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Clinical pearls that you don’t learn during medical training

David Sack, MD

Physician

March 29, 2013

Al Franken, the humorist-turned-senator, once published a book that was titled “Oh, the Things I Know!” Indeed, by the time we reach parenthood, it is truly amazing what we keep up there in that attic of a brain.

Here is a brief selection of things about the practice of medicine that I have had to discover for myself or never quite figured out, including clinical pearls, aphorisms, dictums, platitudes, mysteries and …

Where can doctors publish literary writing?

Louise Aronson, MD

Physician

March 29, 2013

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There are many ways to write about health, medicine, and health care. And there are many people – patients, caregivers, policymakers, pundits, thought leaders, and health professionals – in a position to do so.

Fortunately, the world also offers a similar and growing diversity of places in which to publish this sort of work.

My focus today is more, well, literary.

I know the word “literary” often …

Why coroners should fill out death certificates

WhiteCoat, MD

Physician

March 27, 2013

I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they are being “burdened” with hundreds of extra cases every year that they must handle. And if other doctors don’t sign off on the cause of death, sometimes it takes two …

The resurrection of coenzyme Q10: It’s all about the money

David L. Katz, MD

Meds

March 26, 2013

A recent meta-analysis published in the American Journal of Clinical Nutrition suggests that coenzyme Q10 is of benefit in congestive heart failure. For those who like the idea that food and nutrients can be excellent medicine, this paper is interesting at the very least. But there is a case to be made that it is far more than that. There is a case to be made …

How can you tell if adjuvant chemotherapy works?

James C. Salwitz, MD

Conditions

March 25, 2013

Think you know something about oncology? Ok then, pop quiz: If you are giving chemotherapy to a patient who does not have cancer, how can you tell if it works? Ridiculous question? Not at all. The answer to that question is; “hopefully, we will never know,” and it is at the core of modern cancer care.

In the 1960s, breast cancer surgeons had a serious problem. They were doing large complex …

8 reasons why your practice needs to stay open during lunch

Cheryl Bisera

Physician

March 24, 2013

Most professional business enterprises nationwide understand that they could never expect to compete in the marketplace if they shut down their phones 20 – 25% of important business hours every day. Yet that is exactly what your medical practice is doing if you are shutting your phones down for a “lunch break”.

You might be wondering how important can this really be for a medical practice? Can’t patients just wait an …

Measuring quality: What doctors and teachers have in common

Shirie Leng, MD

Policy

March 21, 2013

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I was watching Jon Stewart recently, and he had Michelle Rhee on. For anyone who doesn’t know her, she’s the superintendent of schools in Washington D.C. who made a bunch of reforms that caused some controversy and resulted in her being one of the main spokespersons for education reform in this country. Her conversation with Jon made me realize the similarities between …

Medical malpractice stress syndrome: The ignored side of litigation

Sherry Gorman, MD

Physician

March 21, 2013

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In March 2008, prominent Denver business owner Leslie Fishbein suffered cardiac arrest and died after receiving trigger point injections with bupivacaine for chronic neck pain. Ms. Fishbein owned a chain of high-end furniture stores. She was well known within the community because of her starring role in television commercials promoting her business. Her death drew tremendous media attention and heavy scrutiny for …

I’m a part time physician, and I’m not sorry

Katie Noorbakhsh, MD

Physician

March 20, 2013

I began the medical school application process 10 years ago. I was 23, single and most of my role models worked full time. I had no idea that a part-time medical career lay in my future. Quite a bit has changed since the days of hoping and praying and crossing my fingers for a medical school acceptance letter. In the past 10 years I have, at varying times, declared …

Questions to ask before your CT scan

Toni Brayer, MD

Physician

March 18, 2013

The United States is higher in its use of computed tomography (CT) scans than any other industrialized country. There were about 3 million scans done in the U.S. in 1980. By 2007 that number had risen to 70 million. A number of articles published in medical journals over the past few years have reported that excess radiation delivered by these scans will …

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Questions to ask before your CT scan

Violence and severe mental illness: 6 questions to ask

Annette Hanson, MD

Physician

March 17, 2013

Recently one of our readers posted this comment:

“If any Shrink Rapper ever has the time and inclination it would be interesting to read about what you would do to fix the mental health system, particularly the issue of involuntary hospitalization, if you had unlimited funds and political resources. You’ve been in the trenches, it would be great to hear your thoughts.”

Over on Peter Earley’s blog I see that …

How to avoid becoming a gunner in medical school

Wayfaring MD

Education

March 15, 2013

gunner: a pre-med or medical student who is ambitious to a fault. They often throw other students under the bus, put their accomplishments and grades on display, and generally make life miserable for any student who they perceive to be a threat to their own success. In short, they are what Hermione would be if she was a Slytherin.

On my blog, I am fairly vocal about my disdain for gunners. They …

The act of incising human flesh is never routine

Sid Schwab, MD

Physician

March 15, 2013

Next in a continuing series.

The preliminaries are over. Sponges, needles, and instruments have been counted and checked, their number recorded on a whiteboard on the wall, as well as a clipboard. The checkoff is a comforting hum of words; the tuned machinery of the workplace. As the bottle of local is opened and poured into a sterile bowl on the …

My workflow for going through old paper charts

Leslie Kernisan, MD, MPH

Physician

March 14, 2013

A few months ago I wrote a post about the 159 page digital fax that I received, containing records for a patient’s recent lengthy hospitalization.

I’ve now discovered something even more time-consuming and annoying: a 202 page paper record mailed to me by a major medical system. (I won’t name names right now; suffice to say this system uses Read more…

My workflow for going through old paper charts

Doctors: Pronounce the names of your patients correctly

Deep Ramachandran, MD

Physician

March 13, 2013

I have it on good authority that it’s not easy being green. But I’m willing to wager that it’s a whole lot easier when you have a lovable name like “Kermit.” Imagine being green (or brown) with a name like “Ramachandran”? Growing up with a name like mine certainly had its disadvantages. While most neighborhoods have a local bully who kicks ass and takes names, in my case, he would …

Working in an urgent care center: An assault on the soul

Richard Young, MD

Physician

March 12, 2013

I recently received this email message from one of my residents who has moonlighted in a local commercial urgent care center. This message is reprinted with his permission just as I received it, except I removed the brand name.

Hey Dr. Young, I’m looking for some basic mentoring advice. I’ve been moonlighting at ZZZ Urgent Care for about a year. Not my favorite work, but oh well. I don’t routinely prescribe antibiotics …

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Working in an urgent care center: An assault on the soul

Let no broken hip go unfixed: When a surgeon fails to communicate

John Schumann, MD

Physician

March 10, 2013

She was 94-years old with advanced Alzheimer’s. She thought it was 1954 and asked if I wanted tea. Not a bad memory for someone in a hospital bed with a broken left hip.

She’d fallen at her assisted living facility. It was the second time in as many months. She’d broken her collarbone on the previous occasion.

Over the past year, she’d lost 30 pounds. This is natural in the progression of …

When it comes to medical residents, patients have a choice

Shirie Leng, MD

Education

March 8, 2013

A resident is a person who has an MD, meaning they have completed 4 years of school, but they are not yet qualified to actually do anything. An MD is just a piece of paper saying you did your time in the lecture hall/lab. Residency is where you learn how to be a doctor. The term “resident” originates from the old days in which newly-minted doctors were actually living at …

You may be surprised at what family physicians do

Aaron George, DO and Dennis Gingrich, MD

Physician

March 7, 2013

There are surprising misconceptions about what family physicians actually do in practice.

Americans maintain a fond respect for the classic image of the family physician, making house calls with black handbag in tow. They admire the Marcus Welbys of the world. While this classic image is endearing, it should not be confused with the 21st century family doctor. The modern family physician is trained to engage in the adaptable world of health …

Medical journals that accept stories and essays from physicians

Louise Aronson, MD

Physician

March 6, 2013

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Health and health care are hot topics lately, and not just for journalists and bloggers debating Obamacare. Suddenly – or so it seems; in fact the trend has been building for years – people from all walks of life want to read about medicine.

Within medicine, a majority of journals now have essay, viewpoint, or perspectives sections. Not only are such sections frequently …