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The role of IVs and central lines in critical care

Conditions

July 22, 2012

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

As a critical care anesthesiologist, I care for patients when they are most vulnerable. Critical care patients require intravenous (I.V.) fluids and medications, frequently through central venous access. These are catheters inserted into larger veins with a special procedure. I believe managing I.V. lines requires procedural skills, …

Do people need to suffer the consequences of their bad behavior?

Greg Smith, MD

Physician

July 19, 2012

You know the headlines. You read them and hear them and see them every day.

Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage.

A family including mother and young children in a van are …

How much does surgery cost? About $147 a minute

Nate Johnson

Physician

July 17, 2012

The patient had a large abscess surrounding his spleen. On a large screen in the middle of the operating room, I watched a surgeon drain the fluid collection and remove the organ with small metal tools.

I remember the surgeon navigating the complex anatomy with alacrity, handling the laparoscopic equipment with expert finesse, and quickly and confidently answering the battery of questions from the assisting medical student. To a young and …

9 essential tips for new medical students

WhiteCoat, MD

Education

July 17, 2012

Whether you’re starting medical school or beginning your second year, this post is for you. Will probably work just as well for PAs, NPs and any other health professional student who hasn’t started clinical rotations.

Our former babysitter just graduated from medical school and the WhiteCoats are just as proud as her parents are. Then I started thinking, what advice would I give to students starting medical school?

Our first day of …

How will ObamaCare affect prostate cancer screening?

Paul Hsieh, MD

Policy

July 11, 2012

When President Obama turned 50 last year, he made an “informed patient request” for a PSA (prostate specific antigen) test. This is the blood test routinely used to screen men over 50 for possible prostate cancer. The President received his PSA test. But under ObamaCare, you may not be able to.

Now that ObamaCare has been upheld by the Supreme Court, all of its major provisions will be in force, …

Tips to be the best intern you can be

Mary L. Brandt, MD

Education

July 6, 2012

Across the country, newly minted doctors have started their internships. The first night on call there won’t be an intern – anywhere in the country – who will sleep. Every new intern is absolutely convinced that the beeper is going to go off and they won’t know what to do. (You get over this by about the 2nd or 3rd call night, by the way).

Graduating from medical school …

Read more…

Tips to be the best intern you can be

Take the time to educate yourself before forming an opinion

Alex Lickerman, MD

Physician

July 5, 2012

Student loan debt is at an all-time high at a little over 1 trillion dollars, a figure that now, for the first time ever, exceeds our nation’s credit card debt. Higher education has never cost more, the rate of rise of college tuition having exceeded in recent years the rate of rise of many other services. Perhaps as a result of this, as well as of the difficulty in obtaining …

Do oncologists have an incentive to prescribe expensive treatments?

Peter Ubel, MD

Meds

July 4, 2012

A recent economic analysis concluded that patients with metastatic cancer value their treatments significantly more than regulators recognize, with many expensive new therapies looking like veritable bargains to most patients. Yet the study ignored the values really driving oncology spending—the warped incentives oncologists have to promote their own bottom line by prescribing expensive treatments.

Let’s start with the economic analysis, another in a series of studies by a USC team of …

The moments that define the job of a physician

Allison Overmon

Education

July 2, 2012

One of the most intense moments of my third-year of medical school was during my internal medicine clerkship when a code blue was called.

It was our responsibility as medical students on the inpatient service to report to every code blue while we were on our calls every 4th night. This time was no different, and my call partner and I ran to the code. When we arrived, I recognized the …

Don’t accept the face value price of a drug

Marni Nicholas, MD

Meds

June 28, 2012

Everybody knows that some medications can cost a lot of money. I always try to take the cost to my patients into account when prescribing a medication- after all, if someone can’t afford it, they are not going to take it. When it’s appropriate (and 9 times out of 10 it is), I try to prescribe a generic medication. They are much cheaper and work just as well as the …

10 topics to discuss with your teen this summer

Natasha Burgert, MD

Conditions

June 27, 2012

In a pediatrician’s office, summertime is teen check-up time.

And, I love it.

Annual checkups are a time for me to catch up on the school year, brag about amazing extra-curricular accomplishments, and swoon over summer vacation plans. It is also a time for anticipatory guidance, private conversations, and facing the often sobering reality of teen life.

Throughout this past year, I have had the privilege of being involved in the lives of many …

Lesser known symptoms of seasonal allergies

Sakina Shikari Bajowala, MD

Conditions

June 26, 2012

My boys and I suffer from tree pollen allergies. More than birds chirping or flowers blooming, I have come to associate boogery sleeves and sneezing with the onset of spring. But these are the typical symptoms, which are easily recognizable as allergy-induced.

What I’d like to address in this post are some lesser known symptoms of seasonal allergies, which may also be rearing their ugly heads this spring. Red eyes and …

Why I chose to become a rural primary care doctor

Josh Bell, MD

Physician

June 25, 2012

My mom always told me she gave me the “doctor name” (apparently my name looks good with an MD after it), so in some ways I knew from an early age that this was going to be my profession. Though I toyed with the idea of being a bank teller in kindergarten, I realized after a while that this was really not the job I thought it was (no offense …

How families cope with the surgical waiting room

Kevin R. Campbell, MD

Physician

June 20, 2012

All of us hate waiting in lines. Our society breeds a “me-first” attitude. Often the lines in which we wait are slow to move and, we become irritable and angry. Somehow there is always someone who is able to outsmart the system and get served ahead of their place in the queue. In the typical queue at the grocery store, (or at the apple store genius bar) we become impatient because …

Why doctors should attend residency graduations

Wes Fisher, MD

Physician

June 19, 2012

June in the United States heralds the month when residencies end and new ones begin. While much will be written soon about the dangers of entering hospitals this time of year (this story never seems to tire with mainstream media), I would like to step back and reflect on why doctors should consider attending residency graduations. I had the pleasure of doing so recently.

Excitement. With all of the dreary news of …

Should medical students consider a combined psychiatry residency?

Julia Frank, MD

Education

June 19, 2012

“What about combined psychiatry-family medicine-neurology-internal medicine programs? Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?”

Every April, I field such questions from a slew of rising fourth year students who have become, to their surprise (and sometimes dismay), passionately interested in psychiatry. Psychiatry is a shortage specialty and psychiatric issues rank high among the challenges facing medical care systems here and around the world. For …

James Reason and the foundation of patient safety

Robert Wachter, MD

Physician

June 18, 2012

Professor James Reason is the intellectual father of the patient safety field. I remember reading his book Managing the Risks of Organizational Accidents in 1999 and having the same feeling that I had when I first donned eyeglasses: I saw my world anew, in sharper focus.

Reason’s “Swiss cheese” model, in particular – which holds that most errors in complex organizations are caused not so much by …

Marcus Welby, MD is still relevant today

Hans Duvefelt, MD

Physician

June 17, 2012

The year is 2012. A 58-year-old veteran Family Physician who has just finished a day with more human heartaches than clinical triumphs settles down among the pillows with his wife in front of his MacBook to watch a movie, delivered wirelessly over the Internet:

“The year is 1969. A 62-year-old veteran general practitioner who has just seen his health threaten to fail him, speaks passionately to a group of doctors about …

Does it matter if your doctor is board certified or board eligible?

Christopher Johnson, MD

Physician

June 16, 2012

Does your doctor have something on the wall that starts with “American Board of … “?

The terms “board certified” and “board eligible” are confusing to people not in the medical profession. It doesn’t help that more than a few doctors blur the distinctions to their own benefit. This post gives you a brief rundown of the distinctions at stake.

The first thing to understand is that anybody who has graduated from …

Clinician researchers meet the physician scientists

Vinay Prasad, MD

Physician

June 15, 2012

Recently our department of medicine grand rounds was on the subject of asthma. It began with a clinical vignette about a child with asthma, lasting three minutes, and, was followed by 47 more of intracellular cascades. The talk was like many others this year, and the speaker, who was introduced as a physician scientist, lived up to the part.

As someone who works in an academic hospital, I know many physician-scientists. …