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So you had a bad day: 3 reasons why doctors should have some perspective

Physician

August 25, 2015

Being a doctor is one of the most emotionally and physically demanding professions out there. The health care landscape may have changed a lot over the last decade, but the basic unavoidable grueling nature of medical practice has been the same for time immemorial. I remember reading a careers advice book when I was a teenager telling me just that being a doctor was “the most challenging of jobs,” and …

How to perform a stool transplant

Frederick Gandolfo, MD

Conditions

August 25, 2015

Fecal microbiota transplantation (FMT) is the process of administering a preparation of healthy donor stool to a patient with a certain disease, usually Clostridium difficile colitis, in an attempt to treat the disease. I covered some of the basics about the microbiome and FMT in a previous article, so this will just be a cookbook-style post on how we do FMT with colonoscopy.

First, a healthy donor must be identified. The donor …

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How to perform a stool transplant

What is a 5-star hospital? The answer may surprise you.

Ashish Jha, MD, MPH

Policy

August 24, 2015

Now we’re giving star ratings to hospitals? Does anyone think this is a good idea? Actually, I do. Hospital rating schemes have cropped up all over the place, and sorting out what’s important and what isn’t is difficult and time consuming. The Centers for Medicare & Medicaid Services (CMS) runs the best known and most comprehensive hospital rating website, Hospital Compare. But, unlike most “rating” systems, Hospital Compare …

What does Sir William Osler think about physician burnout?

Janice Mancuso

Physician

August 22, 2015

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Sir William Osler (1849-1919) is universally considered the father of modern medicine.

“He belongs to medical students of all time, as Lincoln belongs to the common man everywhere.”
– Wilder Penfield, eminent Canadian neurosurgeon, who met Osler while at Oxford

“His energy, productivity, and humanity blossomed out of a deep vulnerability. Between the pages of his books, we can still encounter an Osler who is … …

What causes toxic stress in medical school and how to fix it

Vamsi Aribindi, MD

Education

August 20, 2015

For two years, I served as a representative to my medical school’s student affairs committee. My job was to convey medical student concerns and problems. As part of that role, I had a lot of time to think about how and why many medical students experience depression and stress. Two recent articles have led me to write about the issue now: “10 simple solutions to stop medical student suicide,” …

The truth behind why doctors don’t tell the truth

Kristin Prentiss Ott, MD

Physician

August 20, 2015

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There are two key scenarios when doctors fail to tell “the whole truth and nothing but the truth so help me God.”

Sometimes doctors give a diagnosis we’re not 100 percent sure of and other times we don’t diagnose something we’re almost 100 percent sure of. The truth is complicated and often more gray than black and white.

Scenario #1: “You have [insert diagnosis …

You won’t necessarily be admitted to the hospital. Here’s why.

Edwin Leap, MD

Physician

August 19, 2015

When we take our sick or injured loved ones to the hospital, we often hope that they will be admitted. In many instances, this is a very reasonable request. When heart or lung disease are at work, when severe infections, dehydration, fractures or strokes occur, admission may well be the only option. However, sometimes our desire to admit our family members is a throwback to a simpler time in medicine; …

The story of how one physician recovered from burnout

Tom Murphy, MD

Physician

August 19, 2015

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Time was baffling. It seemed like just yesterday; I sat in a posh auditorium in Chicago as an enthusiastic young adult during my first day of medical school orientation at Northwestern in 1995. Eighteen years later I was a forty-three-year-old burned out physician, practicing in Boise, Idaho, doing Google searches on the most effective way to end my life. During my time …

The most feared medical specialty? It’s actually one of the safest.

Susan G. Curling, MD

Physician

August 18, 2015

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

I often hear patients say, “I am not afraid of the surgery, just the anesthesia.”

But should patients worry? Physician anesthesiologists suffered a crisis in confidence in 1982 when the ABC television program 20/20 aired, “The Deep Sleep: 6,000 …

Spending time with patients. That’s my job.

Nathan A. Pennell, MD, PhD

Physician

August 18, 2015

I’m sure I am not alone in saying that I am almost obsessively conscious of time. Namely, that there never seems to be enough of it. As busy oncologists, we all have constant demands on our time, from our leadership, colleagues, drug company reps, insurers, and our families, not to mention the time we try to carve out for ourselves. But …

After surgery, the scars will always remain

Bruce Campbell, MD

Physician

August 17, 2015

“To be trusted is a greater compliment than to be loved.”
– George MacDonald

As we adjust her position on the surgical table, I spot some short, vertical scars on the front of her neck. The parallel slashes sit directly over her enlarged thyroid — a goiter — and appear to have been deliberately placed. There are two sets of scratches, one set on either side of the neck, nearly identical in length and evenly …

7 ways physicians can improve health care quality

Robert Pearl, MD

Physician

August 16, 2015

Patients want to receive health care that is of the highest quality. Physicians want to provide it. But what is “high-quality health care?” On that, few agree.

Ask most Americans and they’re unsure where to find it. They know they want to be kept healthy, have rapid access to personalized care whenever they need it and be charged only what they can afford.

Ask the leaders of the national medical and surgical …

What does a doctor look like?

Lara Devgan, MD, MPH

Physician

August 15, 2015

As a plastic surgeon, I am interested in how people look. Whether I am piecing together a fractured face or reconstructing a cancer-scarred breast, I am focused on appearance, symmetry, contour, and lines. I am always thinking about how our bodies are the physical manifestations of who we are.

What I am never thinking about is how that sentiment applies to me.

An intern …

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What does a doctor look like?

Please, don’t eat your placenta. Here’s why.

Jennifer Gunter, MD

Conditions

August 14, 2015

Every few news cycles placenta-eating seems to make the rounds. I’ve already seen it a couple of times this year, so I figured the Internet is trying to tell me something.

Some women, but mostly those who recommend and/or prepare placenta for them, think that ingesting placenta can cure/help postpartum depression and possibly a host of other postpartum ills and issues. Some …

This is why the humanities are important in medicine

Nasir Malim, MD, MPH

Education

August 12, 2015

As a medical student having completed my undergraduate major in the humanities, I often receive the question, “Why did you choose to do that?” The underlying thought behind asking why I would choose a major in the humanities while holding the intention to later attend medical school is that medicine is especially distinct from the humanities (and specifically African-American studies in my case). The sciences are just a whole other …

Cerner beats Epic in the DoD sweepstakes. What does that mean for the rest of us?

Margalit Gur-Arie

Tech

August 12, 2015

The health information technology (HIT) world has been hit by a watershed event like no other. The Department of Defense (DoD), widely respected for its indiscriminate generosity to contractors, has awarded the most coveted prize in recent HIT memory: the Defense Healthcare Management Systems Modernization (DHMSM) contract. And the winner is … Leidos, the contractor formerly known as SAIC. A couple of years ago, when the race for …

Slowly, slowly

Christy Duan

Physician

August 11, 2015

“What is the meaning of life?”

A perfectly reasonable question, albeit a strange one considering that I was in the third grade, it was recess time, and I was having a philosophical conversation about death with a grasshopper I had just caught.

Ever since I could remember, I was fascinated by death. But my life was characterized more by loss than by death. When I was three, there were no funeral processions …

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Slowly, slowly

The real cost of MOC is stunning

Tara F. Bishop, MD, MPH

Physician

August 11, 2015

In the past few years there has been tremendous criticism of the American Board of Internal Medicine’s (ABIM’s) maintenance of certification (MOC) program. The MOC program was significantly expanded in 2014 and required doctors to get 100 MOC points every 5 years and do at least one MOC activity every 2 years. These requirements also came with increased fees for the MOC program and increased failure rates for the recertification …

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The real cost of MOC is stunning

Is solving the primary care crisis easier than we think?

Stephen C. Schimpff, MD

Policy

August 10, 2015

Part of a series.

There is a crisis in the provision of primary care in the United States. If you are a patient, a primary care doctor, an insurer, an employer or a policy maker, this crisis is exceptionally important to you. The crisis means that Americans do not get the level or quality of health care that they deserve and need. This crisis is the major reason that …

This is what a successful direct primary care practice looks like

Rob Lamberts, MD

Physician

August 10, 2015

I recently attended (and spoke at) the Concierge Medicine Assembly in Atlanta. My role was to give the perspective of a “successful” direct primary care (DPC) practice. This being the second such conference in three weeks, I’ve learned that my panel of 600+ patients and survival for two and a half years puts me in the higher ranks of solo DPC practices. The Atlanta conference was actually a combination conference, catering to …

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