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“I did not want a baby”: A medical student faces her hardest choice

Anonymous

Conditions and Diseases

November 2, 2019

I did not want a baby. As a 26-year-old third-year medical student who had quite recently ended a far from ideal relationship — of this, I was certain.

On vacation, in New York City, walking in Soho carelessly, I laughed with my friend Noelle over the fragility of condoms. “Trust me,” I said. “They break.”

How many months in my sexually active life did I apprehensively count and recount the number of …

How to structure financial incentives in our health care system

Taylor J. Christensen, MD

Health Policy

November 2, 2019

Next in a series.

In my previous post, I explained the basics of my Healthcare Incentives Framework, which enumerates the jobs we want a health care system to do for us and links them to the parties in the health care system that have the greatest incentive to fulfill those jobs. If you haven’t read that post, I recommend you read it first. For those …

MKSAP: 28-year-old woman follows-up after a pre-employment physical examination

mksap

Conditions and Diseases

November 2, 2019

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

A 28-year-old woman undergoes follow-up consultation regarding a pre-employment physical examination. She reports feeling well, with no recent illness. Medical history is notable for gastroesophageal reflux disease. Her only medication is omeprazole. She is black.

On physical examination, vital signs and other examination findings are normal.

A peripheral blood smear shows …

Parallel thinking won’t solve problems in health care

Paul Pender, MD

Health Policy

November 1, 2019

A lot of media attention, including television, print, and online sources, is focused on various plans to revolutionize the delivery of health care in America. Critics point to medical errors, waste of resources, and lack of access among the numerous factors requiring the replacement of our health care system. To many politicians and think tank experts, the combination of government support programs (including Medicare, Medicaid, and Social Security disability) plus …

What physicians should know about good debt vs. bad debt

Altelisha Taylor, MD, MPH

Physician Finance

November 1, 2019

As a young college student or post-grad, you may have accumulated credit card debt. I certainly did. However, somewhere in the process of “adulting,” you may have realized that having lots of debt isn’t a good thing. You may have even heard investment gurus like Dave Ramsey preach that all debt is bad and insist that people do any and everything to rid themselves of the terrible “D-word” as fast …

The devastating impact of being told one has cancer

Don S. Dizon, MD

Conditions and Diseases

November 1, 2019

As an oncologist, I have seen the devastating impact of being told one has cancer. The reaction I most often see among my patients is fear that they’ve been given a death sentence, an urgent need for a plan, and hope that they will survive. I often want patients to know I too sense their …

How ZDoggMD inspires this physician

Charles Feng, MD

Physician

November 1, 2019

Though I owe a debt of gratitude to all of my internal medicine attendings, none of them can claim credit for getting me through the gulag of residency. That distinction, instead, belongs to Zubin Damania, alias ZdoggMD, an internist and purveyor of viral YouTube music videos.

I first became aware of Damania’s videos when a med school friend sent me a link to his online archives, resulting in one …

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How ZDoggMD inspires this physician

Cancer can be an adventure into the soul

Pat Wetzel and Sherry-Ann Brown, MD, PhD

Conditions and Diseases

November 1, 2019

Storytelling is as old as humanity. In telling our stories, we share, learn, and ideally pass along wisdom. As Isak Dinesen once wrote, “To be a person is to have a story to tell.”

This story starts with PW’s cancer diagnosis in 2009. Nodal marginal zone lymphoma: not curable, hopefully manageable.

For some, cancer invites a retreat within. For others, it can be a call to action. For me, it was a …

Psychological safety in health care: simple, important, fragile

Neil Baker, MD

Physician

October 31, 2019

With the epidemic in health care of overwork, stress, and burnout, psychological safety is a crucial factor in achieving the highest levels of quality of care and quality of work environment. While simple in concept, psychological safety is also quite fragile and needs careful attention on a day-to-day and conversation-to-conversation basis to assure it.

Psychological safety means that people feel safe to speak up about concerns, new ideas, negative feelings, and …

Data has become a four-letter word in primary care

Allison Edwards, MD

Physician

October 31, 2019

We primary care physicians hate data. Taken on their own, numbers are benign, but when we hear the word “data,” physicians are reminded of a litany of related issues that make our lives far more difficult: checkboxes. Regulatory compliance. Prior authorizations. Unnecessarily complicated payment schemes.

By virtue of our training and the principles that guided the decade we spent obtaining our degrees, we are empiricists by nature. It’s sad to think …

Sexual recovery after cancer treatment

Anne Katz, RN, PhD

Conditions and Diseases

October 31, 2019

The couple that entered my office on a warm fall day seemed out of sorts. She looked nervous, and he looked irritated. Before he sat down I heard why he felt that way: “I don’t even know why we’re here.“

I explained briefly what my role is but this did not seem to clear up anything.

“I just want her to be …

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Sexual recovery after cancer treatment

Crazy is how you feel when working within a system you feel you cannot change

Nina Mirabadi

Health Policy

October 31, 2019

You know that one patient? The one who calls the nurses every five minutes and keeps hoarding the jello cups down the hall? She has a thousand problems but doesn’t bother to take care of herself. She keeps coming back complaining about her issues and wasting our time by asking the same question again and again without listening to what we say. And don’t get me started on how awful …

An ode to a cadaver

Anthony Carli

Medical Education

October 31, 2019

It is easy to feel the gravity that accompanies the act of caring for those whose souls are still stuck to the surface of the earth. Their nerves still feel. Their skin still bleeds. Their eyes blink, and their hearts beat. Their chests rise and fall and rest for a moment before this rhythm repeats. They cry when poked and, sometimes, ask if they are going to live or die, …

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An ode to a cadaver

Our healers need healing

Anonymous

Physician

October 30, 2019

I woke up to him, pacing the bedroom.

Within an hour, I was pacing the ER at his bedside.

Our experience at one of the country’s best-ranked hospitals lasted only three days before we were discharged home. What led us there will last a lifetime in our minds. When faced with your own mortality (or that of your husband’s), you are forever changed. We are grateful for his continued recovery from myopericarditis. …

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Our healers need healing

Patients: Be proactive in your health care

Ton La, Jr., MD, JD

Conditions and Diseases

October 30, 2019

If you’ve ever been in the hospital for a surgery, you probably had a resident speak to you about the procedure; you were presented a laundry list of risks, the benefits mentioned, asked if everything was understood. And finally, you initial in several spots before signing your name on the dotted line. You looked at the wall clock and noted that the conversation took a mere six minutes.

Is this proper …

A physician’s plea to patients

Sasha K. Shillcutt, MD

Physician

October 30, 2019

I am a cardiac anesthesiologist. I meet most patients I care for minutes before I take them to the operating room and render them unconscious. I breathe for them, administer pain medicine and drugs to give them amnesia, and I keep their hearts, lungs, kidneys, and brains working.

Pretty important stuff.

I want to speak on behalf of physicians.

I want all patients to know something: We need you to talk to us.

We …

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A physician’s plea to patients

How to make compassion your personal pain reliever

Michael Maddaus, MD

Physician

October 30, 2019

Five months ago, “little kids” started visiting my father-in-law, stealing things. The hallucinations and dementia progressed, and we were forced to move him to a memory care unit.

Memory care unit is the polite term for a lockup unit for people with dementia. Walking through the locked doors for the first time triggered in me an intense urge to run away.

First, you encounter the “dementia parking lot” with the “inmates” parked …

This pediatrician gives her kids candy on Halloween. Here are 7 guilt-free candy tips.

Jennifer Trachtenberg, MD

Physician

October 30, 2019

I’m a pediatrician, mom of three. And to many, this may come as a surprise, but yes, I give my kids candy on Halloween. And I don’t mean the organic, gluten-free, non-GMO, no artificial colors or flavoring, good for you “treats.” I’m talking about chocolate, caramel bars, gummies, and sour balls. Personally, my all-time favorite is red Twizzlers (yup, I’m admitting over the internet) Nevertheless, I have spent over two …

Why developing new antibiotics is a losing battle

Christopher Johnson, MD

Medications

October 29, 2019

“We believe that the current entrepreneurial development model for antibiotics is broken and needs to be fundamentally transformed.”

This provocative opinion is from a recent editorial in the New England Journal of Medicine. The introduction of penicillin, the first antibiotic miracle drug, led to an 80 percent reduction in mortality from infectious diseases. Other antibiotics quickly followed, reducing death rates even further. Over the past several decades, however, the discovery …

Why your doctor may be concerned about prescribing benzodiazepines

Arash Javanbakht, MD

Medications

October 29, 2019

As an academic psychiatrist who treats people with anxiety and trauma, I often hear questions about a specific class of medications called benzodiazepines. I also often receive referrals for patients who are on these medications and reluctant to discontinue them.

There has been increasing attention into long-term risks of benzodiazepines, including potential for addiction, overdose, and cognitive impairment. The overdose death rate among patients receiving …

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