“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 …
This is what practicing medicine in rural America is really like
The couples I see for counseling are not always perfect, not that any couples ever are. But when cancer enters the relationship, for some couples, things get ugly and get ugly fast. I believe that we like to think that cancer makes people “better”; that people rise to the challenge and become the best they can be. I think that we …
The unhappy couples after a cancer diagnosis
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.
How to give constructive criticism as a physician
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, …
4 ways to take a break from your career
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 — …
Residents performing surgery: Why can’t we reach a middle ground?
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 …
Do expired EpiPens still work?
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 …
Why nurses are the best teachers for medical students
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, …
How the $8 bottle of water in Las Vegas is a health care issue
A guest column by the American College of Physicians, exclusive to KevinMD.com.
One thing about me that even my closest friends are unaware of is that I am a zombie fighter. Unlike the ones in video games, TV series, or movies, the zombies that I fight in my practice are prescriptions that won’t die. They …
Averting a zombie prescription apocalypse
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 …
It’s time we look at the Australian health system for lessons
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 …
When science ceases to be value-neutral, science ceases to be science
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 …
5 ways to tell if a practice has integrity
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 …
A medical student fails USMLE Step 1. Can he ever be a surgeon?
When I am facing an alcoholic in the office, I do not advise him to stop drinking.
Other physicians may advocate a different approach. We live in a free society and individuals are free to make their own choices. I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that …
This physician won’t tell his alcoholic patients to stop drinking. Here’s why.
When it comes to the review of systems, I’ve been a natural, a savant — a prodigy you might say.
During my first few weeks of medical school, I remember doing mock interviews with fake patients. This was long before I learned anything about “HPI,” “ROS,” physical exams, billing or anything medically relevant for that matter. As other students stuttered, trying to figure out what to ask a lady pretending to …
Let’s get rid of the review of systems
“OK, it is time to move on,” my professor claps his hands together and yells above the chatter. We all look up from our Netter’s anatomy books and our cadavers. The smell of formaldehyde burns my nose as the fluorescent lights flicker above.
“We have explored the chest cavity and the abdominal cavity. It is now time to move onto the extremities, starting with the arms. I want you to unwrap …
The hands tell us the most about a cadaver
“I like good strong words that mean something.”
– Louisa May Alcott
My resident and I are removing a large, recurrent cancer from the neck. Dense scar tissue is everywhere from prior surgery and radiation therapy. The going is slow. Each move is arduous, and bleeding obscures the view of the anatomy.
“Watch out,” I tell her. “The jugular vein is nearby, probably buried in that scar.”
“Yeah,” she responds. “Look at this nerve! …
What surgeons do is a violent act
During a recent internal medicine rotation, a senior resident expressed disappointment that I’ve chosen a career in family medicine. He was concerned that my talents would be wasted, because — in his words — I wouldn’t get to care for the “more complex patients” he sees in internal medicine. Although I appreciated his confidence in my abilities, I felt my heart sink, as it does each time I am faced …
No, I’m not settling for family medicine
While Muzak plays (think Kenny G covering John Mayer) and courteous expressions like “excuse me” and “thank you” are exchanged in hospital waiting rooms, behind the front desk, angry patients are firing curse words into the hallway like their mouths are assault rifles with an endless supply of ammunition. Nurses are being cussed out by patients who sound like characters in “Platoon.” And medical professionals are dropping f-bombs. All of …
Why medical professionals have potty mouths
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old man is evaluated for recurrent nephrolithiasis. Medical history is significant for Crohn disease complicated by multiple small bowel strictures requiring resection. He began developing kidney stones 3 years ago following his last bowel surgery. Analysis of the stones has consistently shown calcium oxalate, and he has been adherent to a …
MKSAP: 28-year-old man is evaluated for recurrent nephrolithiasis
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