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10 rules every primary care doctor should read

Physician

January 13, 2016

Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of data, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician.

During my 30+ years as a family physician, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Here are ten rules I have found useful, …

The story of how this doctor lost his first patient

Antonio Webb, MD

Physician

January 13, 2016

During medical school, we are taught the physiology, anatomy, and pathophysiology of hundreds of disease processes. One thing medical schools don’t teach well is how to cope with losing a patient. Some physicians will go many years as a physician before having their first patient die on them. Others will lose a patient earlier on during their career. I was the latter. I hadn’t even graduated from medical school yet …

The struggle of mommy-guilt in physician-mothers is real

Emily Knipper, MD

Physician

January 11, 2016

What does a 3 year old know?

If you don’t like our toddler’s opinion, just wait; she’ll change her mind in a few seconds. The ever-changing mind of a 3-year-old is what makes the fact that I decided to be a doctor at that age all the more amazing. But, that’s how old I was when my parents took me on a mission trip to Haiti, and I decided I wanted to …

Prevent your baby from dying: 9 tips every parent should know

Chad Hayes, MD

Conditions

January 10, 2016

Dead babies aren’t something anybody likes to talk about. But while it may be an uncomfortable topic, it’s also an important one — because there are things we can do to make it happen less frequently. The loss of an infant is something parents never really get over, and something that no parent should have to experience. Here’s a look at the most common causes of infant mortality and some things you …

This medical student went to rehab. Here’s what she learned.

Jennifer Adaeze Anyaegbunam

Education

January 9, 2016

As physicians, we are trained to look for change. We look for changes in lab findings and change medications, and we ask our patients, “what has changed since I saw you last?” We are always trying to get our patients to change in one way or another. Doctors are hardwired to seek changes that produce a dopamine release in our brains. We love it when patients see an improvement in …

This doctor won’t prescribe Addyi, the “female Viagra.” Here’s why.

Jennifer Gunter, MD

Meds

January 9, 2016

Addyi (flibanserin), the drug to increase female libido had a timid entry into the market with very few prescriptions considering the “hype.” Bloomberg Business reported 227 prescriptions in the first month. That’s a pittance considering Valeant paid $1 billion for the drug.

I am unlikely to help Valeant recoup their investment, because the more I read about this drug, the worse it looks. Here’s why:

It barely works

One of the study endpoints (meaning …

From medicine intern to radiology resident: Is the grass greener?

Kerri Vincenti, MD

Education

January 8, 2016

When I was an intern in medicine, I couldn’t wait to start my role as a radiology resident. Even though I cared for my patients to the best of my ability and studied their diseases, I knew that my time in the department was limited. I wish I could say that I put my whole heart into my work, but with all of the extraneous demands of intern year — …

This is why patients cannot be customers

Tanya Feke, MD

Physician

January 7, 2016

The customer is always right, or so the saying goes.

If you have ever worked in retail, you may have been frustrated by buyers who ransack neatly folded tables of sweaters and leave them strewn about like tornado wreckage. If you are in the food industry, you may be annoyed by a diner who complains his soup is too cold even as you see steam rising off the bowl.

It can sometimes …

Physicians aren’t burned out. They’re abused.

Pamela Wible, MD

Physician

January 5, 2016

burnout

Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right.

We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get so f’d up so fast? Attention medical students and doctors: It’s not your fault.

Burnout is physical and mental collapse caused by overwork.

So why …

How partnering with urgent care created a dream primary care job

Rebekah Bernard, MD

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 … …
Read more…

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 …

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