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Understanding the uproar over Zohydro ER

Meds

March 30, 2014

In March 2014, Zohydro ER (hydrocodone extended-release) was introduced to the market. Never in my medical lifetime do I recall a medication stirring such angst. Worries of mass overdoses, backdoor FDA conspiracies, and blatant disregard for the public well-being abound. Is there method to this madness?

Zohydro ER is a pain pill that, when taken by mouth, is released slowly over twelve hours. The active ingredient, hydrocodone, is an opioid (i.e. narcotic) that’s been around for decades …

4 keys to manage medical malpractice stress syndrome

Dianne Ansari-Winn, MD, MPH

Physician

March 30, 2014

Most physicians will be sued for malpractice during their career. A group at Harvard has estimated that by age 65, more than 75% of physicians in low-risk specialties such as family medicine and 99% of physicians in high-risk specialties such as surgery will have been sued. Over 95% of physicians do experience emotional distress during some or all of the process of litigation. Malpractice suits can take between …

Choosing a perfect residency: What goes into a rank list

Michael Richardson

Education

March 28, 2014

What do you do when your ideal residency program does not exist? This is a truth that all perspective applicants must come to terms with, but I was still hoping that I would be the exception. I had created my list of everything my top family medicine program must have, including strong research mentorship, dedicated faculty, and a welcoming resident environment, and I had an idea going into the interview season what …

Apps used to monitor blood pressure need better design

Leslie Kernisan, MD, MPH

Tech

March 28, 2014

healthvault BP app entry

Here’s a design approach that I really, really dislike: the scrolling wheel that is often used for number entry in iOS apps.

I find that the scrolling wheel makes it very tiresome to enter numbers, and much prefer apps that offer a number pad, or another way to touch the number you need. (Or at least decrease the number at …

Don’t shorten medical school: Shorten undergraduate training instead

Skeptical Scalpel, MD

Education

March 27, 2014

Should medical school be shortened to three years?

I say, “no.”

Here’s why.

There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase — residency training.

I do not see how medical students can choose a career path before they have …

When doctors care too much

Hans Duvefelt, MD

Physician

March 27, 2014

Doctors today are often accused of being uncaring: Their eyes are glued to their computer screens and their attention is focused on test results and technology instead of patients.

But some doctors care too much: A seasoned cardiologist blogs about letting his emotions lead him astray in keeping an elderly patient on life support too long. Was it his emotional attachment to the charming, elderly woman, or was it professional hubris, …

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When doctors care too much

A 10-step process to finding a good doctor

Val Jones, MD

Physician

March 25, 2014

Most people, including physicians, rely on personal references to find a good doctor. But what do you do when you’re far from home, or you don’t know anyone with firsthand knowledge of local doctors? My parents recently asked me to recommend a physician for them in a state where I knew none of my colleagues personally. This is the 10-step process that I used to help them navigate their way …

What are the characteristics of a good primary care physician?

Stephen C. Schimpff, MD

Physician

March 25, 2014

Next in a series.

As a general rule, PCPs like people. This was true of them long before they started medical school and it will have only blossomed further during training. Ask PCPs, as I have with in depth interviews, and they will tell you that certain types of individuals are drawn to primary care careers.

They like to converse with people. They enjoy getting to know about a person — …

Weighing a patient offers a treasure trove of information

Greg Smith, MD

Physician

March 21, 2014

As a psychiatrist, I was trained to begin the mental status examination and overall assessment of my patient as soon as I greeted them in the waiting room. Even now, three decades after finishing medical school, I follow almost the same sequence of actions in my day-to-day interactions with my patients that I did as a resident in training. Granted, there are now electronic medical records and I rarely come …

Young patients with adenomas: Who should get genetic testing?

Patrick M. Lynch, MD

Conditions

March 20, 2014

While it is unusual for gastroenterologists to see colorectal tumors in patients under the age of 50, and even more uncommon before the age of 40, it does happen, so patients need to be aware of their risks. Colorectal tumors in young people are often detected either through symptom evaluation or because of a colonoscopy performed for an underlying risk factor, most commonly a family history of colorectal cancer (CRC).

During …

This is why doctors practice cover your ass medicine

Shirie Leng, MD

Physician

March 20, 2014

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A small case with big implications almost escaped my notice recently The Boston Globe reported a case in which a family sued after a 23-year-old man died after being diagnosed with a lung infection.

According to the Globe, the young man went to one of the Boston emergency rooms complaining of cough, fever, and chest pains. OK, stop right there all …

Is Match Day outdated?

Allison Bond

Education

March 19, 2014

Match Day: It’s among the most memorable moments of medical school, a time when students, friends, family and faculty gather to open those coveted white envelopes. It’s the symbolic first step out of medical school and into residency, and a tradition that is beloved by many. Yet the matching process is viewed by those outside of the medical profession (and to some within it) as a very odd way to …

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Is Match Day outdated?

People die without love: Why I prescribe the love drug

Pamela Wible, MD

Physician

March 17, 2014

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As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love.

During medical school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the …

The disturbing confessions of a medical scribe

Anonymous

Physician

March 9, 2014

As a medical scribe working with a large, well-known scribe company, unnamed to protect my job, it makes me proud reading all the articles published about how much having a scribe benefits a physician, especially in the emergency department. I enjoy my job immensely and I am grateful for the opportunity to learn and engage in patient care. However, as a …

Tips for expats working in health care

Rajka Milanovic Galbraith, MD

Physician

March 9, 2014

How does a working mom and physician keep practicing medicine when her husband’s career brings her halfway around the globe? For me, it was an adventure. While it can be challenging, I encourage other physicians to experience the world with their families while still practicing medicine.

As a 14 year family practitioner from Ohio, I suddenly found myself in Qatar with two young children because of my husband’s job. Qatar is …

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Tips for expats working in health care

Aviation and anesthesiology: The importance of training

James R. Mesrobian, MD

Physician

March 8, 2014

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

Comparisons between the airline industry and anesthesia care are common. One of the most commonly heard analogies is that the takeoff and landing of a jetliner are similar to induction and emergence during a general anesthetic. But there are other equally important analogies between the two …

The request to leave AMA is a signal for an honest conversation

Ishani Ganguli, MD

Physician

March 7, 2014

His nurse paged me at 9pm: Mr. L wants to leave against medical advice (AMA). As the covering doctor, I dreaded the impending standoff even more than usual.

I emerged from the elevator minutes later to find that the gaunt octogenarian had advanced from his isolation room, passed the nurse’s station and the unit doors, and arrived at the elevator bay to greet me. Security guards hovered at a cautious distance …

The societal problem of opioid addiction

Albert Fuchs, MD

Meds

March 6, 2014

Opioids are a family of pain medications chemically related to opium and heroin. They include morphine, fentanyl, codeine, hydromorphone and others. Opioids have unique properties that make them both indispensable for pain management and extremely dangerous.

Unlike virtually any other family of medications, opioids have no maximum effective dose. If any dose, no matter how high, is ineffective at controlling pain, a higher dose can give more pain relief. Most other …

Treating a symptom is not the same as treating a disease

Michael Kirsch, MD

Conditions

March 6, 2014

Physicians and patients collaborate to treat symptoms. This is not newsworthy and even sounds appropriate. Isn’t that what doctors are trained to do? It is but I’m not sure this should be a central focus of our healing mission. Treating a symptom is not the same as treating a disease.

For example, if an individual is having abdominal discomfort, pain medicine should not be the first responder, even if this would …

The myth of the entitled single mother remains as relevant as ever

Rhea Boyd, MD

Physician

February 28, 2014

There is a disconcerting myth about single mothers that has been circulating in our society for some time. It was popularized in the Reagan Era as a denunciation of US social welfare policy and resulted in a pointed caricature of a woman on welfare, forever to be known as the “welfare queen” or the entitled single mother.

The narrative of such a woman goes something like this: Not only is she …