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Why this physician doesn’t prescribe pain medications

Meds

July 18, 2017

It may seem strange that a gastroenterologist like me does not prescribe pain medicines.

Let me rephrase that. I don’t prescribe opioids or narcotics. I write prescriptions for so few controlled substances that I do not even know my own DEA number. You might think that a gastroenterologist who cares for thousands of patients with abdominal pains would have a heavy foot on the opioid accelerator. But, I don’t. Here’s why.

I …

Remembering Larry Weed, founder of the SOAP note

Robert Centor, MD

Physician

July 18, 2017

1973, as we prepare to start our clinical rotations, the chief medical residents taught us the new concept of SOAP notes.

Larry Weed developed the concepts of the problem-oriented medical record and notes that included subjective, objective, assessment and plans for each problem. We wrote our notes each day using his system.

I have wondered in many conversations what he would think of the unreadable computer printout notes of …

Good communication is at the core of all good medical care. Here are 3 examples.

Suneel Dhand, MD

Physician

July 17, 2017

There are many different theories out there about the direction that health care should go, and what we need to be doing in the future.

Passions run high, and peoples’ opinions vary wildly. It’s frequently difficult to find agreement on anything. There is, however, one universal truth I’ve found about the everyday practice of medicine, and what constitutes great medical care for any individual in any health care system. Having worked …

Doctors are smart but not emotionally intelligent

Maiysha Clairborne, MD

Physician

July 15, 2017

As physicians, we are regarded as intelligent. Are we, as a community, as emotionally intelligent as we could be? The answer is no. Let’s face it. We are trained from the time we are medical students to disconnect and suppress our emotion, and we are taught to appear stoic and strong. Showing emotion in front of patients is discouraged, even in a situation that would be deemed acceptable by most. …

The great dilemma: Go part-time now or retire early?

Dr. Curious, MD

Physician

July 12, 2017

Early retirement is a hot topic these days, particularly in the field of medicine. It is associated with the concept of financial independence, and together they are known by the acronym FIRE (financial independence and retiring early). In essence, FIRE means having enough saved that you can live off your investments, and no longer need to work for a salary. While FIRE is not for everyone, it is something my …

11 tips medical interns need to hear before they start

Canting Guo, MD

Education

July 10, 2017

When I started my intern year, I was told that I was going to be sleep deprived and it was going to be the worst years of my life.

Yes, there were times I racked up a sleep debt, but it was for patient care. And because of the camaraderie and relationships I formed (both inside and outside the hospital), I will forever remember residency with a smile.

Rather than the words …

Is the medical profession at its end?

James C. Salwitz, MD

Physician

July 8, 2017

At the graveside, they still talk about judgment, intelligence, and the wisdom that is the practice of medicine.

Deans and health care leaders wax poetic as they tell stories of great cures to lift in memoriam remarkable healers. Yet, though we bow to Hippocrates, Osler, and Salk, the time has come to mark a revolution in human history: The art of medicine is dead.

It is not that doctors have fallen from …

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Is the medical profession at its end?

Behind the scenes of a detox scam

Britt Marie Hermes, ND

Meds

July 7, 2017

It is surprisingly easy to sell snake oil. I know, because I’ve done it. In 2014, I helped create and sell The Right Detox. This was a bogus detoxification program that purported to improve anyone’s well-being and perhaps, cure disease. I was the face of the scam. I launched The Right Detox at a spring-time women’s health expo in Tucson, Arizona.

I kicked off my sales-pitch in front of a small …

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Behind the scenes of a detox scam

10 ways for doctors to think outside of the box

Danish Siddiqui, MD

Physician

July 5, 2017

Thinking outside the box is a somewhat cliché way to illustrate thinking beyond the norm and imagining what “could be” with an innovative mindset. This imagery of being stuck in a box rings true for many physicians, given how many of us are quite literally surrounded by the four white walls of an exam room most of our lives.

Physicians work hard to treat each patient individually, but this feeling of …

My patient is dying, and I don’t know what to do

Jeremy Topin, MD

Physician

July 5, 2017

The patient in front of me is trying to die. Elderly and frail, he is lying in bed. His ribs outlined under the skin that should be smooth. His temples are concave where they should be flat. Both are an outward display of internal damage from his lung cancer. More striking than his cachexia are the strained muscles in his neck and his pursed-lip breathing. He is working hard for …

The 3 phases of a physician’s career transition

Neil Baum, MD, Joel M. Blau, CFP, Peter Moskowitz, MD, and Ron Paprocki, CFP, JD

Physician

July 3, 2017

An excerpt from The Three Stages of a Physician’s Career: Navigating from Training to Beyond Retirement.

The practical aspects of making a medical career transition can be divided into three phases or stages: waking up, taking stock, and taking the leap of faith. Note that this process is the same whether the physician is anticipating a transition out of full-time practice, planning a transition …

I couldn’t save my father

Jake Minor

Education

July 2, 2017

There was more than one tooth missing, maybe three or four from what he could tell. He held one in his scraped hand as I searched for the others, not sure what I would do with them if I found them. My little sister’s bike laid on top of him, a paperweight on his frail frame. Blood pooled in his mouth and dripped onto his shirt when it ran out …

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I couldn’t save my father

Trauma in the OR. From doctors’ bullying.

Anonymous

Physician

July 1, 2017

It’s Friday morning in any operating room, USA. Nurses and techs are scrambling to get everything in place before the surgeon arrives because if not, there will be hell to pay. The first patient arrives late, the second patient needs to use the bathroom, the third patient needs blankets before the IV is started … and here he comes … and we’re not ready. The fear is palpable.

Down the street, …

MKSAP: 21-year-old woman with mosquito bites

mksap

Conditions

July 1, 2017

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

A 21-year-old woman is evaluated for mosquito bites on her arms and legs that she received 1 week ago that she has been scratching regularly. One of the bites on her left thigh is now painful with a small amount of drainage. She otherwise feels well, has no significant medical history, and …

I’m your anesthesiologist. Let me explain what that means.

Sasha K. Shillcutt, MD

Physician

June 30, 2017

It’s still dark out when I walk into the busy and bustling preoperative area where patients and their family members crowd into small bays. They hand over their personal belongings to the RNs and their trust to me. As I walk in, I grab my patient’s hand, smile and say, “Hello. My name is Dr. Shillcutt. I am a cardiac anesthesiologist, and I am going to take care of you …

Expanding our definition of spiritual competence

Eric Nelson

Conditions

June 30, 2017

The first thing I remember as I regained consciousness, lying in a hospital emergency room, was hearing a nurse ask my mom if I was allergic to any foods. With my eyes still closed, I said, “asparagus,” thinking this might reduce the chances of anyone serving me what was then a dreaded vegetable.

“Asparagus,” repeated the nurse, making a note on my admission form.

And then, with a chuckle and what must …

11 ways to be an doctor and still live your travel dreams

Sightsee, MD

Physician

June 27, 2017

So, you’re a physician with a love of travel — awesome! One week of your salary allows you to travel anywhere in the world (coach, at least) — double awesome! But, as you are acutely aware, there is a catch … a big one. As a full time doc, how do you possibly get the time off to explore new cultures, hike/bike amazing trails and eat/drink around the globe?

As physicians …

How to respond to physician burnout in a colleague

Gail Gazelle, MD

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 …

The striking parallels between doctors and journalists

Michael Breen, MD

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 …

How to maintain a sense of accomplishment as a physician

Pooja N. Gidwani, MD

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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