This gynecological issue is misdiagnosed over 50 percent of the time

Conditions
May 4, 2017

As a consultant in gynecologic pathology, I receive requests for second opinions from patients who have been diagnosed with endometrial hyperplasia. My opinion is based upon correlating the relevant clinical history with a review of the patient’s pathology slides and report. In my experience, there is a difference of opinion that leads to a change in treatment in about half of the cases. 75 percent of cases with changed diagnoses …

Read more…

This gynecological issue is misdiagnosed over 50 percent of the time

Should we standardize clerkship grades?

Education
May 4, 2017

I’ll be honest, when I first matriculated into medical school, I didn’t even know what a USMLE Step exam or clinical clerkship was. In fact, the first time I ever heard of them was from another applicant on the interview trail. I have always been a take-it-one-step-at-a-time type of person, but eventually, I would have to succumb to the pressure and ask upperclassmen about the exam. And what did they …

Read more…

Should we standardize clerkship grades?

There she was, hanging in our closet

Conditions
May 4, 2017

No matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it’s some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight.

That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali …

Read more…

There she was, hanging in our closet

Doctors aren’t cops: We need to change gunshot reporting

Education
May 4, 2017

On my first trauma shift as a fourth-year medical student, a young, disheveled man with blood-soaked pants hobbled into the emergency department. Wincing in pain, he offered me a bizarre history of being shot in the leg by a nail gun that went off after he dropped it on some stairs while helping a friend move. He lifted his right pant leg and removed the bloody, tattered bandana wrapped around …

Read more…

Doctors aren’t cops: We need to change gunshot reporting

Other jobs have strict rules on hours worked. So should doctors.

Finance
May 3, 2017

There has been much talk over the years about resident work hours. How long is a safe shift? With safety being considered for both the patient and the resident. But no one ever discusses attending work hours. If putting in a 24-hour shift is bad for a resident, isn’t it bad for an attending as well? When I was working in critical access hospitals, I usually was on call for …

Read more…

Other jobs have strict rules on hours worked. So should doctors.

An extraordinary day in the life of a physician

Physician
May 3, 2017

Walk with me, why don’t you? It’s time, don’t you think? We have been avoiding this for quite a while. But it’s best to bring this out from the shadows and into the light. Let’s take a walk through part of my day.

Be careful.

You won’t like what you see. I don’t like this much, but I just keep moving forward, one foot in front of the other. Don’t stop. Can’t …

Read more…

An extraordinary day in the life of a physician

What is the right way to deliver bad news?

Physician
May 2, 2017

Recently, someone close to me was diagnosed with cancer. Due to a series of missed phone calls on both sides, he had not heard the results of his biopsy prior to his follow up appointment. When his young doctor walked in, he started with, “So you know you have cancer, right?” I just wanted to scream, “What the f*ck!”  It is never easy to give someone bad news, but this …

Read more…

What is the right way to deliver bad news?

Facility fees are ruining quality care

Policy
May 1, 2017

The Affordable Care Act Medicaid expansion resulted in unanticipated negative consequences for many patients and physicians in rural, underserved or medically isolated communities across America. Consolidation of health care entities was financially incentivized by the ACA, and slowly my beloved corner of the Pacific Northwest is becoming a medical wasteland.

In a beautiful community on the Olympic Peninsula, just north of where I live and practice, it happened again; another private …

Read more…

Facility fees are ruining quality care

MKSAP: 29-year-old woman with nodules over her lower extremities

Conditions
April 29, 2017

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

A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, and she takes no medications.

On …

Read more…

MKSAP: 29-year-old woman with nodules over her lower extremities

Are patients with minor ailments visiting the doctor too often?

Physician
April 28, 2017

acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

Lately, I’ve been asking myself whether today’s patient is less able to self-manage minor illnesses than their parents or grandparents. That question was inspired by my review of notes from my patients’ visits with my nurse practitioners or to our after-hours clinic, as …

Read more…

Are patients with minor ailments visiting the doctor too often?

What medical school fails to teach

Education
April 28, 2017

This May, I will graduate from medical school. I will also be part of the first group of medical students to graduate from its new Literature and Medicine track. To me and the other participants, this has been one of the most important components of our medical education. In many ways, it has kept us grounded, serving as a constant reminder that there are experiences different from our own.

We know …

Read more…

What medical school fails to teach

Face it, doctors are bad leaders

Physician
April 27, 2017

As physicians, we are seen as leaders whether we like it or not. And as such, we are charged with modeling greatness. But do we? Our training, while teaching us to be experts and authorities, does not teach us how to be leaders. However, somehow we get out into practice and are automatically seen as leaders, and thrown into positions that require a skill that we don’t have. And we …

Read more…

Face it, doctors are bad leaders

“I hate myself. I don’t deserve to be a doctor.”

Education
April 27, 2017

Dear Dr. Wible,

We’ve talked before. To catch you up, I’m in my clinical years now and I keep waiting to feel the same starry-eyed excitement I felt during the first months of med school, when I thought that becoming a doctor would finally give me a tangible purpose and make me a better person by helping me do right by others in …

Read more…

“I hate myself. I don’t deserve to be a doctor.”

5 things I learned while having 3 kids during medical school

Physician
April 27, 2017

During medical school, I made it a goal to graduate with a degree in one hand and a baby in another. I had a supportive husband, so we started trying to conceive when I was in my third year of medical school. We didn’t get pregnant as quickly as I thought, and we almost gave up on the idea of having a baby at that time. I was already 28 …

Read more…

5 things I learned while having 3 kids during medical school

The hardest thing to do as a physician

Education
April 26, 2017

I’ve been told that one of the hardest things that a physician endures is the passing of her first patient. However, what I imagine to be even more challenging than this is pronouncing the death to the patient’s family for the first time. Although I find myself in a similarly intimidating and burdensome position of addressing the loved ones of our gracious donors tonight, for my first time, I feel …

Read more…

The hardest thing to do as a physician

Top 5 reasons why doctors lack self-confidence. And how to fix it.

Physician
April 26, 2017

In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back.

What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and compassionate humanitarians. Soon, we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? Attention, medical …

Read more…

Top 5 reasons why doctors lack self-confidence. And how to fix it.

The dangers of being overly apologetic

Physician
April 26, 2017

“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other.

“Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave …

Read more…

The dangers of being overly apologetic

If she gets pregnant, she might die. Do I help?

Physician
April 26, 2017

When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability of allowing a patient who refuses necessary blood products to die. For this reason, these institutions are not welcoming to Jehovah Witnesses. This is of special concern in surgical specialties …

Read more…

If she gets pregnant, she might die. Do I help?

A letter from my med student self to me now

Education
April 25, 2017

Dear Me, MD:

Now that you have opened this letter, you may have graduated or maybe you just matched into residency — somewhere, anywhere, hopefully?! As you read this, it should be some time during spring 2017. But, you never know, sometimes the train derails, and it takes a little longer than expected, so forgive yourself if that is the case. You learned a while back that the fast lane is …

Read more…

A letter from my med student self to me now

649
pages