When physicians deviate from evidence-based medicine

Conditions and Diseases
December 1, 2019

From time to time, patients ask my advice on colonic hydrotherapy, vigorous sessions of enemas that aim to cleanse the body of toxins that are reputed to cause a variety of ailments. The logic sounds plausible to interested patients. Over time, toxins accumulate and leech into the body, wreaking havoc. Indeed, using the label “toxins” already suggests that these are noxious agents. If one accepts this premise, it is entirely …

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When physicians deviate from evidence-based medicine

What car racing taught me about physician burnout

Physician
December 1, 2019

Back in 2016, my hospital, also my employer, changed the EMR. I was fully integrated into another EMR, so changing was not on my to-do list in the later part of my career as a diabetologist.

As you would expect, the transition was a nightmare and took me to a new low in my life. Crying in my wine became my new norm. I became distraught, felt imprisoned, and felt that …

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What car racing taught me about physician burnout

9 hacks that will increase your clinical efficiency immediately

Health Technology
December 1, 2019

I recently spoke with a colleague who transitioned out of the military in the last year. He was previously excited about his new job opportunity, but now a year later, he tells me, “I hate civilian medicine.”

I was surprised because he had been excited about the opportunity to teach in a residency program again. He said, “I love teaching, and I love the residents. …

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9 hacks that will increase your clinical efficiency immediately

Health care needs new presentation techniques

Health Technology
December 1, 2019

“So, if you look at this table, you can see that group X had a small but statistically significant increase in mortality over group Y. What does that tell us? It suggests that maybe there is some signal that intervention A is better than intervention B.”

The slide has some table from some journal, and the speaker will then often circle some p-value and talk about the strengths and weaknesses of …

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Health care needs new presentation techniques

Doctors on TV: today vs. 20 years ago

Physician
November 30, 2019

I’ll admit it. I’m a medical-TV junkie, addicted to 21st-century doctor and hospital dramas (most of which are now streaming on Netflix and other services).

Although some physicians are bothered by sensationalized depictions of their profession, I appreciate these shows for what they deliver: equal parts entertainment and insight. On the one hand, medical dramas are made for our amusement. They’re theatrical escapes from reality, meant to be enjoyed from comforts …

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Doctors on TV: today vs. 20 years ago

Drugmakers discover tardive dyskinesia. And they profit in it.

Medications
November 30, 2019

Before direct-to-consumer ads, physicians tried to reassure patients they were probably fine. Today, drug ads and online symptom checkers do just the opposite. The most insidious are “unbranded” ads that scare people about a disease without mentioning the drug they are trying to sell. Notable unbranded disease campaigns sell the obscure exocrine pancreatic insufficiency, shift work sleep disorder, and non-24-hour, sleep-wake disorder. Unbranded advertising is designed to appear like a …

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Drugmakers discover tardive dyskinesia. And they profit in it.

The stethoscope is not just a prop

Physician
November 30, 2019

Stock photos of “health care workers” who attend patients — physicians are no longer distinguishable — usually feature a stethoscope draped around the neck.

But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”

The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence and the rubber tubes by sophisticated …

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The stethoscope is not just a prop

MKSAP: 38-year-old man with dyspnea on exertion

Conditions and Diseases
November 30, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 38-year-old man is evaluated for a 6-month history of dyspnea on exertion. He has gastroesophageal reflux disease and Raynaud phenomenon. He does not smoke and has no cough or wheezing. Current medications are lansoprazole and amlodipine.

On physical examination, vital signs are normal. Oxygen saturation is 91% breathing ambient …

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MKSAP: 38-year-old man with dyspnea on exertion

Doctor: You were strong. You are still strong today.

Physician
November 29, 2019

You were strong in college

You were strong enough to get through weed-out classes in undergrad.  You were strong enough to balance the extra-curricular activities and clinical shadowing expected of you while crushing a 21-hour semester.  You were strong enough to say, “no, I have to study” when friends wanted to go out because you had a dream of becoming a doctor someday.

You were strong enough to pay for the applications, …

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Doctor: You were strong. You are still strong today.

The first lesson in medical school: Say you’re sorry

Physician
November 29, 2019

I paced in the hallway outside of the patient’s room, going over my mental checklist of items to do during the history and physical examination. Bringing in a paper list was discouraged; we were meant to “flow” through the exam “naturally.”

I stuffed my hands into the pockets of the white coat I’d received three weeks earlier, during the White Coat Ceremony for first-year medical students. Feeling around the deep pockets …

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The first lesson in medical school: Say you’re sorry

What would an optimal single-payer health care system look like?

Health Policy
November 29, 2019

Next in a series.

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge …

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What would an optimal single-payer health care system look like?

The secret to travel doctor success? Bring your family.

Physician
November 29, 2019

I recently returned from my second extended stay in New Zealand with my family. The entire experience was wonderful, but perhaps our most memorable day began with our three teenage sons waking up early to surf in the South Pacific Ocean. Once we had our fill of tropical paradise, we jumped in the car and drove a few hours to the local ski resort, where we found 10 feet of …

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The secret to travel doctor success? Bring your family.

Physicians are usually adulting in every other aspect of their life except money

Physician Finance
November 28, 2019

This week my wife and I celebrated our 31st wedding anniversary. It made me think about how my life has changed from when I was a single freshman in college. A time when I didn’t always do the right thing. I knew it was against both the law and school policy to drink alcohol at my age during a frat party, but I sometimes did it anyway.

We know we have moved …

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Physicians are usually adulting in every other aspect of their life except money

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3 reasons every physician investor should consider self-storage as part of their alternative investment portfolio

Physician Finance
November 28, 2019

We talk with a lot of physicians every day who ask us a simple question.  “Why should I invest in self-storage?”  Obviously, as a self-storage operator, we are biased, but there are three data points that we believe make this a fantastic asset class for physicians to evaluate for their own portfolios.

Wait a minute, self-storage is a legitimate asset class?  Some statistics on the self-storage industry that may surprise you.  …

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3 reasons every physician investor should consider self-storage as part of their alternative investment portfolio

7 reasons why it’s hard to be kind

Physician
November 28, 2019

Why do so many of us (meaning me) need to be reminded to act with kindness? Why can’t we “just do it”?

Yesterday, a friend asked me why we don’t celebrate World Kindness Day every day. I believe that’s a wonderful idea. But in practice, it’s not so easy. So, I got to thinking about why that is.

If we want to spread the ripple effects of kindness — to our families, …

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7 reasons why it’s hard to be kind

Doctors shouldn’t be horse whisperers

Physician
November 27, 2019

I scribbled my signature on a pharmaceutical rep’s iPad today for some samples of Jardiance, a diabetes drug that now has expanded indications, according to the Food and Drug Administration. This drug lowers blood sugar (reduces HbA1c by less than 1 point) but also reduces diabetes-related kidney damage, heart attacks, strokes and now also admission rates for heart failure (from 4.1% to 2.7% if I remember correctly – a significant …

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Doctors shouldn’t be horse whisperers

I’m a surgeon and I don’t depend on narcotics

Physician
November 27, 2019

I recently had a conversation with a new patient who was referred for surgery.

As it happens, she discussed me with people she knew before her appointment. I like patients to look me up, talk to friends, find out who I am, and come with an expectation of what they will get in my clinic. We had a normal new patient visit, and per my typical workflow, I explained the agenda: …

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I’m a surgeon and I don’t depend on narcotics

What will happen when the mentally ill get older?

Patient
November 27, 2019

Jacob is just past 30 by a year or two. He is, as I like to describe him, a little boy trapped inside a man’s body and very much mentally ill. He started off with fetal alcohol syndrome, which means his mother drank heavily when she was pregnant. I am not sure I believe that diagnosis is correct, by the way. Fetal alcohol syndrome is a much more complicated condition …

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What will happen when the mentally ill get older?

3 reasons why smart doctors fail big exams

Medical Education
November 27, 2019

OK, quick — word association time.

I say “doctor,” and you think what? “Smart,” right?

And it’s true. Doctors are smart. But before you buy into the myth that every doctor has breezed through school and could fall out of bed with a #2 pencil and crush an exam without thinking about it, consider that over 1,100 internal medicine doctors fail their board exam every year.

And that’s just one medical specialty. When …

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3 reasons why smart doctors fail big exams

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