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When physicians inappropriately judge

Physician

September 1, 2019

All physicians naturally make judgments regarding the parents they are interviewing. For example, we assess how accurate and plausible their history is. We try to decide if they are telling us the whole story and, if not, if they are inadvertently or deliberately holding something back from us for whatever reason. All experienced physicians do this. What we rarely do, however, is judge the parents’ worth as people, as individuals …

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When physicians inappropriately judge

Why can e-cigarettes advertise on TV?

Michelle Andrews

Health Policy

September 1, 2019

Why does e-cigarette maker Juul advertise its product on TV when cigarette ads are banned? The short answer: Because it can.

For nearly 50 years, cigarette advertising has been banned from TV and radio. But electronic cigarettes — those battery-operated devices that often resemble oversized USB flash drives with flavored nicotine “pods” that clip in on the end — aren’t addressed in the law.

Since launching its product in …

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Why can e-cigarettes advertise on TV?

A nurse’s powerful ER exit letter

Jessica Nandino, RN

Health Policy

September 1, 2019

Dear hospital,

The last three years, I have had the pleasure of working in our state’s renowned emergency department and level-1 trauma center. My departure closes out a decade of my nursing career as an emergency room and flight nurse. This department — the staff, in particular — will forever hold a very special place in my heart. I leave with a great amount of respect and thanks for this exceptional …

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A nurse’s powerful ER exit letter

How nurse practitioners can expand abortion access

Vanessa Shields-Haas, RN

Health Policy

September 1, 2019

It has been a savage few months for reproductive rights, with 12 states passing 26 bills to ban abortion, including measures that ban abortion as early as six weeks into pregnancy, as well as attempting to outlaw safe methods of abortion. In the face of this extreme, unprecedented wave of attacks, several states pursued an alternative route, passing laws that expand the scope of abortion providers …

Today’s medicine is not the medicine I signed up for

Talia Sierra, PA-C

Physician

August 31, 2019

Today’s medicine is not the medicine I signed up for. I am a Xennial. Sandwiched between generation X and millennials, I don’t really belong to either. I didn’t grow up with the technological advancements that the millennial generation enjoy. I grew up with corded telephones, large box televisions, and without a computer in the house. We played in the streets until dark with the neighborhood kids and played board games …

Do physicians feel guilt and embarrassment more often than they admit?

Bobak Akhavan, MD

Physician

August 31, 2019

I was an intern, doing a rotation in the coronary care unit (CCU) of a large urban hospital. It was very challenging: The patients had complex medical issues, and my fellow residents and I were given lots of responsibility for their care. Still, I felt I was finally getting the hang of residency.

One of the first patients I saw was Mrs. Smith, a middle-aged woman who had come to the …

These medical students support Medicare for all. Here’s why.

Scott Swartz and Bradley Heinz

Health Policy

August 31, 2019

The most difficult part of our first year of medical school wasn’t memorizing anatomy or mastering the patient interview, but seeing firsthand how broken our current health care system is. We pay twice as much as other wealthy nations for health care, but receive some of the worst outcomes. Many factors contribute to this dysfunction, and one looms large: a medical system dominated by for-profit private insurers. We hear about …

MKSAP: 64-year-old woman with severe COPD

mksap

Conditions and Diseases

August 31, 2019

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

A 64-year-old woman is evaluated during a posthospital visit for severe COPD with an FEV₁ of 30% of predicted. She has been admitted three times during the last year with acute exacerbations characterized by cough, increased purulent sputum production, and dyspnea. She is now at baseline of her exertional dyspnea …

Is medicine really a model family-friendly profession?

Kristina Fiore

Health Policy

August 30, 2019

An article in the New York Times touting medicine as a family-friendly profession has stirred up critics who say it denies the reality of career sacrifice and gaps in leadership and pay that female physicians face.

Writer Claire Cain Miller profiled female doctors whose specialties afford them flexible work hours that make it easier to balance their professional and caregiving responsibilities. Britni …

Should hospital systems post physician salaries?

Smart Money, MD

Physician Finance

August 30, 2019

One of my coworkers who grew up in India told me that their teachers in grade school would post everyone’s scores in the hallway after every exam. This comparison of grades and objective testing further extended to cities and even regions in the country. There are people going through the hierarchical ranks with “gold medals” in science or engineering. Throughout this process, it was relatively transparent who the smartest or …

Doctors have little clue about what actually goes on in their colleagues’ offices

Michael Kirsch, MD

Physician

August 30, 2019

When I meet patients in the office, our conversations do not focus exclusively on the medical issue at hand. Of course, if you come to see me with a stomach ache, at some point, I will direct the dialogue toward your abdomen. Often, our conversations are far removed from livers and pancreases, and deal with more personal vignettes and anecdotes. Why does this happen? First, I enjoy it; and secondly, …

3 myths about financial freedom

Passive Income, MD

Physician Finance

August 30, 2019

Every July, we have some time to think about our independence and freedom. We also celebrate and spend time to be grateful for those that helped us achieve that.

Everyone reading this certainly has a lot to be grateful for. But I also know that there are those that might feel a bit trapped in their current life situation.

Some might hear the term “financial freedom” and think it’s …

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3 myths about financial freedom

Will separating obstetrics from gynecology help specialist burnout?

Robert Pearl, MD

Physician

August 30, 2019

At the end of a long table covered with hors d’oeuvres and a birthday cake, I struck up a conversation with three primary care physicians.

I was hungry for their opinions.

Inside the crowded apartment, we spoke for some 20 minutes about the systemic and cultural causes of burnout in primary care—a conversation that informed the first article in this series.

As I was about to leave, I …

What to consider before undergoing stem cell treatment or banking stem cells

Miles J. Varn, MD

Conditions and Diseases

August 30, 2019

It can be difficult to tease out the evidence-based science amidst the claims of successful adult stem cell-based treatments for a range of health problems from joint pain to Parkinson’s disease, macular degeneration, and spinal cord injury. Even a number of well-respected medical centers now offer patients regenerative medicine treatments that use the patient’s own fat or bone marrow cells or extracts created from platelets in their blood. …

The sensitive topic of physical contact during exams

Hans Duvefelt, MD

Physician

August 29, 2019

Touch is a sensitive thing. No pun is intended here, but whether and how we touch our patients deserves our careful thought and deliberation.

So much interpersonal contact these days is virtual, with emojis, abbreviations and whole words thrown around as substitutes for human contact. Think XOXO and, “hugs and kisses.” And when people do touch in our health care environment, it is often with gloves, even for simple fingerstick blood …

Just because EMRs can document everything doesn’t mean they should

Fred N. Pelzman, MD

Health Technology

August 29, 2019

It’s always kind of a surprise when you read a patient’s chart, and you see an examination of a body part they just don’t have.

Just the other day, I was reading a consult note on a patient of mine who had been seen by a subspecialist for evaluation of a serious issue, and I received back a long detailed office …

Life hacks from a 9-month-old infant

Andrew Wilner, MD

Physician

August 29, 2019

The problem

Sometimes, you reach a stage in life where each day has become predictable. Despite success, you slide into a rut. The status quo doesn’t cut it. Your patients are interesting, but not stimulating enough. Your staff is well-trained, but not helpful enough. You make a good living, but you’re not earning enough.

The ennui extends beyond the clinic and hospital. You live in a comfortable house, but it isn’t big …

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Life hacks from a 9-month-old infant

The costly decision of delaying surgery

Cullen Ruff, MD

Conditions and Diseases

August 29, 2019

It was a common enough reason for someone to have a CT scan. The order read, “Abdominal pain, colon cancer resected in January.” It was now March, only two months post-surgery. Yet the patient’s CT scan showed a number of large masses in the liver, consistent with metastatic cancer.

I compared the current study to the CT performed before surgery. The liver had looked perfectly normal at that time.

“That’s an amazingly …

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The costly decision of delaying surgery

It’s time to seriously study gun violence

Michael B. Bagg

Health Policy

August 29, 2019

I have been working on gun violence prevention for the past two years. After the Las Vegas shooting, I worked with a fellow medical student to create a course teaching medical students about gun violence and how it relates to medicine. We taught future physicians, the ones who will be responsible for treating gun injuries, about the complexities of firearms in America. I have spoken to medical student members of …

Why the Lancet’s editorial on Kashmir is unhelpful

Dr. Saurabh Jha

Health Policy

August 29, 2019

If Rudolph Virchow’s observation that “medicine is a social science and politics is nothing but medicine writ large” is true, then medicine is bias writ large because politics is nothing but bias on steroids. Virchow’s maxim is now adopted by medical journals which freely mix medicine with politics. No journal has taken this mixology to greater depths than the Lancet. In its pages, you’ll find tomes on the efficacy of …

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