques to real patients

Video
June 20, 2017

Dr. Leon Pedell discusses how to transition from memorizing physical exam techniques to applying them with real patients to find real abnormalities. Many students have a misconception that they can forget much of what they learned in first and second year as, “low yield.” This is not the case. More than anyone else on a care team, medical students have time to perform thorough physical exams and you …

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Transition from memorizing physical exam techniques to real patients

Is direct primary care doomed to fail?

Physician
June 19, 2017

A recent Medical Economics article asked “Is the DPC model at risk of failing?”

The piece focuses on two large DPC-like organizations, Qliance Medical Management of Seattle, Washington and Turntable Health of Las Vegas, NV, working in partnership with Iora Health, which recently closed their doors. Qliance and Turntable were not actually DPC practices by strict definition; they were innovative large business operations providing health care services to patients and excluding …

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Is direct primary care doomed to fail?

Radiologists have an image problem

Physician
June 19, 2017

Here’s a question that has been debated for several years: Should radiologists talk to patients about their imaging results?

Citing several issues, I came down solidly on the “no” side in a 2014 blog post.

Two major radiology organizations have committees looking into the concept, and New York Times article said, “they hope to make their case [for it] by demonstrating how some radiologists …

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Radiologists have an image problem

Test prep companies are more powerful than medical school

Education
June 18, 2017

High-stakes standardized testing is an enduring facet of medical education, and the standardized test that is on every medical student’s mind is the USMLE Step 1. The paramount importance of this test for getting into residency creates a demand for high-quality test preparation materials. Established test prep names like Pathoma, Sketchy Medical, First Aid and UWorld fill that demand in a market consisting of more than 40,000 test takers worldwide …

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Test prep companies are more powerful than medical school

Interested in being a locum tenens physician? Read this first.

Physician
June 16, 2017

I receive a significant amount of email in response to my blog posts about locum tenens work. Curious colleagues (from surgeons to internists and emergency medicine physicians) ask for insider insight into this “mysterious business” of being a part-time or traveling physician. I am always happy to respond individually, but suddenly realized that I should probably post these conversations on my blog so that all can benefit.

The most common question …

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Interested in being a locum tenens physician? Read this first.

Observing Ramadan as a medical student

Education
June 14, 2017

3 a.m. The alarm blares. Get up, make food, study. Maximize caffeine intake, maximize studying efficiency.

4:12 am. Take the last sip of water, pray. Maximize studying with residual caffeine power.

7 a.m. Get dressed, go to work. Stay awake, stay alert, see patients, present well, regurgitate answers, retain information. Produce saliva, clear dry throat. Study during lunch break. Stay awake, stay alert, see patients, present well, regurgitate answers, retain information.

6 p.m. …

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Observing Ramadan as a medical student

Medical school is miserable. Here’s the secret to surviving it.

Education
June 13, 2017

Dear future medical student:

It’s graduation week. I’m running into people I haven’t seen in a long time. There are a few things on my mind currently, and in four years, you’ll have the same conversations.

“Did you have so much fun in med school? Did you love it?”

“No.”

“Wow! Those four just FLEW by, didn’t they?”

“No. They absolutely did not.”

“Well just WAIT ‘til you get to residency. THAT was hard. What you …

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Medical school is miserable. Here’s the secret to surviving it.

The slow death of private practices

Physician
June 13, 2017

Doctors have been bemoaning changes in the practice of medicine for years and with good reason. It’s harder and harder to make a go of it in private practice. In recent years our area has lost several small practices — Hal Grotke’s Redwood Family Practice closed, Dr. Garcia retired, Teresa Marshall’s solo office shut its doors, Eureka Internal Medicine transitioned to Humboldt Medical Specialists (which then became St. Joseph Hospital …

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The slow death of private practices

Stop asking doctors for free advice

Physician
June 12, 2017

My husband is a doctor. Similar to any other career, this is what he spends most of his time doing. It’s also our family’s livelihood — how we pay our mortgage, our bills and send our daughter to preschool.

He went to through seven years of training after college, often working all night or even 24-plus hour calls. He’s had to miss family dinners, birthday parties, nights of putting our daughter …

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Stop asking doctors for free advice

Doctors: You have a PR problem

Physician
June 12, 2017

Over the last few decades, public perception of physicians has been on the decline. Many issues are to blame, but a largely overlooked contributing factor is the media. Physicians are often portrayed negatively, with stories of narcotic abuse, greed and medical mistakes dominating the news. Rather than fight back, physician organizations have stood silently and allowed their reputations to be tarnished. On the other hand, nursing organizations have been busy …

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Doctors: You have a PR problem

Better care: Private practice or academic center?

Physician
June 12, 2017

Throughout training, I had an idea. And that idea was — I would be a great academic physician. I had the right training. I had done research from college through fellowship. I had received research grants from medical school through fellowship, published numerous papers and started defining a niche. Everything was going great.

Academia — here I come!

Then attending-hood arrived. I looked for positions in academic centers. I was limited by …

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Better care: Private practice or academic center?

How a one-time bridging prescription became an every time refill

Meds
June 11, 2017

At what point, we have to ask ourselves, does a medical error that we do over and over again cease to be an error, and simply become business as usual?

At one of the patient safety conferences this week, where we reviewed sentinel events that occurred in the hospital and in the outpatient setting, one of the cases was about a patient who developed an abnormal cardiac rhythm as a result …

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How a one-time bridging prescription became an every time refill

MKSAP: 37-year-old man with low libido and fatigue

Conditions
June 10, 2017

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

A 37-year-old man is evaluated for a 2-year history of low libido, loss of morning erections, fatigue, and decreasing muscle mass. His medical history is otherwise unremarkable. He takes no medications.

On physical examination, vital signs are normal. BMI is 35. The remainder of the examination, including genital examination, is normal.

Laboratory studies:

Luteinizing hormone 10 …

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MKSAP: 37-year-old man with low libido and fatigue

This is what it’s like to be a military physician

Physician
June 7, 2017

After another long shift of patients with colds, bug bites, ankle sprains and sore throats I eagerly looked through the wine selection at the local grocery store. It was my wedding anniversary and nearing 9 p.m. at the beginning of a holiday weekend. While at the checkout line, an elderly woman in front of me thanked me for my service. At that moment, I realized that I was wearing my …

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This is what it’s like to be a military physician

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