MKSAP: 68-year-old man with new-onset ascites

Conditions
April 22, 2017

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

A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, …

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MKSAP: 68-year-old man with new-onset ascites

Welcome to planet medicine

Education
April 21, 2017

Welcome to planet medicine, where four rides around the sun earns you a golden ticket to study more, to train more, and to enjoy splicing two sacred letters onto the end of your title. The days are long, the weeks go fast, and sleep is optional. In this world, all-star draftees leave their immaculate collegiate careers as masters of memorization and intellectual puzzle solvers only to still be no more …

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Welcome to planet medicine

Normal aging: A steady loss of organ and process function

Conditions
April 20, 2017

Part of a series.

The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again.

There are many …

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Normal aging: A steady loss of organ and process function

An emergency physician frozen by fear, and what she learned from it

Physician
April 19, 2017

Am I the only emergency physician who sometimes wonders who left me in charge of an ED? I should be confident in managing whatever comes through those ED doors after more than ten years of single-coverage night shifts, but each night I hear a little voice in my amygdala questioning whether tonight will be the night I won’t be able to handle something. Sometimes I feel afraid of the unknown …

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An emergency physician frozen by fear, and what she learned from it

How useful is a cardiac calcium CT scan?

Conditions
April 19, 2017

Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium …

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How useful is a cardiac calcium CT scan?

Is health care a right or a privilege? Why can’t the answer be both?

Policy
April 18, 2017

Election Day 2016 should have been Christmas morning for Republicans. Long awaited control of the White House and both houses of Congress. A chance to deliver on an every two-year election cycle promise to repeal and replace Obamacare. In 2010 Republicans needed the House. They got it. In 2014, it was the Senate. Delivered. But we still need the White House they said. Asked and answered with President Donald Trump.

So, …

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Is health care a right or a privilege? Why can’t the answer be both?

8 secrets to landing a locum tenens job

Physician
April 16, 2017

In the market for a locum tenens position? If you search online “How to book a locum assignment?” you’ll likely find vague advice such as “Develop a relationship with a recruiter.” Or “Do your homework when choosing an agency.” Thanks, Internet …

Having worked as a locum tenens recruiter for over 15 years, I have seen consistent trends in how the best clinicians are able to stand out and book jobs. …

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8 secrets to landing a locum tenens job

We made it! An open letter to my son.

Education
April 15, 2017

“Ya mero llegamos?”

Are we almost there? These become one of the most dreaded words I have to hear every weekend, when I pick you up from the long commute that is from Sacramento to the bay area to spend time with you. Oftentimes I am just as inpatient as you my love. This has been our sacrifice these last few years, being physically away from one another. I take a deep …

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We made it! An open letter to my son.

The pros and cons of moonlighting for medical trainees

Finance
April 15, 2017

Are you a medical resident or fellow?  Do you have a family to provide for?  Do you feel that your biweekly paycheck is not quite enough to justify the hard work you put in?  Luckily for you, your program offers the great benefit of “moonlighting.”  Should you take advantage?  Here are some of my thoughts on the matter.

What is moonlighting?

Like so many other things we take for granted in medicine, …

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The pros and cons of moonlighting for medical trainees

Stressed and sad as a medical intern? You’re not alone

Physician
April 14, 2017

A few weeks after I started residency, two of my peers killed themselves in New York City. No one I knew was surprised.

Intern year is hell, and everybody knows it from TV shows like “Scrubs” and books like “House of God.” Old doctors tell tall tales of working a million hours without sleep before training standards got “soft,” limiting residents’ monthly work hours to 320 and requiring four days off. …

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Stressed and sad as a medical intern? You’re not alone

Please stop asking about my wife

Physician
April 13, 2017

“Do you have sex with men, women or both?”

This is the way that we were taught in medical school to ask a patient about their sexual history.  When we took our sample standardized patient exams, we were scored whether or not we asked this question.  In my understanding, this was supposed to be a non-judgmental, non-assuming way to elicit a sexual history.

However, romantic partners generally come before sex (unless we …

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Please stop asking about my wife

The suicide rate is increasing. Why is that?

Conditions
April 11, 2017

Those of us who work in pediatric intensive care have frequent encounters with the problem of suicide and attempted suicide. It has seemed to me for some years that the numbers are increasing, and this has been shown to be the case. After years of declining, the suicide rate in our country has been increasing, now at about 125 percent of the rate of several decades …

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The suicide rate is increasing. Why is that?

My prayers and my medical practice

Physician
April 10, 2017

“Help!” I yelled out of our open apartment door.

I was seven years old, and my family had recently emigrated from Egypt to the U.S. We’d been feeling elated that week because, after months of interviews, my father had matched into a pediatric residency.

That morning, he’d awoke feeling nauseated. My mother and sister went to buy some soothing food. I noticed that he’d vomited in the bathroom; now he was feeling …

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My prayers and my medical practice

Recognize the importance of the physical exam in the history of medicine

Tech
April 9, 2017

A patient comes into the ER complaining about throbbing migraines after falling off her bicycle; thus, the physician quickly orders an X-ray, complete blood count, and asks the nurse to schedule the patient for an MRI of the head and neck in case both those tests come back inconclusive. As an ER scribe, I saw many conditions where the physician would quickly do a physical exam, and then use a …

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Recognize the importance of the physical exam in the history of medicine

MKSAP: 79-year-old man with right hip pain

Conditions
April 8, 2017

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

A 79-year-old man is evaluated for a 3-month history of right hip pain. He points to the center of his right buttock when asked to identify the location of the pain. He has no radicular symptoms. He reports no focal trauma but believes his symptoms began after he stepped off a curb that …

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MKSAP: 79-year-old man with right hip pain

What do you do when you know someone is going to die?

Physician
April 7, 2017

What do you do when you know someone is going to die? I’m not talking about death when it comes at the end of a long protracted illness or a terminal diagnosis. Or the final act at the end of a “good” life, when the body and mind have ultimately given way. I’m talking about when you realize the twenty-five-year-old woman in front of you, who you met five minutes ago, …

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What do you do when you know someone is going to die?

Have doctors become desensitized to gruesome realities?

Physician
April 7, 2017

So it’s a Wednesday night, and I just got home after completing a shift. I’m beat. My beautiful sofa beckons to me, and my TV seduces me with brainless images and sound. I succumb to the temptation. I turn on Netflix. Too many movies, too many decisions. Screw this; I didn’t just finish up a shift to have to sit and make more decisions. I go to the suggested for …

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Have doctors become desensitized to gruesome realities?

The gunner culture hurts the future of medicine

Education
April 6, 2017

As graduation nears, I recall an away rotation that concerns me for the future of medicine. I remember eagerly boarding my plane, ready to work hard, learn as much as possible, and explore the unknown. My first day in clinic, I was excited to befriend the student I would rotate with. After seeing our first patient together, she asked me to share my clinical reasoning for the case. I happily …

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The gunner culture hurts the future of medicine

Can physicians be introverts? A introverted physician speaks her mind.

Physician
April 6, 2017

I’ve known since I was very young that I just experienced life differently than did my extroverted family members and friends. During parties, they seemed to truly enjoy the loudness and chaos of get togethers and the seemingly endless small talk, while I would secretly yearn to return home so that I could read my latest novel in peace. An older family member once told me that I would eventually …

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Can physicians be introverts? A introverted physician speaks her mind.

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