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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. …

Please stop asking about my wife

Anonymous

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?

Christopher Johnson, MD

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 …

My prayers and my medical practice

Fredy El Sakr, MD

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

Rafid Rahman, MD

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 …

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

mksap

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 …

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

Jeremy Topin, MD

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, …

Have doctors become desensitized to gruesome realities?

Zahir Basrai, MD

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 …

The gunner culture hurts the future of medicine

Kelsie Riemenschneider

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 …

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

Aparna Iyer, MD

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 …

This is what heroin addiction looks like

Debbie Moore-Black, RN

Conditions

April 6, 2017

What can I tell you? It started out innocently. College exams were over. And that meant one thing — party time! Bubbly, shots, beer, cocaine and Percocet. Everyone was happy. It was a celebration.

Pam came from a pretty strict religious family: no alcohol, no premarital sex and no crazy music in her house growing up. It was church every Wednesday and Sunday. And if you missed a Sunday, you were …

The infantilization of medical students

Jonathan Coleman

Education

April 6, 2017

I was sitting on hold in the resident room gearing up to beg the IT person that would soon come on the other line for enough authorization to be able to view the residents’ patient problem list, and I found myself thinking about what some of the old docs must think of us third-year students now. Talk to some of these older physicians and they’ll tell you their stories of …

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The infantilization of medical students

Why this medical student joined the National Health Service Corps

Asaad Traina

Education

April 5, 2017

Like many of my peers, I started medical school with idealistic dreams of providing compassionate care for poor patients. I thought being a physician was a noble profession and even discussing money, much less changing my career choices based on it seemed antithetical to that. A visit to the financial aid office quickly cured me of my naiveté. I was facing over $300,000 in debt and would be forgoing millions of …

Think we evolved to eat meat? Think again.

Shivam Joshi, MD

Physician

April 4, 2017

Eating meat has been linked to cancer, high blood pressure, heart disease, diabetes, stroke, dementia and many other diseases. Nearly every modern lifestyle disease has been associated with meat. With so much emerging evidence against meat, it begs the question: Did we …

8 things doctors secretly want to tell their patients

Brian C. Joondeph, MD

Physician

April 4, 2017

As the repeal of Obamacare is debated in the halls of Congress and on cable TV, one common theme is: “What will happen to patients?” Questions loom about what might change with coverage, about cost, about whether you’ll still be able to keep your doctor, and if medications will still be covered

But what about doctors? What about how they’re doing?

There are things doctors want to tell their patients, not only about …

Do dog walkers make more money than doctors?

Pamela Wible, MD

Physician

April 3, 2017

I recently reported on a doctor-turned-dog-walker who says with her career switch she’ll enjoy more happiness — and income! In her own words:

Dear Pamela, Today I realized that if I become a dog walker and charge $25/hour and walk five dogs per day, I would make my equivalent salary with fewer hassles. I’m seriously considering this as a career move. I could …

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Do dog walkers make more money than doctors?

Why we need more doctors opting for academic medicine

Angira Patel, MD and Kelly Michelson, MD

Physician

April 3, 2017

Match Day results were announced recently and a record high 35,969 medical students learned the location and specialty of their first job. As these newly indoctrinated physicians chart their next steps, the majority will opt out of academia, creating a potential crisis in medicine and healthcare innovation.

Although 45 percent of graduating medical students aspire to work in an academic setting, only about 16 percent will do so. Of those who do …

The little-known ACGME guideline change every resident should know

Christopher Gable

Education

April 2, 2017

On July 1st, 2017, the updated Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements will take effect. The increase in the maximum continuous work hour shift from 16 to 24 hours has surely received the most attention, and will likely continue to do so.

However, the ACGME did make some significant improvements in this latest guideline update worth noting. Among them was a slight conjunctional switch from an “and/or” …

The problem with too many health insurance options

Tenessa MacKenzie, MD

Policy

April 2, 2017

Medical school didn’t teach me about the intricacies of health insurance. My family medicine residency program took pride in caring for all patients regardless of insurance status. When I worked in New Zealand and Canada it was a relief to not worry about which diabetic test strips were on formulary or whether a patient’s insurance would cover their birth control.

In my current position as a primary care physician at an …

MKSAP: 52-year-old man with sudden onset of erectile dysfunction

mksap

Conditions

April 1, 2017

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

A 52-year-old man is evaluated for the sudden onset of erectile dysfunction that has persisted for 6 months. He reports having erections that are inadequate for vaginal penetration. He feels guilty about not being able to satisfy his wife’s requests for sexual intercourse, although he still has sexual desires. He has been sleeping poorly …

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