We are, I trust, all but universally familiar with the knee-jerk, or patellar, reflex. A doctor taps the patellar tendon with a rubber mallet, and our leg kicks forward in response.
The reaction is famously unthinking. In fact, it is literally so. What makes a reflex a reflex is that the brain is substantially uninvolved. The stretch of a tendon by the mallet …
Beware your doctor’s knee-jerk reflex: 3 questions to ask
My patients lie to me every day. Some tell me that they have been taking their medications regularly when they haven’t. Some say that they have been eating a healthy diet and exercising for at least 30 minutes every day and don’t know where the extra pounds are coming from. Some lie that they are using condoms every time they have sex, that they have quit smoking, and if they …
Lying to receive pain medications hurts patients in true pain
Dr. Michael Pappas hates it when a nurse practitioner is called a mid-level provider: “Stop calling nurse practitioners mid-level providers.” So do I, though my reasons are a bit different. In order to understand them it will be necessary to revisit those dark ages, a time when such individuals were few and the roles played in the drama we know …
Solving the mid-level dilemma: Call them what they really are
“If a tree falls in a forest and no one is around to hear it, does it make a sound?”
Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn’t know what’s …
DNR/DNI: More code than status
Direct primary care (DPC) and concierge medicine are rapidly growing models of primary care. Though the terms are used interchangeably, both are not the same. Such liberal use of terms, many times by even those within the industry, confuses those who are attempting to understand how these primary care models operate. As former concierge physician for the Pebble Beach Resorts, and subsequent founder of one of the nation’s largest direct …
Direct primary care and concierge medicine: They’re not the same
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started …
MKSAP: 59-year-old man with intermittent itching
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 21-year-old man is evaluated during a medical examination for health insurance. The patient is a weight lifter. He has no medical problems and takes no medications or illicit drugs.
On physical examination, blood pressure is 128/73 mm Hg, pulse rate is 56/min, and respiration rate is 16/min; BMI is 30. Increased skeletal …
MKSAP: 21-year-old man with a heart murmur
Attention all doctors: The first three are mine. The rest are from miserable colleagues. All true. And common. If you’re a doctor and you recognize anything on this list, please quit your job.
10. You feel nauseated when you see your clinic logo; you alter your commute to avoid streets with your clinic’s billboard.
9. Discouraged by the general despair among staff, you …
Top 10 ways to know it’s time to quit your job as a doctor
Today’s article highlights the lingering problem of physicians buying and selling prescription medications to patients — at a profit.
The medical profession has struggled with this controversial practice for more than 150 years.
In George Eliot’s 1874 novel “Middlemarch,” an idealistic young doctor named Tertius Lydgate questions the ethics of fellow physicians who make handsome profits prescribing and dispensing their own remedies to the townsfolk. His medical colleagues shun him for it.
Around …
Oncologist pay and chemotherapy: Buy and bill needs to stop
There are two new high-tech ways that aim to help you with Kegel exercises, both with Kickstarter campaigns. There is the Skea (Smart Kegel Exercise Aid), basically a video game that proposes controlling the avatar with a vaginal probe that uses the pelvic floor muscles and kGoal, a vaginal insert that is meant to connect wirelessly with your smart phone and measures your squeeze …
Vaginal video games: What to make of mobile Kegel apps
While demographic data may suggest otherwise, I still consider myself a minority, albeit a less common one. I am a young woman in medicine, and I am a natural blonde.
I barely qualify for a prescription for eyeglasses, but I have found they give credence to my words and patients seem to take me more seriously. Perhaps three years of residency training …
The blonde minority: Sexism is alive in medicine
As a fourth-year medical student, it was fairly easy to maintain a healthy lifestyle. When you have much leisure time and are relatively stress free, you can eat healthy, stay physically active and maintain quality mental health. However, as I begin the journey called residency, it is clear that the task of maintaining my own health will be much more difficult.
But the importance of this task should not be overlooked. …
The unhealthy behaviors of physicians
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old woman is evaluated for a 2-week history of decreased exercise tolerance and substernal chest pain on exertion. She also has an 8-month history of macrocytic anemia.
On physical examination, temperature is 36.7 °C (98.0 °F), blood pressure is 137/78 mm Hg, pulse rate is 104/min, and respiration rate is 17/min. BMI …
MKSAP: 57-year-old woman with decreased exercise tolerance
Ink is everywhere these days, and I don’t mean on newspapers or in magazines. Tattoos are far more pervasive than I can ever recall in my fifty years. There was a time, when I was young, that boys were awestruck by the old Navy veterans, whose arms bore anchors, and the Marines with Semper Fi across their battle-scarred chests. Occasionally, when …
Consider the messages that tattoos are sending
A version of column was published in USA Today on July 2, 2014.
There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs. I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, …
Are American doctors paid too much or too little?
“Daddy, I think we have a flat tire.”
I just rolled out of the garage with my 4th grade daughter. It was Tuesday morning. Usual daily routine. Drop her off at school then go to work. A little different today as I was to lead an important meeting.
How could she possibly know what a flat tire sounds like? Now? Right now? She’s …
Chest pain and what we can learn from changing flat tires
We are at a pivotal moment in health care. It’s changing so rapidly even the people leading the change can barely keep up. One of the biggest paradigm shifts over the last decade is the focus on quality over quantity. Improving the health care experience and patient satisfaction are also being talked about in boardrooms across the country (largely due to the link with reimbursements, but still unthinkable a few …
A letter from a hospitalized patient to a hospital CEO
Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital. Yay me.
I went to visit a patient who was admitted over the weekend to see what was going on. She was a bit upset about the confusion of the hospitalist service and how orders apparently didn’t get written for her care by the admitting physician. …
At the hospital, I’m Dr. Nobody
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
Daily, and often several times a day, I am asked by patients about my role as a physician anesthesiologist. Occasionally the answer involves reiterating to patients that an anesthesiologist is a physician. Once we get into the discussion, patients are also surprised to learn that …
A primer on the anesthesia care team model
My recent New York Times op-ed on robot caregivers for older adults has elicited curiosity, enthusiasm and controversy.
I have to admit that my own first reaction to the topic was captured in the Times’ letter from Sherry Turkle whom I mention in the piece. I was in a meeting and turned to a colleague, clumsily patted her on the back and said, “It … …
10 potential benefits of robot caregivers
Get free updates delivered free to your inbox.
