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The proctor seized during a USMLE Step 3 test. See what this doctor did next.

David Pyle, MD

Physician

May 9, 2016

USMLE Step exams are a rite of passage in medical education. They mark the transition from pre-clinical years to clinical years, from medical school to residency and from intern to resident. One of the more difficult aspects of the transition to residency was convincing myself that I really was a doctor. The habits of explaining my role as a student, of hedging every statement with “I’ll need to ask the …

This pediatrician learned why it’s so important to listen to a parent

Niran S. Al-Agba, MD

Physician

May 8, 2016

Medicine can wear down our hearts and souls. My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency. By that final year of training, I was no longer certain medicine was really the right choice for me. I was struggling with the notion that after almost 11 years of education, the destination was not quite …

Don’t be ashamed to receive an epidural during childbirth. Here’s why.

Cesar Padilla, MD

Conditions

May 8, 2016

Life as a resident doctor can bring some of the most memorable patients encounters of our career. After all, this is the time in our training when we are the most naïve, vulnerable and most importantly impressionable. There is a certain patient scenario, however, which has changed the way I view one the most important experiences a patient can have: labor.

Let me explain.

I get paged for an epidural. Once I …

Should white coats be only worn by physicians?

Anonymous

Physician

May 7, 2016

Maybe it’s just me, and maybe this is a regional/local phenomenon, but I have noticed a sharp increase in the number of non-physicians who sport their white coats on a daily basis around the hospital.

First, let me preface this piece by saying I have absolutely nothing against any person who partakes in the care of patients; in fact, I commend all the helping hands that routinely dedicate themselves to health …

The white coat doesn’t mean much anymore

Frederick Gandolfo, MD

Education

May 6, 2016

I’ll just start this off by saying that I am not exactly sure where I stand on the white coat thing. One part of me loves the white coat as a symbol, a shield against disease, and a place with pockets to put my things; and then there are other days when I just want to throw that germ-ridden cotton barrier to the doctor-patient relationship in the trash, roll up my sleeves, …

My double life: Mental illness in the health care

Kristen Beatty

Conditions

May 6, 2016

I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have …

When patients cry, please don’t do this

Peter Ubel, MD

Physician

May 2, 2016

Just three weeks earlier, she had noticed something strange about one of her breasts. An irregular shape. Her daughter brought her to the doctor, and soon the patient, I’ll call her Amanda, was diagnosed with breast cancer, stage “to be determined.” In fact, she was now in an oncologist’s office, learning what tests she would receive to determine the extent of her tumor. And sitting between her and the doctor …

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When patients cry, please don’t do this

Conquering guilt as a trauma surgeon mother

Jamie Coleman, MD

Physician

April 30, 2016

Guilt was not a huge part of my vocabulary until I became a mom. I never felt much guilt about how I spent my time. Didn’t feel guilty about sleeping in, or working out, or having a girls’ night out. And so on and so forth.

And then I became a mom. You know, that moment when you get shoved into the most beautiful world; a place more beautiful than you could …

“You can’t create an addict in the ER.” Yes, you can.

Edwin Leap, MD

Physician

April 29, 2016

I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs.

I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in …

What this physician learned from the starfish story

Kathy Stepien, MD

Physician

April 27, 2016

I thought about the rather corny starfish story when I was driving home after clinic today. You know the one. It goes something like this:

A man was walking along a deserted beach at sunset. As he walked, he could see a young boy in the distance. As he drew nearer, he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again …

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What this physician learned from the starfish story

The ever expanding list of reasons for a doctor’s note

Yul Ejnes, MD

Physician

April 27, 2016

A guest column by the American College of Physicians, exclusive to KevinMD.com.

If the old adage “the pen is mightier than the sword” is true, then the doctor’s note is the most powerful weapon around.

When I entered practice over 25 years ago, I wrote notes when people were too sick or injured to work, or to verify …

Surgical residency hurt the people that mean the most to me

Anonymous

Physician

April 27, 2016

Three weekday call shifts left and two more weekends. The light at the end of the tunnel is shining bright, and I am relieved to be walking towards it. The only question that remains is what will I have left of myself and my life when I get there?

I started residency with a husband who I loved more than life itself. I was codependent to a fault, never wanted to …

How to perform services that increase primary care revenue

Betsy Nicoletti, MS

Policy

April 24, 2016

CMS states it wants to increase pay to primary care physicians. And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself. In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems …

Why paying hospitals for clerkships is good, and necessary

Heidi Chumley, MD, MBA

Education

April 24, 2016

Critics have been making the rounds again with a warmed-over complaint: International medical schools that offer U.S. teaching hospitals financial support for clerkship programs are unfairly buying access for their students instead of “more deserving” U.S.-based students. As the proud dean of a Caribbean medical school, I want to set the record straight yet again: This argument is hollow and based on a false dichotomy. In fact, the argument has …

Every physician is a wounded healer

Chris Cantilena, MD, MMM

Physician

April 24, 2016

I recall during my freshman year in medical school, sitting in class and listening to what were supposed to be 50-minute lectures from people who’d been teaching the same course for years. These were highly educated and intelligent folks; they knew how much material they could cover in 50 minutes. Yet, they frequently went past their time; encroaching on what was for some a badly needed bathroom break, and for …

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Every physician is a wounded healer

Ask patients how they feel, along with how they are feeling

Daniel L. Meltzer, MD, MPH

Physician

April 23, 2016

“How are you feeling?”

It’s a question we frequently ask patients — on rounds, in the clinic, post-operatively — and with all good intentions and gentility. But, do we ever stop to think: What is really the point of this question? What information are we trying to glean? I think for most of us, we’re asking the question with a cognitive bias towards the physical. How are they “physically” feeling: better, …

Learn the physical exam by following an oncologist

Miriam A. Knoll, MD and George Dawson, MD

Education

April 23, 2016

“Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
– Sir William Osler, “The Father of Modern Medicine” (1849–1919)

In this modern era of oncology, the potential extent of malignant spread is staged by high-quality scans. Further, when …

Medicine is the most emotional profession. This story proves it.

Free N. Hess, MD

Physician

April 19, 2016

There you are in your father’s arms. He is practically running to keep up with the triage nurse. The nurse is walking quickly toward the room that we leave open for true emergencies and the sickest patients. Your father’s eyes are full of fear, and the nurse’s tone is worrisome.

I look down at you all snuggled up to your father’s chest. You are beautiful. So small and bright-eyed. You don’t …

You should want surgery residents for your operation. Here’s why.

James Wu, MD

Physician

April 19, 2016

A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed …

How to destroy a great ER: A step by step guide

Thomas Paine, MD

Physician

April 19, 2016

I took a fantastic emergency medicine (EM) job when I finished residency. There was no question in my mind that it was the best job within a hundred mile radius, maybe more. When I first started, my expectations were met. My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed. The hospital was independent, …

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