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No doctor should have to side hustle to make a good living

Physician Finance

August 6, 2019

I would have thought that all doctors are on the same page about being overworked and underpaid, but I was surprised to read on a recent physician forum that some doctors claim that our profession overall is compensated adequately. Complacency tends to kill innovation, but hey, to each her own. Online forums certainly leave a lot of variables on the table — we’ve all seen trolls or even just people …

Who are the best educators for medical students?

Kunal Shetty

Medical Education

August 6, 2019

I shared my assessment and plan with the preceptor as she walked into the room. She cut me off, “You think this patient needs surgery?” she smirked. “He has no idea what he is talking about, don’t mind him,” she whispered loudly to the patient. I kept quiet until the patient left, and my preceptor began writing her note. I pulled up a recent research article I had found prior …

The importance of patient education before surgery

Steven Young, MD and Joseph Answine, MD

Conditions and Diseases

August 6, 2019

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

For years, research and common belief have supported the concept that patient education alters patient behavior and improves patient outcomes. For instance, lifestyle changes, implemented after improved physician-patient engagement and education, have demonstrated clinical benefits in a wide range of chronic illnesses, …

How have EMRs changed the doctor-patient relationship?

Michael Kirsch, MD

Health Technology

August 5, 2019

I have penned several posts on the pitfalls of the electronic medical record (EMR) system that we physicians must use. Indeed, I challenge you to find a doctor who extols the EMR platform without qualification. Sure, there are tremendous advantages, and the ease of use has improved substantially since it first came onto the scene. But, keep in mind that these systems were not devised and implemented because physicians demanded them. To the contrary, …

Physician burnout is as much a legal problem as it is a medical one

Sharona Hoffman, JD

Health Policy

August 5, 2019

A career as a physician has traditionally been considered to be among the best vocations that talented students can pursue. That may no longer be the case. All too many doctors report that they are unhappy, frustrated, and even prepared to leave the profession. That should worry all of us. The physician burnout crisis is likely to affect our quality of care and our access to health care providers.

According to …

Are the concerns about consumer genetic tests overblown?

Erik Parens, PhD and Paul S. Appelbaum, MD

Conditions and Diseases

August 5, 2019

When the Human Genome Project began in 1990, bioethicists feared that giving people the results of genetic tests would do them a lot more harm than good.

Experts feared that individuals who received genetic information about their future health status would be overwhelmed by depression or anxiety. Or as genetic testing became more widely available, it …

Has your doctor asked you about climate change?

Martha Bebinger

Health Policy

August 5, 2019

When Michael Howard arrived for a checkup with his lung specialist, he was worried about how his body would cope with the heat and humidity of a Boston summer.

“I lived in Florida for 14 years, and I moved back because the humidity was just too much,” Howard told pulmonologist Dr. Mary Rice as he settled into an exam room chair at a Beth Israel Deaconess HealthCare clinic.

Howard, 57, has chronic obstructive pulmonary …

How to prevent patients from falling through the cracks

Fred N. Pelzman, MD

Physician

August 5, 2019

Falling through the cracks, when it comes to health care, is a bad thing, but the way things are going, it’s getting harder and harder to avoid.

Providers in every setting are bombarded on all sides with data, results, messages, and things crying out — screaming — for our attention. Take, for instance, the conundrum that appears when a patient is …

Think of diagnostic excellence as playing smooth jazz

Robert Centor, MD

Conditions and Diseases

August 5, 2019

When we think about clinical reasoning, most talks focus on diagnostic errors and the reasons for those errors. The legacy of Kahneman and Tversky focuses on errors and the many named mistakes we make. We focus on avoiding errors, but their work and too often our teaching does not focus on the road to diagnostic excellence.

Gary Klein, the pioneer of naturalistic decision making, has focused more on the road to …

My residency spending plan: a new way to think about budgeting

Altelisha Taylor, MD, MPH

Physician Finance

August 4, 2019

As a young professional with many competing expenses, it is paramount for me to prioritize my spending. However, adhering to a strict budget can seem a bit daunting and restrictive. To get over this anxiety, I started out with a spending plan that mirrors the “50-30-20 rule” by allocating money into three different buckets: things I have to buy, things I want to buy, and things I should buy. Let …

The calm before the hospital

Meghan Gaffney Liroff, MD

Conditions and Diseases

August 4, 2019

I’m in the back of an ambulance rig driving 110 miles an hour down the highway with the lights and sirens blaring. The knuckles of my right hand are crushed every four minutes as my patient has contractions. She cries only a bit. She’s sixteen and her last period was nine months ago, but she hasn’t seen any other physician before me.

This last contraction was an intense one — my …

Read more…

The calm before the hospital

UpToDate? Information my cardiologists didn’t have.

Anonymous

Conditions and Diseases

August 4, 2019

I have always felt lucky and relieved when a cardiologist told me I seemed to be fine despite my heart condition. My condition, referred to as congenital, complete AV block, is estimated to affect between 1 in 15,000 to 22,000 live-born infants. The electrical block is more commonly seen among older, adult patients where it presents an acute pacemaker indication.

Researchers do not know very much about what causes the condition …

A critical discussion is needed about planned death

Tom Schaaf, MD and Hope Wechkin, MD

Conditions and Diseases

August 4, 2019

“Planned death.”

When you put it like that, this can only mean one of two things: suicide or murder. For most of us in medicine, the very idea of “planned death” seems safely outside our purview. After all, the bulk of medicine is concerned with staving off death. And the very nature of death’s uncertain timing enables practitioners of everyday medicine to take refuge in its mystery.

When necessary, we prognosticate. But …

Physicians need better PR

Rebekah Bernard, MD

Physician

August 3, 2019

On July 8, 2019, the American Academy of Emergency Medicine wrote a letter to the American Medical Association, asking the organization to create a public campaign to support physician-led care.

Noting concerns over the recent media crusade to promote nurse practitioner care to patients, including the American Association of Nurse Practitioners “We Choose NPs” campaign, the letter asks the American Medical Association to combat the …

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Physicians need better PR

What The Big Sick says about our profession

Lindsay Ripley, MD

Physician

August 3, 2019

“The Big Sick” is an intimidating name for a movie. I never know what to think when “sick” is used as a noun. Does it mean vomit? Are we referring to ailing people? Just as the name doesn’t give you much insight, neither does the beginning of the film. It has nothing to do with illness. It’s about a Pakistani standup comedian/Uber driver who starts dating a white girl, but …

Roundsmanship: the skill you didn’t know you needed

Shannon Casey, PA-C

Physician

August 3, 2019

“What’s the most common missed fracture?” my supervising PA asked during my clinical rotation in the emergency department. “The second one,” I answered confidently. It was the right answer, and I surprised him by knowing it. He had previously given a lecture to my class and had emphasized this clinical pearl in such a way that I knew it was one of his favorite trick questions.

Unfortunately, I didn’t always know …

MKSAP: 69-year-old woman with new-onset dependent edema

mksap

Conditions and Diseases

August 3, 2019

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

A 69-year-old woman is evaluated in the emergency department for new-onset dependent edema that began 3 weeks ago. She says it is difficult to walk, and she has gained 4.5 kg (10 lb) of fluid weight. History is significant for obesity and hypertension. Her only medication is lisinopril.

On physical …

When should physicians read the House of God?

Paul Sax, MD

Physician

August 2, 2019

Many consider the novel the House of God, written by Samuel Shem (pen name for Stephen Bergman), to be a must-read for any physician or soon-to-be physician. A fictionalized account of his internship year, the book details how the accumulated stress, fatigue, and powerlessness of being a first-year doctor inexorably accumulates during that year — with sometimes hilarious, and but also disastrous, results.

The survival strategies of the interns in …

Having health coverage isn’t the same as being covered

Peter Ubel, MD

Health Policy

August 2, 2019

Something like one in seven people living in the U.S. have no health care insurance. In fact, the number of uninsured people has grown by 7 million since 2016. These numbers are atrocious. Embarrassing. Shameful, actually, in a country as wealthy as ours. We need to recommit ourselves to guaranteeing people access to affordable health care insurance.

And then we need to go one step …

The entire medical education system needs sweeping change

Rachel Goossen, MD

Physician

August 2, 2019

In May 2019, headlines of a study out of University of Michigan hit the lay media: “New Doctors’ DNA Ages 6 Times Faster Than Normal in First Year.” Using DNA samples submitted by medical residents across the country, the Intern Health Study measured telomere length before and after residents completed their intern years. Loss of telomere length has been associated with morbidity, mortality, and even depression. A …

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