Many physicians do not seem to grasp the risks inherent in physician employment agreements that impose a minimum threshold of wRVU production. However, there can be many pitfalls in these agreements.
What is the effect of the threshold?
The first pitfall is determining the effect of a threshold. Some agreements provide a salary “assuming a minimum threshold of” some number of wRVUs. I have reviewed many agreements with a provision like that …
“When people with ADHD are able to get the treatment that they need as soon as they’re diagnosed as children, it gives them the best chance to realize their full potential.” These were the words that hit me like a ton of bricks one day as my preceptor was talking about his experiences treating adult patients with ADHD. I was soaking up every bit of information as he was teaching …
Have you ever wondered how a single online comment might shape your reputation as a physician? I have, especially after reading a review that sardonically suggested I had earned my medical degree from Amazon (the company, not the rainforest). The jab was clearly meant to sting. Although I regret the dissatisfaction behind it, it gave me pause. How much weight do we give these offhand remarks, and what do they …
Every cardiology clinic has them: patients with swollen, aching legs and bulging varicose veins. We talk about conservative management: exercise, leg elevation, and, of course, compression stockings. And almost without fail, patients smile politely, nod, and then admit at the next visit: “I couldn’t wear them. They’re too tight, too hot, too uncomfortable.”
The paradox of a simple solution
Compression stockings are one of the most effective noninvasive treatments for varicose veins …
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Dentist Lincoln Harris discusses his article, “How cloud-based simulation training is revolutionizing dentistry.” Drawing on his background as a pilot, Lincoln exposes the critical training gap in modern dentistry, arguing that dentists …
I’ve seen clients start GLP-1 medications full of hope, and stop them feeling betrayed by their own biology. Some reached their limit with side effects: relentless nausea, fatigue, or the quiet loss of joy in eating. Others simply couldn’t afford to stay on. A few never saw the promised results at all. But for nearly all of them, the story ended the same way: one step forward, five steps back.
We …
Most midlife men don’t walk into our clinics asking for help. They walk in asking for labs.
They’ll tell us they’re “just tired,” “not as sharp,” or “feeling off.” They’ll blame work or age. They’ll ask for hormone testing or a quick fix. What they rarely say (and what most of us rarely ask about) is the deeper truth underneath the symptoms.
There is a silent crisis unfolding in midlife men, and …
My mother’s life was defined by silence. She was born in India. In a world where a woman’s worth was measured in duty: how well she cared for others, how quietly she endured. She was obedient. Her dreams were practical, her voice gentle. Never shared an opinion.
I used to think that by becoming a doctor (a woman with a career, a passport, a voice) I had escaped that silence for …
A 2022 KevinMD article raised concerns about generic formulations of ADHD medications. The author described what many patients and families had already discovered: Not all generics are created equal. For those of us who lived through the substitutions, the difference was not abstract. It was a roller coaster that intruded on daily life, even on vacation.
The generic in question was manufactured by Mallinckrodt. Unlike Concerta, which uses an osmotic-controlled …
In May, a published report indicated that changes indicative of Alzheimer’s disease (AD) were detected at age 24 via a blood test, which is increasingly available. These changes may begin earlier, but these were the study’s youngest participants. There are no medical treatments for these early manifestations, and aside from providing knowledge of a possible future and potentially causing anxiety, what value does the test hold? Unless a person has …
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Neurologist Carolyn Larkin Taylor discusses her article, “How medical gaslighting almost cost me my life.” Carolyn shares her terrifying personal story of being dismissed by her long-time gynecologist, who labeled her cancer …
During health care encounters with patients from diverse linguistic and cultural backgrounds, there is always a concern about information getting lost in translation between health care providers and their patients. Language and cultural concordance significantly affect the quality and effectiveness of health care delivery. Although phone-in interpreters, with or without video capabilities, are accessible online, none can match in-person interpretation. Even if high-profile political conversations have adapted to artificially intelligent …
I still remember the feeling of relief standing by my uncle’s bedside. The monitors were humming with steady rhythms; the surgical team was congratulating themselves on a textbook procedure. By all clinical metrics, he was a success story. The intervention worked. The pathology was addressed. He was “stable.”
We celebrated his discharge as a victory lap. We trusted that the packet of papers in his hand (filled with appointments, medication schedules, …
ADVERTISEMENT
The National Academy of Medicine defines diagnostic error as “the failure to (a) establish an accurate and timely explanation of the patient’s health problem(s) or (b) communicate that explanation to the patient.” Office-based practices are the predominant setting for malpractice claims related to diagnostic error.
Yes, office-based care settings.
Fast-paced, high-acuity emergency departments (EDs) have fewer malpractice claims related to diagnostic error than physician offices, according to recent research. Furthermore, 53 …
“No medical malpractice lawsuit is frivolous,” is the narrative echoed by plaintiff attorneys. Medical malpractice lawsuits are vastly underrepresented. Also, because frivolous lawsuits are too expensive to litigate, expense is a natural deterrent for filing one. Plaintiff attorneys have controlled this narrative for as long as I’ve been in practice since 1972.
Recently, I examined the veracity of this claim. Indeed, there are 66 million civil lawsuits filed in the …
Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Pediatrician Wendy Schofer discusses her article, “Why food perfectionism harms parents.” Wendy explains how the intense worry over family eating habits and ultraprocessed foods is often a symptom of a deeper issue: …
Keeping my head down and working through intern year was all I had known. My days blurred into nights, and my weeks into months. The dreary Pacific Northwest winters had only compounded this. Despite a quiet yearning for connection and community, I declined most social invitations. My sense of obligation did not end at the hospital doors. It followed me home, where expectations and emotional responsibilities lingered. I often felt …
Last winter, a senior nurse in our psychiatric unit told me, “The dashboard says we’re low-risk. But during night shifts, I don’t even feel safe walking to the bathroom.”
The monthly quality report on her desk said the same thing it had said for nearly a year: “Violence incidents: no significant difference among the three wards (p > .05).”
On paper, her ward looked normal. At the bedside, it was anything but.
Her …
The recent Atlantic article by Olga Khazan, “Avoiding Ultraprocessed Foods is Completely Unrealistic. Especially if you have kids,” brought a concern that I’ve carried for a long time into full clarity: Our worries about family weight and eating habits aren’t actually about the physical body. They’re about perfection. And they are a call to approach health completely differently.
I am a pediatrician working at the intersection of family stress, emotional …
The British tend to use the term “carer” for the people who help other persons with needs. It seems to emphasize its root word, care, with implications for family members, volunteer helpers, and professionals who fill that role. The American term tends to be “caregiver;” its usage has become more common.
Even when I worked in health care, I had never used either of those terms. But over the last fifteen …
Get free updates delivered free to your inbox.
