The abscess that surprised this emergency physician

Conditions
June 1, 2017

I carried it around with me the entire shift. I showed it to my E.R. colleagues, the internists, and even a couple of surgeons. I’d tell them the story. “Never,” one of them said. “Not in twenty-eight years. Never seen that before.”

One of them held the small urine jar up to a light and began unscrewing the lid.

“Don’t!” I said.

“Why not?”

“It stinks. You wouldn’t believe how much it stinks. We …

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The abscess that surprised this emergency physician

CSF is soap for your brain

Conditions
May 31, 2017

Recently after pulling a couple 20-hour shifts, people kept encouraging me to sleep on my break. They were obviously concerned for my well-being but it got me thinking more about the role sleep plays in our lives. If the average life expectancy is 78 then we spend 30 percent of our lives asleep which is also the same amount we spend in our cars commuting, and a meager 0.16 percent …

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CSF is soap for your brain

6 tricks that pharmaceutical marketers use

Meds
May 30, 2017

Long before the Internet and direct-to-consumer advertising, the medical profession tried to reassure people about their health concerns. Remember “take two aspirins and call me in the morning?”

Flash forward to today’s online “symptom checkers.” They are quizzes to see if someone has a certain disease and exhortations to see their doctor even if they feel fine. Once drug makers discovered that health fears and even hypochondria sell drugs, there seems …

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6 tricks that pharmaceutical marketers use

Listen up GEHA: Vaccines should not be an out of pocket cost

Policy
May 29, 2017

In a little piece of legislation known as the Affordable Care Act, preventive services are mandated to be covered with no out-of-pocket expense to consumers. According to the Healthcare.gov website, approved insurance plans must cover a “list of preventive services for children without charging a copayment or coinsurance.”

Number 18 on that preventive care list is childhood immunizations for children from birth to age 18, acknowledging regional variation in the standard …

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Listen up GEHA: Vaccines should not be an out of pocket cost

Is there a medication that can combat rigid and robotic thinking?

Meds
May 29, 2017

I had an interesting conversation with a patient in the office some time ago.

He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel. I did not think that these laboratory abnormalities portended an unfavorable medical outcome. Beyond the medical issue, he confided to me a harrowing personal tribulation. Often, I find that a person’s personal story is more interesting and significant than …

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Is there a medication that can combat rigid and robotic thinking?

Seeing your gynecologist is not just for a Pap smear

Physician
May 29, 2017

Some days, I get so frustrated at work. Yes, we all have our frustrations. Maybe traffic is slow, and you get to work late. Maybe you spill your coffee on your work clothes as you walk into your office. Maybe someone calls in sick, and you are short help at work. But this is big! Like so big, it can impact the trajectory of someone’s life. They, in turn, are forced …

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Seeing your gynecologist is not just for a Pap smear

To help patients, doctors should consider going on strike

Physician
May 28, 2017

Last fall I was witness to a miraculous event. I rarely take off from work, but did so on a Friday to go to Baltimore to lend moral support to my family doctor friend, Cathy Maslen. She and her workmates at Chase Brexton Health Care (a community health clinic in the Baltimore area with a focus on the gay and transgender community and the inner-city poor) were doing something that …

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To help patients, doctors should consider going on strike

This is what practicing medicine in rural America is really like

Physician
May 27, 2017

“So tell me why you think you you’re having a stroke?”

The nice lady, mid 40s, sat on the ER exam table in work-clothes, an anxious look on her face. “Well, I was working the cattle up in the timber, and when I got back to my 4-wheeler my heart was racing, and I was short of breath. My arms were tingling, and so was my face. I’m concerned it might …

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This is what practicing medicine in rural America is really like

How to give constructive criticism as a physician

Education
May 26, 2017

Here are some questions that are still on my mind as I approach the tail end of my chief year. I’m thinking about the best ways to offer constructive feedback.

  • What is the best way to approach a struggling learner?
  • What is the best way to give guidance and feedback without being perceived as a tyrant or overbearing?
  • How can I maximize the potential of my team members and the trainees …

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How to give constructive criticism as a physician

4 ways to take a break from your career

Finance
May 26, 2017

My cousin visited me in sunny Cali this past weekend. She lives a life that many in the medical community can appreciate: a stable and successful job for many years, but burnt out. She then decided to take six months to work on her writing and try establishing herself through various pursuits. While successful in some ways, she decided she needed a more stable position. So she found a job, …

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4 ways to take a break from your career

Residents performing surgery: Why can’t we reach a middle ground?

Physician
May 25, 2017

A comparison of appendectomy outcomes for senior general surgeons and general surgery residents revealed no significant differences in early and late complication rates, use of diagnostic imaging, time from emergency department to operating room, incidence of complicated appendicitis, postop length of stay, and duration of post-op antibiotic treatment.

The only parameter in which a significant difference was seen was that attending surgeons completed the procedure significantly faster by 9 minutes — …

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Residents performing surgery: Why can’t we reach a middle ground?

Do expired EpiPens still work?

Meds
May 24, 2017

A small study published this month showed that most Epipens retain their potency for at least 4 years after their expiration date. That’s no guarantee, of course. I’d still recommend as a “best practice” that families replace them as they expire. But it’s reassuring to know that they’ll usually be effective even when expired. And using an expired EpiPen is almost certainly better than using nothing …

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Do expired EpiPens still work?

Why nurses are the best teachers for medical students

Education
May 24, 2017

It was 5:30 a.m., and I could barely contain my excitement. I was almost done with my clinical rotations.

I had worked tirelessly to improve my medical knowledge and spent hours mastering my clinical skills. Now, as I was nearing the end of my third year of medical school, I felt more than ready for what lay ahead.

I walked into my patient’s room. As she slept, I examined the lines and …

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Why nurses are the best teachers for medical students

How the $8 bottle of water in Las Vegas is a health care issue

Physician
May 23, 2017

I recently attended the annual Society of Hospital Medicine conference in Las Vegas.

As a proud hospital medicine doctor, this organization has grown exponentially over the last decade, and thousands of hospital physicians from across the nation descended on the city for a few days of great learning and networking opportunities. However, away from the conference, this being Vegas, there had to be some time for fun as well.

On Saturday evening, …

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How the $8 bottle of water in Las Vegas is a health care issue

It’s time we look at the Australian health system for lessons

Policy
May 22, 2017

President Donald Trump in a recent press briefing with Australian Prime Minister Malcolm Turnbull announced, “Of course the Australians have better health care than we do – everybody does.” On the heels of the House narrowly passing the first in many steps toward Obamacare repeal and replace, President Trump’s comment caused a bit of a stir, to say the least.

MSNBC was all over it. Chris Hayes interviewed fellow socialist Senator …

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It’s time we look at the Australian health system for lessons

When science ceases to be value-neutral, science ceases to be science

Physician
May 22, 2017

Recently, the Harvard Chan School of Public Health reported on the effect of surgical checklists in South Carolina. The press release was titled, “South Carolina hospitals see major drop in post-surgical deaths with nation’s first proven statewide Surgical Safety Checklist Program.”

The Health News Review, for which I review, grades coverage of research in the media. Based on their objective criteria, the Harvard press release would not score highly.

The title exudes …

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When science ceases to be value-neutral, science ceases to be science

5 ways to tell if a practice has integrity

Conditions
May 22, 2017

I stood in line behind a physician, slightly balding and in a long, starched lab coat at the coffee shop in our hospital. As he paid and took his coffee, I noticed that he smiled and called the clerk by name, “Thank you, Terri.” He went on about his day, and I was left to wonder about the man, his practice and what type of person he was.

My friend has …

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5 ways to tell if a practice has integrity

A medical student fails USMLE Step 1. Can he ever be a surgeon?

Physician
May 20, 2017

I received these emails recently. The writer gave me permission to publish them. They have been edited for length, and some details have been changed to protect his anonymity.

I’m a third-year medical student at an allopathic state medical school. I’ve always wanted to do surgery. My problem is I failed USMLE Step 1 the first time and got a 207 on my second attempt. I hadn’t failed anything else throughout first …

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A medical student fails USMLE Step 1. Can he ever be a surgeon?

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