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MKSAP: 35-year-old woman with constipation

mksap

Medications

June 8, 2019

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

A 35-year-old woman is evaluated for constipation. She reports passage of hard stool every 3 to 4 days and associated bloating. Her symptoms have been present for more than 10 years and have progressed gradually. Trials of over-the-counter fiber supplementation and polyethylene glycol worsened the bloating, prompting discontinuation. Senna …

The journey from hand surgeon to entrepreneur

Eric George, MD

Physician

June 7, 2019

An excerpt from We: Ditch the Me Mindset and Change the World.

We use them to greet friends, congratulate acquaintances, and embrace loved ones.

To lay bricks, perform surgeries, and sculpt artwork.

Everyone uses them thousands of times a day in a variety of different ways.

It took me years to recognize the essential role they play in everyone’s life, no matter their age, ethnicity, or background. For someone with a …

In our health system, who “owns” patients?

Philip A. Masters, MD

Health Policy

June 7, 2019

A guest column by the American College of Physicians, exclusive to KevinMD.com.

When talking with patients – particularly those with multiple, complicated medical issues – it often doesn’t take very long to hear about their increasingly suboptimal and sometimes harrowing interactions with our health care system.

Examples include inpatient experiences in which care is provided by …

PTSD changed how this physician cared for pregnant women

Shivani Patel, MD

Conditions and Diseases

June 7, 2019

Appointments with my doctor make me nervous. That’s highly ironic, because I’m a doctor, a maternal-fetal medicine specialist who regularly deals with high-risk pregnancies. But ever since developing preeclampsia during my first pregnancy eight years ago, the thought of having my blood pressure taken triggers flashbacks and anxiety. The silver lining is that my experience has changed …

Bringing hospitality back to the hospital: lessons from a bartender

Cory Michael, MD

Physician

June 7, 2019

It was a beautiful day in southern California as I made my way along Interstate 5 en route to San Diego from Los Angeles. Seeking a venue near the ocean to get some work done on my computer and maybe a snack with my iced tea, I turned off the interstate in search of a restaurant I had heard about with a good local reputation and well-reviewed food.

The 9 types of manipulative patients

Jeffrey E. Keller, MD

Physician

June 7, 2019

One of the more common complaints that I hear from medical practitioners in jails and prisons (especially new practitioners) is, “These manipulative patients are driving me crazy!” Well, to be honest, I ran into a lot of manipulative patients when I worked in the ER, as well. But it is true that many of our patients in jails are especially …

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The 9 types of manipulative patients

3 steps to reconnect to who you are behind the white coat

Stephanie Wellington, MD

Physician

June 7, 2019

A doctor’s life is a life of service to others. In today’s medical arena, that service goes beyond patient care. As early as residency training, doctors have to learn how to navigate their workflow and the energy of nurses and other team members involved in the delivery of patient care. Doctors assume administrative roles and have to effectively manage their time between meetings and patient care. It’s easy to understand …

How depression made this doctor a better physician

Alistair MacDonald, MD

Physician

June 6, 2019

Residing in all of us, whether or not we feel it, is an innate zest for life. As a family medicine resident, I live with enthusiasm daily, because I am happy seeing patients, no matter my rotation. From the acute care wards to the family medicine clinic, I enjoy and relish the opportunities to sit with patients. Unfortunately, this zest for life was once lost on me, and at times …

Burnout prevention should be taught in residency

Kristin Yates, DO

Physician

June 6, 2019

I was not at all prepared for my transition from being a resident to an attending. Now that there are work hour restrictions and constant oversight during training, graduating residents seldom get a preview of what it feels like to be at the top of the decision tree. I am an OB/GYN physician, so for me, this meant that I went from being on call with a handful of other …

When physician pay packages become hospital kickbacks

Jordan Rau

Health Policy

June 6, 2019

For a hospital that had once labored to break even, Wheeling Hospital displayed abnormally deep pockets when recruiting doctors.

To lure Dr. Adam Tune, an anesthesiologist from nearby Pittsburgh who specialized in pain management, the Catholic hospital built a clinic for him to run on its campus in Wheeling, W.Va. It paid Tune as much as $1.2 million a year — well above the salaries of 90% of pain management physicians …

It is time to consider the health of health care workers

Sonali Mantoo, MD

Physician

June 6, 2019

As health care workers, we spend most days in hospitals, clinics, ambulances, and the like — places that are concrete containers for pain and human suffering. And we are bound to be affected by what we see, even if it isn’t apparent. Most people do not witness acute and extreme suffering on a daily basis. Between a comfortable home, car, school, grocery store or office, there is little opportunity to …

Would you trust Alexa with your patient data?

Elisabeth Rosenthal, MD

Health Technology

June 6, 2019

Amazon has opened a new health care frontier: Now Alexa can be used to transmit patient data. Using this new feature — which Amazon labeled as a “skill” — a company named Livongo will allow diabetes patients — which it calls “members” — to use the device to “query their last blood sugar reading, blood sugar measurement trends, and receive insights and Health Nudges that are personalized to …

A love-hate relationship with nursing

Debbie Moore-Black, RN

Conditions and Diseases

June 6, 2019

If you went to go to a museum in New York City and saw a live heart encased in glass, still pumping and pulsating — it would be my heart, shredded into a thousand pieces all in disarray. But it still would be pulsating. This describes my life as a nurse.

Nursing was a vacuum that sucked me dry and left me dangling with nothing more to give. Three years left …

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A love-hate relationship with nursing

How to save tens of thousands of dollars on your medical school loans

Rishi Thaker, DO

Physician Finance

June 5, 2019

If you’re planning on applying for Public Service Loan Forgiveness (PSLF) and spending the first ten years of your career in academic medicine or working for 501c(3) employers, this scheme could mean paying off your loans six months sooner, saving you an average of $30,000.

Consolidate your loans with your loan servicer and begin one of the income-driven repayment plans (IBR, RE-PAYE, ICR, or PAYE) immediately, foregoing any deferment or grace …

8 tips for having a baby while applying for residency

Molly Johnson, MD

Physician

June 5, 2019

Being a medical student is tough, applying for a competitive residency spot is tough, and being a new mother is also very tough. I am one of the lucky women to do all three at the same time. I had my child early August of my fourth year of medical school. The fourth year of medical school is a great time to become a new mother. The schedule is more …

How anti-vaxxers are just like the rest of us

Jennifer Reich, PhD

Medications

June 5, 2019

Whenever I talk about my research on how parents come to decide to reject vaccines for their children, my explanations are met with a range of reactions, but I almost always hear the same questions.

What is wrong with those parents?
Are they anti-science?
Are they anti-expert?
Are they simply ignorant or selfish?
Are they crazy?

The year is not half over, and the number of measles cases has now exceeded highs not …

Here’s the secret to emergency department efficiency

Phillip Stephens, DHSc, PA-C

Health Policy

June 5, 2019

A gray-haired emergency medicine physician once provided the most succinct view of ED efficiency ever uttered. He said, “Sometimes they ask us to dig a ditch. Then they give us spoons with which to do the job.” Though cynical, it is the view of many. There really is only one problem and a single solution to ED efficiency. The problem is variation. The answer is scale.

Biologists understand variability best. Biologic …

When gender identity confuses the electronic health record

Fred N. Pelzman, MD

Physician

June 5, 2019

One little thing.

Somehow, with the changeover to the latest release of our electronic medical record, something happened to some of the demographic information on our patients. Suddenly, an enormous number of patients were now labeled as choosing not to disclose their gender.

When I first noticed this, it was flagged in bright yellow on the banner in a patient’s chart when I …

School vaccine exemptions must be for medical conditions only

Shetal Shah, MD

Health Policy

June 5, 2019

No, vaccines do not cause autism.

No, vaccines do not cause cancer.

No, vaccines are not toxic.

No, getting the disease is not safer than vaccination.

Yes, they are safe. Yes, they are effective. As a pediatrician, I spend countless hours each week talking about vaccines and counseling parents about the importance of immunization. While parents may not know anyone with rubella, polio or tetanus — almost every parent knows someone who knows someone …

Physicians-in-training learn to cook for improved health outcomes

Joshua Rothman, MD and Tara Mataraza Desmond

Physician

June 4, 2019

If an apple a day can keep the doctor away, how much more can a delicious burrito bowl with citrus lime vinaigrette do?

About half of all American adults – 117 million — have one or more preventable chronic diseases, many of which are related to poor quality eating patterns and physical inactivity. According to the U.S. Office of Disease Prevention and Health Promotion, more than two-thirds of adults and nearly …

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