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After residency: I’m scared to practice outpatient medicine

Education

December 3, 2014

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As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this?

Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient …

Why teaching anatomically correct words matters

Natasha Burgert, MD

Physician

December 2, 2014

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As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals.

In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have …

Two patient result letters: Which one did this physician send?

Lucy Hornstein, MD

Physician

December 2, 2014

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Middle-aged lady, twenty pounds overweight.

Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.

Yada, yada, yada.

Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …

Medicare’s perverse incentive to keep patients on dialysis

Natasha Deonarain, MD, MBA

Policy

December 2, 2014

One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients.

I began to understand this paradox clearly when I listened to my friend’s anguish.

She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town …

Medicare will pay for care coordination. Should doctors take the money?

Richard Hodach, MD, PhD

Policy

December 1, 2014

CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients. When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …

Consider the lipstick sign in your next physical exam

Elizabeth Horn, MD

Conditions

December 1, 2014

The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning.

Fine motor skills and concentration can be correlated with a positive …

$2.6 million: Is the cost of becoming a doctor worth it?

Richard Gunderman, MD, PhD

Education

November 30, 2014

Each year, over 20,000 U.S. students begin medical school. They routinely pay $50,000 or more per year for the privilege, and the average medical student graduates with a debt of over $170,000. That’s a lot of money. But for some who pursue careers in medicine, the financial cost has been considerably greater. Melissa Chen, 35, a final-year radiology resident at the …

Having children during medical residency: 6 tips to survive

Jasmine Almeida

Physician

November 27, 2014

We had our first child during the fourth year of my husband’s ophthalmology residency, and our second son joined us during the first year of a surgical retina fellowship. Juggling long hours, multiple medical commitments and the needs of two small children can be exhausting but every day is complete with fulfillment and laughter — and who can ask for anything …

What a messy house has to do with medicine today

Abigail Schildcrout, MD

Physician

November 25, 2014

I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time.

I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of …

How to survive a night float rotation

Kerri Vincenti, MD

Education

November 24, 2014

I recently began a rotation at the hospital as one of the night float interns. As part of this responsibility, I manage the care for approximately fifty patients each night. Day after day, I perform the same routine in preparation for the night ahead: Grab my stethoscope and pager, claim one of the code pagers, pick up a time sheet to fill in the nightly team to-do’s and mentally prepare …

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How to survive a night float rotation

What will future of medicine look like? Start here.

Bertalan Mesko, MD, PhD

Tech

November 23, 2014

Excerpts from The Guide to the Future of Medicine.

Enormous technological changes are heading our way. If they hit us unprepared, which we are now, they will wash away the medical system we know and leave it a purely technology–based service without personal interaction. Such a complicated system should not …

Reflections after the first cadaver lab

Avi Friedman

Education

November 22, 2014

“To help other people overcome their injuries.”

This mantra was accompanied by flushed faces, hidden trembling hands, and nervous chuckles as the majority of my peers told the class why they decided to pursue physical therapy as a career. Soon thereafter, this adage was lost as we dived into our studies, learning every bone, muscle, and organ. Focusing on the human body is a must for all healthcare professionals, and PTs …

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Reflections after the first cadaver lab

Why does Medicare pay resident salaries?

Ramin Lalezari

Education

November 16, 2014

Training doctors is no easy task. After medical school, newly minted doctors enroll in residency programs at various hospitals throughout the country for a length of 3 to 8 years, depending on their specialty. Some specialties, like family medicine, are even considering adding another year to the process. Resident physicians spend this time working long, arduous hours under their attending physicians, learning the clinical intricacies of their specialties that could not …

When is it right to share our personal struggles with patients?

Alexis Drutchas, MD

Physician

November 15, 2014

I remember the day like it was yesterday. I was 10 years old, dressed in kid pajamas with sleep still in my eyes. I walked upstairs with a sense of purpose. “I can’t take it anymore,” I told my parents. At that point it had been a year since we found the surgeon who was finally able to offer the chance …

Physician suicide 101: Secrets, lies and solutions

Pamela Wible, MD

Physician

November 13, 2014

This article adapted from a lecture presented by Pamela Wible, MD, at the 2014 American Academy of Family Physicians Scientific Assembly in Washington DC.

Why did you go to medical school?

I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I’m unhappy with the direction …

Why do drugs cost so much?

Janice Boughton, MD

Meds

November 12, 2014

Drug prices are a difficult issue to write about because real data about the workings of pharmaceutical companies is very difficult to uncover. Still, I came face to face with something that seemed extremely not right and so I feel I should at least make some comment. It started when I prescribed a patient sumatriptan for her recently more frequent migraines. …

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Why do drugs cost so much?

It’s time to tell fast medicine to slow down

Richard Gunderman, MD, PhD

Physician

November 11, 2014

Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals …

Money has always been and will always be a big part of medicine

Edwin Leap, MD

Policy

November 11, 2014

Medicine is not about money, except when it is.

When I was in my residency training, pharmaceutical reps still roamed the land. Vast herds of gorgeous young women in tight skirts and stilettos traveled through doctor’s offices, clinics, hospitals and residencies all over creation. Their appearance was always a thing of joy, especially for sleepy, hungry physicians-in-training. Someone would run to the …

When you can’t share experience: The power of listening

Abigail Schildcrout, MD

Physician

November 11, 2014

I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference — she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through.

I have a different thought.

Although every experience …