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Debunking the myth that life gets easier once you finish medical training

Physician

November 11, 2019

Residents and fellows around the country have bought into the “medical training myth.” The myth states: “Life will get so much better when I finish residency/fellowship.”

Sadly, too many house staff buy into this false belief and experience tremendous letdown when they graduate.

Residents often see their attending stroll into the team room with a cup of coffee at 8 a.m., ready to round. Meanwhile, they think, “I’ve been …

How we can help our veterans die in peace

Diane D. Blier, DNP

Health Policy

November 11, 2019

The World War II veteran, now in his 90s and receiving hospice for end-of-life care, was playing military anthems on his harmonica for fellow veterans. But the next minute, reliving the horrors of combat, he grew agitated and started to cry. “Oh, all those bodies!” he suddenly called out. “Terrible, terrible! Oh, the bodies.” He finally blurted out what he had kept to himself for decades. Two days later, he …

Including the patient perspective on tumor boards

Don S. Dizon, MD

Patient

November 10, 2019

I am a firm believer that medicine is best practiced as a team, with the one undergoing treatment at the center participating fully. It’s a belief embedded in the multidisciplinary care model. I have been fortunate to have been exposed to multidisciplinary clinics in my fellowship at Memorial Sloan Kettering Cancer Center and have worked …

The barriers to patients choosing higher-value providers and insurers

Taylor J. Christensen, MD

Health Policy

November 10, 2019

Next in a series.

I have developed a framework, which I call the Healthcare Incentives Framework, that helps me understand health care systems. It outlines the jobs we expect a health care system to do for us and identifies which parties in the health care system have the primary incentive to fulfill each of those jobs. This is helpful because, if we are unsatisfied with how …

How race plays a role in palliative care

Eve Makoff, MD

Physician

November 10, 2019

“Black life remains unexpected.”

I have been mulling over these words written by Ibram X. Kendi, in The Atlantic. This followed his piece exploring the “anniversary” of slavery in 2019. He experiences this 400-year marker both with hope and concern given the persistence of a split America: “Black death matters to racist America. Black life matters to African America.” He writes, “there may be no more consequential white …

Maybe being a physician was just not enough

Ellen C. Miele, MD

Physician

November 10, 2019

Do you ever see other people in their careers and think to yourself, “Maybe I could do that?”

I am a board-certified pediatric physician with over 25 years of experience in private practice, and I recently decided to try my hand at acting.

Much to my surprise, I was awful. It was almost as if there were basic premises of the craft that I did not understand at all. But I suppose that …

Why physicians should never try to time the market

Cory Fawcett, MD

Physician Finance

November 9, 2019

I read a Facebook post asking what people were doing about a recent market drop. As much as I watch the market (very rarely), I didn’t know the market had dropped until I read that comment. This question was raised on a site that is constantly teaching people that there is no way to time the market. Those who follow me always agree with this concept, until the market drops, …

A solution to reduce defensive medicine

David Lozar, MD

Physician

November 9, 2019

An excerpt from Technology and the Doctor-Patient Relationship.

As disturbing as the structure of malpractice insurance is in America, a more significant problem is the defensive style of medical practice it induces. In a large-scale survey done by Jackson Healthcare in 2010, between 73-92% of physicians self-reported ordering unnecessary …

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A solution to reduce defensive medicine

What physicians should do when life gets in the way

Stephanie Wellington, MD

Physician

November 9, 2019

There are times in our journey as doctors when life gets in the way. Well, life got in the way, and I had to go back to the basics and deepen my understanding and connection to myself and my source to easily navigate the curves and the bumps in the road.

I had to figure out a way to move through the tears that came with the diagnosis and poor prognosis …

MKSAP: 19-year-old man with lightheadedness and nightly fevers

mksap

Conditions and Diseases

November 9, 2019

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

A 19-year-old man is hospitalized with a 6-day history of lightheadedness and nightly fevers. He also reports sore throat, headache, joint and muscle aches, and a dry cough. He recalls a blotchy rash on his trunk and arms, which has resolved. He returned home 12 days ago from a …

What does a cardiologist think of the keto diet?

Deepti Bhandare, MD

Conditions and Diseases

November 8, 2019

Being a cardiologist, the most frequent question coming my way for the last few years is “Doc what do you think about the “keto” [ketogenic] diet.”

All foods contain both micronutrients and macronutrients that are essential for the body to function optimally. The human body requires macronutrients in large amounts, which include carbohydrates, proteins, and fats. These nutrients provide energy for your body in the form of calories. Micronutrients are nutrients …

4 essential tips for residency interviews

Vivy Tran, MD

Medical Education

November 8, 2019

I have just finished another round of that dreaded process that we call “the interview process.” Without fail, this process has haunted me almost cyclically every 3 to 4 years in the last 11 years of my life. First, there were medical school interviews, residency program interviews, and then lastly, fellowship interviews.

You would think that after so many rounds of applying, it would get easier. You would think after I …

Increasing strictness of gun laws correlates with fewer children killed by guns

Christopher Johnson, MD

Physician

November 8, 2019

Between 2011 and 2015 there were over 21,000 children killed by guns. This recent study in Pediatrics, the journal of the American Academy of Pediatrics, further analyzes the question; it compares pediatric firearm fatality rates among the various states and then tests for correlation between children killed and the degree of strictness or not of the state’s gun laws. There are extensive data on whole populations showing that stricter …

Physicians must first establish their life priorities

Meagan W. Vermeulen, MD and Todd Skertich

Medical Education

November 8, 2019

An excerpt from Career & Life Planning Guidebook for Medical Residents: The Best Part of Your Journey Is about to Begin.

Life is a journey. Where is this journey of life taking you? Do you know? If I asked you where you will be in seven years, could you tell …

A poem for the pediatrician on a Monday

Hila Beckerman, MD

Physician

November 8, 2019

It’s Monday, I recall as I step into work;
“Preparing for battle,” I say with a smirk.
Surviving all weekend with a sick kid in tow,
the parents’ relief as they waited to show
you their child with fever, diarrhea and sneezing,
the one who is too hot, too cold or is freezing,
the one who forgot that a helmet is needed,
the one who is eating too much, they conceded.
The one who still haunts you when …

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A poem for the pediatrician on a Monday

How illusions impact how we practice medicine

Navpreet Sahsi, MD

Physician

November 7, 2019

We can learn a lot about ourselves by looking at, and thinking about, perceptual illusions and our biases.

Look at the image above. The classic, Muller-Lyer illusion.

We know that the two lines are the same size. But no matter how much we intuitively “know” this to be true, we see the top line as bigger. We can’t unsee it — even if we …

How compensation can affect physician burnout

Sneha Mantri, MD, Andrew Spector, MD, and Nada El Husseini, MD

Physician Finance

November 7, 2019

Burnout in medicine has reached epidemic proportions. A recent systematic analysis found that the prevalence of burnout was as high as 80.5%. All medical specialties are affected, although prevalence rates of burnout vary widely between specialties.

Classically, burnout is defined as a triad of emotional exhaustion, depersonalization, and inefficacy. Recently, moral distress or moral injury has also been recognized as a potential component of Read more…

How compensation can affect physician burnout

Why diverticulitis can be an elusive diagnosis

Michael Kirsch, MD

Conditions and Diseases

November 7, 2019

I have been treating diverticulitis for 30 years the same way. When I suspect that a patient has this diagnosis, I prescribe antibiotics. This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through.

It is an easy task to miss the diagnosis. Every physician has done this.

The diagnosis can be …

The healing patient-physician analog relationship is in critical condition

Craig M. Wax, DO

Health Technology

November 7, 2019

In the history of medical care, medical records served one purpose and two masters: to record diagnosis and treatment for physicians to refer to and for patients to use to transfer care when they desired. The medical record was a simple 3 x 5 or ledger card in the 1950s. The patient paid directly for care at the time of service. Usually, the physician had a nurse and a spouse …

Health coverage really isn’t covering much

Todd Rice, MD, MBA

Health Policy

November 7, 2019

I’m a healthy 48-year old, ASA physical class I anesthesiologist. At least I was healthy until an unintentional 20-pound weight loss over the summer, accompanied by an unquenchable thirst, insatiable appetite, blurry vision, and the bathroom frequency of an elderly prostatic.

My lab workup would reveal a fasting blood sugar of 310 mg/dL, an A1C >14, positive urine ketones, low C-peptide, and glutamic acid decarboxylase antibody (GAD-65) level that was off …

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