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A medical student’s struggle with continuity of care

Education

September 16, 2016

“I can’t find the fetal heart tones.” The nurse states with a tone of underlying panic as she exits the patient room.

It’s around 7 a.m., and those of us working the night shift are getting ready for morning sign out before we can head home and get some much-needed sleep after a crazy 14 hours shift.

“Tessa, go scan her” the resident nods towards the ultrasound machine, and I cheerfully follow …

The social history: Our patients are more than their diseases

David Goldberg, MD

Physician

September 15, 2016

“Any alcohol use? Any tobacco use? Any other drugs?”

These are the three main questions that most health care providers ask their patients when documenting a social history on a note.

“What stressors do you have in your life? What social support do you have? What is your home life like? What do you do for fun? Do you wear a helmet when you ride a bike? Do you wear a seatbelt?”

I …

The inhumanity of medical residency programs

Natasha Deonarain, MD, MBA

Physician

September 13, 2016

My mother-in-law died last week.

She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now …

Medical eponyms: Where women are clearly underrepresented

Antoinette Rose, MD

Physician

September 13, 2016

The month of September has been Women In Medicine Month (according to the AMA) since 1989.

Statistics are always telling:

Currently 65 percent of practicing physicians are men, and 35 percent women.

According to the Medscape Physician Compensation Report of 2016, male physicians still make substantially more than their female counterparts ($252,000 vs. $192,000 for primary care, $324,000 vs. $242,000 for specialties, on average)
47.5 percent of …
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Medical eponyms: Where women are clearly underrepresented

You can’t prepare for a rotation in the pediatric ER

Austin Beck

Education

September 12, 2016

Walking into Riley Pediatrics Hospital in Indianapolis, Indiana, and having just completed two prior rotations in emergency medicine at two different level 1 trauma centers, I thought I would be able to easily fit in with pediatric population here. I thought I would be able to slide fluidly from patient to patient, oral reports to consults, while staying connected with the rest of the team. I thought I would be …

MKSAP: 34-year-old woman with very dry, painful hands

mksap

Conditions

September 10, 2016

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

A 34-year-old woman is evaluated for very dry, painful hands. She works in a daycare center and washes her hands 15 to 20 times daily, often for 2 to 3 minutes at a time. She has been applying lotion multiple times daily with no relief of the pain. She has a history of …

The story of a neurologist who quit medicine and lives on a boat

Melinda Burnett, MD

Physician

September 9, 2016

I write this while sitting in our sailing catamaran, swaying in the wind and current eight feet above sand and sea grass. I know this because I can see right through the water in the Bahamas. There is clarity here.

When I started this journey thirteen months ago, I was burning with anger. I was angry at insurance companies for developing complex, mutable formularies, coverage policies, and appeal procedures, maximizing my …

How nurses and law enforcement can work together

Jason Lee, TCRN, CCRN

Conditions

September 7, 2016

The recent horrible events involving racial profiling, excessive force, and gun violence are deeply troubling but not new. Who can forget the Bronx shooting of Amadou Diallo in 1999 when 41 bullets rained down on his unarmed body. I can uniquely identify with the black experience because of my own numerous experiences of being pulled over for no other apparent reason except for being in the wrong neighborhood, wrong state …

The cure for a poor historian? A good medical record

Eric Beam, MD

Physician

September 4, 2016

Think keeping your life organized is hard? Try keeping your doctors organized.

In this era of fragmented health care, patients find themselves in the impossible position of having to coordinate their care themselves — a task that many can’t meet. Having multiple chronic medical conditions often means being subjected to a dizzying assortment of specialists, medical terminology, and tests that can quickly overwhelm patients.

How many times have you found yourself in …

How a board of optometry is restricting eye care to homebound adults

Helen Kao, MD

Physician

September 2, 2016

This spring, the California Board of Optometry shut down the only optometrist providing services to homebound patients in the San Francisco Bay Area. I learned about this because affected patients included several referred from our UC San Francisco Housecalls program, one of a few non-profit, non-concierge home-based practices in the state providing geriatrics care to homebound adults.

With over 1 million adults homebound in California, why would any board deliberately limit …

What kind of doctor do you want to be? Think about it.

Brian Sutterer

Education

August 31, 2016

“A doctor’s mission should not be just to prevent death, but to improve the quality of life. You treat a disease, you win-you lose. You treat a person, I guarantee you’ll win, no matter what the outcome.”
– Patch Adams (1998)

It’s that time of year where everyone begins residency applications, and you commonly hear conversations along the lines of, “What are you going into?”, or, “what type of doctor are you …

To the doctors struggling with depression: You are not alone

Elisabeth Poorman, MD

Physician

August 30, 2016

By the end of my first year of residency, I knew I was in trouble.

I was overwhelmed by the 15-hour days, the unbearable sadness of the tragedies I witnessed, my feelings of impotence and my fears of making a mistake.

My life was my work, and everything else seemed to be falling apart: my physical health, my relationships, my ability to sleep after months of night shifts.

Yet, I came to work …

Why are ERs so busy? It’s really no surprise.

Manuel Momjian, MD

Policy

August 29, 2016

If the emergency room is the most expensive place to receive health care, then why are more patients visiting the ER than ever before? There are no local doctors’ offices that can charge $1,000 to put a Band-Aid on your finger or $8,000 to tell you that your abdominal pain is due to drinking too much coffee. But, I don’t think you would mind paying this premium if you were having …

You failed your surgical boards. What’s next?

Skeptical Scalpel, MD

Education

August 26, 2016

“I graduated this July and took the QE (written general surgery boards) on July 19th. I got my results today, and I failed. Not only did I fail but my score placed me in the 5th percentile. Needless to say, I’m disappointed. You hear stories about CE (oral exam) failure but never about QE failure. I never blew the ABSITE out of the water (50, 29, 20, 34, …

The bureaucratic hassles physicians face are extraordinary

Peter Ubel, MD

Physician

August 25, 2016

Left to our own devices, most of us physicians try our best to provide high-quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many of us get so caught up in our busy clinic schedules we occasionally forget to, say, order mammograms for women overdue for such tests, or we don’t get around to weaning …

Donald Trump’s medical letter has so many things wrong with it

Jennifer Gunter, MD

Physician

August 25, 2016

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Donald Trump is talking about Hillary Clinton’s health as are two doctors who have never evaluated Clinton. This attention on Clinton has renewed some interest in the letter Donald Trump released last year from his personal physician.

Many outlets have picked it apart, but I want to tell you as a doctor exactly how bad it is. I would never write …

A physician tells a health insurance CEO what she really thinks

Cathleen London, MD

Physician

August 24, 2016

I graduated medical school in 1995. I believe in a single-payer health system. I am about championing for my patients. I left a salaried position in academic medicine to go an underserved area of rural Maine and start a practice. This is the letter I wrote to the CEO of a large health insurance company recently.

Dear Mr. CEO,

My name is Cathleen Greenberg London. I am a family medicine physician who …

Laughter? That’s the sound of resiliency you hear.

Cindy Winebrenner, MD

Physician

August 21, 2016

Sometimes, the loudest sounds I hear in the emergency department are laughter. It may seem irresponsible. It may seem discordant. It may seem callous. To me, it is the sound of survival. It is the sound of resiliency. It is the sound of making it through the day.

My father was at work when he suddenly became cold, clammy, and collapsed to the ground unresponsive. His staff did the right thing …

Death is not the enemy. More physicians need to realize that.

Nancy Wang, MD, MPH

Physician

August 20, 2016

I knew it was bad when she couldn’t tell me her name. I watched her face fill with frustration as a word she had uttered countless times over eight decades somehow got lost between her brain and her lips.

It was 2 a.m. and I was on call as the surgical resident. I had been told that a patient with bladder cancer was being transferred from another hospital, and, as these …

A reminder that life is indeed too short

Neha Sharma, DO

Physician

August 19, 2016

I recently took care of a young patient whose case left an impact on me. When I admitted him, he was fighting a lost battle with cancer.

A few months prior to admission, he had been experiencing new headaches. When he sought medical attention, he was diagnosed with an extremely aggressive brain tumor that had spread to his spine, and was given a very poor prognosis.

Unfortunately, his condition deteriorated quickly thereafter, …