I have been exposed to many patient interactions during my first year of medical school. However, my first real patient interaction was when I accompanied my attending to a homeless shelter in downtown Phoenix. I can clearly remember being very excited the day before the visit to the homeless shelter; this was to be the first time I would actually interact with real patients. …
To a patient: Stay strong. Don’t lose hope.
Note: This case is meant to illustrate the potential negative effects of inappropriate imaging. It is not intended as a diatribe towards any member of the health care team. Really the only “mistake” made here was the ordering of the CT scan in the first place.
A 37-year-old woman presents to her local emergency department (ED) with a 4-hour history of heartburn …
How heartburn caused a patient to lose her left leg
I am presenting my startup costs here, to give some ideas for those providers who are considering starting their own family practice, or for those who say it can’t be done anymore.
To become a business, I spent $50 for the state LLC filing, and $12 for business cards. I already had my medical license and DEA from residency, so the only certificate …
I started a family medicine practice for $11,000. You can, too.
The medical world has made terrific scientific and technological progress over the last century. Previously incurable diseases can now be treated as day cases, and patients no longer have to accept a paternalistic, one-sided relationship with their doctors. Hospitals too, have a come a long way if you look at pictures of what they used to look like in those old …
It’s time that all hospitals have single patient rooms
This cartoon is based on data from the 2015 Medscape Physician Compensation Report. Dermatology is on one end, internal medicine on the other. The other specialties in between. Doesn’t seem to be a trend between the cognitive and procedural specialities, which is a bit surprising. You’d think the latter would skew towards the “happiness” side.
Do you …
Where are you on the physician pain scale?
An excerpt from So You Got Into Medical School… Now What?: A Guide to Preparing for the Next Four Years.
By far one of the most unique experiences first-year medical students can have is working in the gross anatomy lab. From the potent smell of formaldehyde to the …
Gross anatomy: What’s a first-year medical student to do?
1. Due to intermittent monitoring versus continuous fetal monitoring which is standard in the hospital, the patient has increased mobility and a wider range of laboring positions/options: sitting, standing, walking, water, birthing balls. The American Congress of Obstetricians and Gynecologists (ACOG) has agreed that there is not a medical benefit to continuous fetal monitoring compared to intermittent monitoring in low-risk women.
2. …
10 reasons to have your baby at a birth center
I work in a place where nobody calls me by my name.
They all address me by a moniker of their choosing that I have asked them not to use. I have asked them to use my name. Aside from a few who respect my wish, most of my co-workers just call me by the impersonal-sounding phrase they’ve selected instead. It creates …
I’m a physician. But please don’t call me doctor.
Kaitlyn Elkins was a medical student at the Wake Forest School of Medicine in North Carolina and a member of the class of 2015. She excelled academically, named the valedictorian of her high school class and graduating summa cum laude from Campbell University. She wrote poetry in her free time. She had a cat, lovingly named Gatito. On April 11, 2013, just …
Medical student suicide: It’s impact is devastating. This case proves it.
We’ve all heard it said that learning medicine is like drinking from a firehose. Yet many students and schools don’t use one of the most effective study techniques available to them. Spaced repetition is a powerful, evidence-based study technique that can enhance learning and long-term retention of medical knowledge. Medical students and schools could both benefit from understanding and using spaced repetition to produce more knowledgeable and better-informed doctors.
Over a …
Want to enhance medical education? Use spaced repetition.
One of my favorite physician sayings is, “Don’t just do something, stand there!” Which means that it’s better to do nothing than to do something that doesn’t help. As I move through my career, I find myself agreeing. I am endlessly amazed at the number of things we do for no good reason, and that patients come to expect, also for …
The problems with a low salt diet
As someone who has practiced hospital medicine up and down the East Coast for the last several years, I’ve had the fortune of working with some absolutely terrific colleagues. The hospital environment is by its very nature a busy and hectic one — where we all put our heads down and work tirelessly at the coalface for hours on end. Doctors …
Doctors: Be sure to thank the case managers
There was once a woman whom I met for the first time when she came to the ER, on death’s door, metaphorically. I told her and her family just how seriously ill she was, and how slim the chances of survival. We all agreed on that day to take a shot at it — at survival, that is — despite lousy …
We all have the ability to touch other people’s lives every day
Evidence-based medicine (EBM) has been classically described as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” At first look, this well-accepted approach to clinical medicine appears not only completely reasonable, but also somewhat obvious given the immense amount of research available for academic consumption.
EBM has been repeatedly preached as the gold standard of clinical care across all medical …
The challenge of evidence-based medicine to the new physician
No one wants to hear that they have a disease. And yet everyone will develop some degree of degenerative disc disease (DDD) — or degenerative spine disease — over the course of a lifetime. DDD refers to a combination of age-related and wear-and-tear-related changes that occur within the spine over time. It is very common and a natural part of aging.
Most …
A neurosurgeon teaches us about degenerative disc disease
I used to be a surgical resident in the U.K. One day, I was a little dispirited during a brutal call, and my senior resident asked, “Do you love surgery?”
“I like surgery,” I replied.
“If you don’t love surgery, love it unconditionally I mean — like loving your child — you will be unhappy.” He warned.
I really liked surgery. I like radiology. …
Should I go into radiology? A radiologist gives honest answers.
Some months back I read an interesting interview with Jonathan Skinner, a researcher who works with the group at the renowned Dartmouth Atlas of Health Care. More than anyone else I can think of, the people at the Dartmouth Atlas have studied and tried both to understand and to explain the amazing variations we see in how …
The problem with cowboy doctors in health care
I didn’t really notice him standing in line. But how could I? Hundreds of kids came through the high school gym yesterday. His turn for the heart and lung portion of the high school sports physical had come. He said he was going to play baseball and basketball. How could he with that arm he carried so carefully? I am not …
A high school physical that shook this student to the core
What is it like for physicians to fail their ABMS Maintenance of Certification® (MOC) program examination? How does the largest member board of the ABMS, the American Board of Internal Medicine (ABIM), respond to doctors who fail their secure examination?
As I continue to confidentially collect information from physicians who have failed their MOC examination, I thought it would be important to publish …
So you failed maintenance of certification. What now?
An excerpt form Baby City: An Inside Look into Labor & Delivery.
I am going to make this medical student cry.
I don’t know how I know it, but somehow I can sense it. I know it the second she walks into the resident room on labor and delivery at Cadence …
A medical student on her obstetrics rotation: Behind the scenes
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