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From an ER physician: Write your own admitting orders

Edwin Leap, MD

Physician

April 7, 2015

While working at small rural hospital I was once again faced with the emergency physician’s dilemma. Admitting a patient and being told to write holding orders. In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counterintuitive electronic orders system. All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble …

Boarded to death: When will testing for doctors ever end?

Brian Levine, MD

Education

April 2, 2015

I am relieved and proud to report that I passed my boards: I am officially a diplomate of the American Board of Obstetrics and Gynecology. While the oddly formal “diplomate” is a term in common use with physicians, I didn’t understand what “diplomate” and its sister phrase “board-certified physician” meant until I undertook my own board preparation.

The Medical College Admission Test (MCAT) is a memorably stressful element of applying to …

This is what patient safety means to me

Christine A. Sinsky, MD

Physician

April 1, 2015

What does patient safety mean to you?

I believe patients get the safest care when

The patient is known as an individual.
The health care team gives the patient their undivided attention.
The team is well-supported with efficient workflows and organized, easily accessible information.
The health professionals find joy in their work.

By being “known” I mean, that the nurses and physicians know the patient as a real person, what their life is like, who are their …

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This is what patient safety means to me

Capturing moments of innuendo in the emergency department

StorytellERdoc, MD

Physician

April 1, 2015

Although I pride myself on catching the obscure snapshots of typical life moments that occur daily while dealing with patients and their families in the emergency department, occasionally there are times when I am so focused on the task at hand that I completely fail to see a glaring moment of obvious humor, sadness, or tenderness. At times like this, then, I am glad to have our hard-working nurses and …

As a doctor, I need to understand power, trust, and pain

Cia Bishop, MD

Education

March 31, 2015

“You have the nurse hand you the equipment, that way she doesn’t just stand and stare like a chaperone,” my doctoring mentor explained to me before we entered the room to do a pap smear on a young, 35-year-old woman. My doctoring mentor is a middle-aged, 6-foot-5, exceptionally hairy, broad-shouldered man that carries a warm, jovial presence. Yet the reality of the fallen world is that no matter how sweet, happily …

Ground rules for the aspiring surgeon

Matt McCarthy, MD

Physician

March 29, 2015

An excerpt from The Real Doctor Will See You Shortly. Warning: Contains explicit language.

It started with a banana peel.

After years of quiet study in the libraries, laboratories, and lecture halls of Harvard Medical School, I finally made the tectonic shift to hospital life in the summer of 2006. The third year of medical school marks a …

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Ground rules for the aspiring surgeon

Can introverts survive in medicine?

Nathaniel Fleming

Education

March 27, 2015

Does the profession of medicine favor certain personality types over others?

When I was younger, it seemed like all of my doctors were gregarious, self-confident, and humorous, leaving me to wonder if one can “make it” in medicine without being outgoing. This seemed a natural consequence of the fact that so much of medicine is team-based and demands constant interpersonal interaction with colleagues and patients. For many introverts, a career in …

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Can introverts survive in medicine?

Patient refuses ED discharge: Admitted to the hospital against medical advice

FirstWorldEM, MD

Physician

March 27, 2015

The following article is satire.

In the first application of a new “reverse AMA” system put into place to improve patient satisfaction, a patient was admitted to the hospital for the first time against the wishes of her treating ED physician. Constance Dolor, a 37-year-old morbidly obese patient with chronic unexplained pain and a frequent visitor to the emergency department, became the first person in known history to be admitted the …

I’m not apologizing for my part-time role in medicine

Anonymous

Physician

March 26, 2015

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Over the course of pre-professional and professional education, my colleagues and I have had numerous moments of self-doubt. Would the next organic chemistry exam eliminate my 3.99 GPA? Would the MCAT decide what medical schools would immediately ignore me without ever meeting me? Would the sheer volume of material weed out the persons sitting next to me in medical school or …

The day that I truly became a cardiology fellow

Chiduzie Madubata, MD

Physician

March 24, 2015

shutterstock_141857752

As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies.

As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is …

The last breath can be seen as a the passage into eternity

Kathryn A. Hughes, MD

Physician

March 24, 2015

Eonia I Mnimi (Eternal Memory)
– Greek Orthodox Funeral Blessing

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.

***

My uncle had been declining for several years with Lewy …

Television ruins your sleep. Here are 5 ways how.

Deep Ramachandran, MD

Conditions

March 24, 2015

As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; any more than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of …

Are cardiac risk calculators accurate?

Kenneth Lin, MD

Conditions

March 23, 2015

After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient’s estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline’s new risk calculator had not been validated in …

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Are cardiac risk calculators accurate?

What does it mean to live in the age of Abilify?

Steven Reidbord, MD

Meds

March 23, 2015

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S. To be a top seller, a drug has to be expensive and also widely used. Abilify is both. It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill. Annual sales are over $7 billion, nearly a billion more than the next runner-up.

Yes, you read that right: $30 a pill. A little more …

8 reasons why you should marry a female physician

Jamie Coleman, MD

Physician

March 23, 2015

A couple of years ago, I asked a friend of mine how she met her husband. It was at a bar, and when she asked his occupation he replied, “I work for the city.” She took that to mean he was a construction worker. They began dating and quickly fell in love. Much to her surprise about a month into their …

Heart-wrenching photo of a doctor crying goes viral. Here’s why.

Pamela Wible, MD

Physician

March 20, 2015

Outside of a Southern California hospital, an ER doctor is crouched down against a concrete wall grieving the loss of his 19-year-old patient. A paramedic snaps a photo of the tender scene. His coworker, a close friend of the doctor, posts the photo (with permission) online. Minutes after the photograph, the doctor returns to work “holding his head high.”

Thousands of people have …

Eulogy for the doctor

Michael Brant-Zawadzki, MD

Physician

March 17, 2015

No physician, however conscientious or careful, can tell what day or hour he may not be the object of some undeserved attack, malicious accusation, blackmail or suit for damages … “
– Assaults Upon Medical Men. Journal of the American Medical Association, 1892

It’s happened again: A well-liked doctor is killed by his patient. Last year’s horrific death of a physician in our community, a …

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Eulogy for the doctor

Want your ER physician to leave happy? Do these things.

Thomas Paine, MD

Physician

March 17, 2015

I have been doing emergency medicine for almost ten years — thirteen if residency counts, and I sure think it does. I face the same issues that cause my work colleagues, physicians and nurses alike, to burnout. I struggle with burnout myself, but I keep coming back. Many days (and nights), I ask myself why I continue to do what I …

3 myths and 3 truths about hospice

Monica Williams-Murphy, MD

Physician

March 17, 2015

As I travel around speaking about preparing for peace at the end of life, I have found that there are three pervasive myths about hospice that might cause you to inadvertently rob yourself or your family of a peace-filled end-of-life experience.

So, I am taking on the job of myth-buster to clear the air. Here goes:

Myth #1: Hospice is a place. While hospice can be a place, it is primarily a service. …

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3 myths and 3 truths about hospice

Surprise! When it comes to a vaginal hysterectomy, this insurance company gets it right.

Jennifer Gunter, MD

Conditions

March 16, 2015

The preferred route for a hysterectomy is vaginal. This means the entire surgery is done through the vagina with no incisions in the abdomen of any kind. The joke among surgeons is that it is a bit like taking a car apart through the muffler. While doing surgery entirely through the vagina may sound highly complex, it’s really just like any surgery. A vaginal hysterectomy done correctly it is an …

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