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How partnering with urgent care created a dream primary care job

Physician

January 3, 2016

I have a dream job.

I make my own hours, working three 12-hour shifts on Tuesday, Wednesday, and Thursday. I’m off Friday through Monday, and I don’t take any call. I take as much vacation as my budget will allow, and if I wake up with the flu, I call off from work without the usual feeling of guilt and anxiety.

It wasn’t always this way. Like all new doctors recently out …

10 tips to make residency more enjoyable

Jessica Deslauriers, MD

Education

January 3, 2016

As a second year resident, I often do not feel like an expert in anything. Every day I learn more about medicine and realize how much more I still want to learn. In spite of the emotional, physical and mental challenges that being a young doctor entails, I have remained positive and have grown stronger throughout residency. As I reflect on the past year and a half, I appreciate the …

I’m not worried about colon cancer. I’m worried about the potential colonoscopy.

Justin Reno, MD

Physician

January 2, 2016

“Don’t forget to bring that stool card back in, OK?”

As he walked out of the room, carrying his portable oxygen, he turned back, with the nasal cannula in his nose, and replied, “I’ll get it back to you soon. I’d hate to have colon cancer.”

At this point, I’d hate for him to have a positive occult blood card. I could really care less about colon cancer. Colon cancer isn’t going …

MKSAP: 48-year-old man with newly diagnosed hypertension

mksap

Conditions

January 2, 2016

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

A 48-year-old man with newly diagnosed hypertension is referred for an echocardiogram to assess findings of left ventricular hypertrophy noted on the electrocardiogram. He is asymptomatic, and his medical history is unremarkable other than hypertension. His only medication is chlorthalidone.

On physical examination, blood pressure is 128/70 mm Hg, pulse rate is 60/min and regular, and …

A physician goes on paternity leave. Here are 6 things he learned.

Nadim Lalani, MD

Physician

January 1, 2016

It is important that I make two disclaimers:

Disclaimer 1: I am a human being. I feel we run the risk of idolizing people through social media and I want to come out and say that I am really no different than any other person — flaws and all.
Disclaimer 2: I am well aware that your amazing blog aims to promote the stories, journeys and challenges of women in EM … …
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A physician goes on paternity leave. Here are 6 things he learned.

Physicians with anxiety shouldn’t suffer in silence

Anonymous

Physician

January 1, 2016

I thought about you, the patient that I’m about to perform surgery on, all night last night and because I doubted myself, I took clonazepam to calm the anxiety so I could sleep. Today I’ve taken 10 mg of propranolol and some Kava, a natural supplement known to decrease anxiety.

As I start the surgery, the propranolol coursing through my veins blocking the sympathetic nervous system, I fear it will come. …

The exotic choice of staying home: Why CME rules have to change

David M. Mitchell, MD, PhD

Physician

December 30, 2015

San Diego, Tucson, Orlando, and Dallas. Those are a few of the modest destinations to which I have traveled, as a hospitalist, to attend CME conferences, using the pre-tax CME benefit from my employer, including paid days off.

As a young professional, my yearly CME trips gave me a mildly magical sense of privilege: “Really? They’re going to pay for all of this?” Browsing through various CME conference options and dreaming …

Doctors and nurses need better support when they make errors

Nina Shapiro, MD

Physician

December 28, 2015

In September 2010, a seasoned pediatric intensive care unit nurse administered an accidental overdose to a critically ill baby, giving ten times the amount of calcium that was prescribed. Five days later, this baby, with an already tenuous heart condition, died. The nurse recognized her mistake immediately, informed her superior, and also told the family and physicians. She was, however, escorted out of the hospital, put on administrative leave, and …

When “healing” loses its meaning: A cynical medical resident meets Patch Adams

David Zacharias, MD, MPH

Physician

December 26, 2015

The afternoon began like any other day in medical school. Students arrived at the lecture hall and took their seats. An individual with long blue-and-white hair and handlebar mustache entered the room wearing oversized fish-print pants, a loose-fitting clown shirt, and a single earing fashioned out of a bent fork. He casually strolled up to the front, introduced himself as Dr. Patch Adams, and told us …

How the meat industry is acting like big tobacco

Shivam Joshi, MD

Physician

December 26, 2015

Recently, the World Health Organization (WHO) released its report condemning processed meat as a group 1 human carcinogen — a classification that includes such notorious companions as tobacco smoking, smokeless tobacco, and second-hand smoke. This is not surprising considering that processed meat contains many of the same known or probable carcinogens as cigarette smoke, like heterocyclic amines and N-nitrosamines.

Red meat was labeled in the runner-up category as a …

How physicians can resist succumbing to hubris

Lucy Hornstein, MD

Physician

December 25, 2015

Dr. Robert Centor has an important post about hubris. It’s not a long post, if you want to click through and quickly read it. It’s about the danger of overweening pride and overconfidence that can come from blindly believing the praise that is often heaped upon us by those in our care. Essentially Dr. Bob is saying that we must avoid believing all the wonderful things our patients …

A patient with Creutzfeldt–Jakob disease. An unconditional love.

Helena Frischtak

Conditions

December 23, 2015

Today, I talked at length with that lady whose husband has Creutzfeldt–Jakob disease (CJD). That patient — the one with arbitrary myoclonic jerks, always naked and uncovered by blankets due to uncontrolled flailing, his penis and Foley catheter exposed. That one with overgrown mycotic toenails and eyes that are always only half-open, his gaze drifting everywhere. He was until now just a patient for me — the CJD patient.

Yet today …

Misogyny in medicine is alive and well

Laura Faiver

Education

December 20, 2015

In 1978, my mother interviewed for dental school. On her post-interview tour of the school, her male tour guide assumed she was applying for dental hygiene school and showed her only those areas of the school. Upon my mother informing him that she was applying for dental school, he smirked and said, “Good luck getting in, you’re a woman,” and walked away laughing.

Of course in 1978, overt sexism was neither …

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Misogyny in medicine is alive and well

7 things doctors should consider before signing for a new job

Eve Shvidler, MD

Physician

December 16, 2015

So, you’ve finished all your job interviews and think you’ve found a perfect fit. Graduating from residency is exciting, but did you get any training on what it all means to sign on the dotted line?

Below is a quick and dirty run-down of the contracting process from an industry insider.

1. Non-compete clauses. Non-compete clauses are not just a big med phenomenon; they are part of contracts in many different clinical settings. …

A low-grade fever that humbled this physician

Hans Duvefelt, MD

Conditions

December 16, 2015

The clues are usually there, even in the hardest of cases. They just aren’t presented to you on a silver platter.

Gwen Stephenson had an ill-defined polyarthritis and had been on methotrexate for some time. Her rheumatologist, Norm Fahler, had tapered her off the medication while keeping an eye on her inflammatory markers and they had leveled off at just above the normal range.

Seven or eight years ago, Gwen had suffered …

Physicians are jaded, but this is what keeps them in medicine

Cindy Winebrenner, MD

Physician

December 15, 2015

I am constantly coming across articles of physicians with strong voices. Physicians that are jaded. Physicians that didn’t go into medicine to be defined by patient satisfaction surveys. Physicians that didn’t go into medicine expecting that people wouldn’t trust in their training because the Internet begs to differ. Physicians that cringe at the drive-through mentality that patients can present with diagnoses in hand and demands for tests to be done. Physicians …

My first year as a nurse taught me what true resiliency is

Mandeep Garha, RN

Education

December 13, 2015

I remember attending an eight-hour seminar on my job, where experts educated new nurses about the transition we would experience in our profession. We learned about the change theory and the different levels of transition, from novice to expert. I remember not taking the two-day session very seriously, thinking that my accelerated three-year nursing degree had prepared me well for the workplace. Now that my one year of practicing as …

We should radically change the way we play football

Keith Pochick, MD

Physician

December 12, 2015

As the awareness and recognition of concussion in sports continue to increase and the frightening long-term outcomes for frequently and severely concussed athletes are realized, as a physician I cannot help but advocate drastic changes in football. Of the major sports, it sees the highest rates of concussion, and for every highly publicized Greek tragedy of a broken NFL star (Jim McMahon, Junior Seau, Dave …

MKSAP: 28-year-old woman with progressive dyspnea and fatigue

mksap

Conditions

December 12, 2015

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

A 28-year-old woman is evaluated for a 1-week history of progressive dyspnea and fatigue. She was diagnosed with Hodgkin lymphoma 2 months ago and is receiving chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). She takes no other medications.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 134/82 mm Hg, pulse rate …

When an advocate goes too far in the exam room

Anne Katz, RN, PhD

Conditions

December 10, 2015

When is an advocate not an advocate? When should a spouse step back and let the husband make a treatment decision? When should an adult child of a man with prostate cancer let their father decide what is best for him? These are questions that, fortunately, I don’t have to ask all that often. Most men I see for prostate cancer …

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