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The folly of using money to improve health care quality

Health Policy

February 20, 2019

Imagine you’re a CEO in charge of a health care organization with thousands of physicians and 19 hospitals.

Overall, the quality of care delivered is good. Prices and costs are low. But there is a problem: Patients rate your service below average. Making matters worse, a swarm of low-priced competitors have moved in, challenging your market share. You’re going to need to improve patient satisfaction to survive. What do you do?

About …

Physicians: Don’t make these mistakes when looking for your first job

Smart Money, MD

Physician

February 19, 2019

We all have either experienced the fears of starting our first job or will eventually do so at some point in our careers. It only happens once for everyone. Those of us who are in the market for a job change will end up reliving some of the challenges in job hunting; hopefully, we all have learned from our past mistakes. As I am advising upcoming graduates during their job …

A physician who’s always in control

Edwin Leap, MD

Physician

February 19, 2019

My friends and family used to say that I was born 30 years old. I get it. From the time I was young, I was controlled, risk-averse, studious, and polite. In addition to the fact that I was naturally reserved, I learned over time to do my best not to make anyone uncomfortable. I frequently refused to stand up for what I wanted, always deferring to the wishes of others. …

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A physician who’s always in control

Will the public be able to resist the pitch from 23andMe?

Michael Kirsch, MD

Conditions and Diseases

February 19, 2019

Just because something is legal, doesn’t make it right. Just because we enjoy a right of free speech, doesn’t mean we should be verbally insulting people. Just because the Food and Drug Administration (FDA) approves a treatment or a test, doesn’t mean we should pursue it.

The FDA has given approval to 23andMe, a private company, to provide genetic testing directly to individuals. The results provide genetic risks of contracting several …

Be careful of assigning the diagnosis of ADHD to young children just entering school

Christopher Johnson, MD

Conditions and Diseases

February 19, 2019

Attention deficit hyperactivity disorder (ADHD) is a common diagnosis in children today, and is increasingly a diagnosis assigned to adults, too. ADHD is a real thing, despite some having some skeptics and a few outright denialists; differences in brain scans between persons who have it and who don’t show there is a definite physiological basis for the disorder.

But in practice, we don’t do brain scans. We base the diagnosis on …

Why medical students need more continuity of care training

Nathaniel Fleming

Medical Education

February 18, 2019

One of the major challenges of being on medical school rotations is the necessity of changing rotations every four weeks, and how adapting to each new specialty feels like going through the first day of school all over again.

I want to share my experience on other side of the coin. About a year ago, I started participating in Stanford’s Continuity of Care program, a clerkship in which I am excused from …

Breastfeeding and newborn hospitalization rates: What should be done about it?

Roy Benaroch, MD

Conditions and Diseases

February 18, 2019

An August 2018 paper in Academic Pediatrics found an unsettling conclusion: Breastfed newborns have about double the risk of needing to be hospitalized in their first month of life, compared to babies who were formula-fed. The numbers are solid, and they jibe with the real-life experience of many pediatricians, including me. So what should we do about it?

The study itself looked at about 150,000 healthy, normal newborns born in …

Most physicians don’t realize how easy it is to become debt free

Cory Fawcett, MD

Physician Finance

February 18, 2019

Most don’t realize how easy it is to become debt free. Instead, they envision a horrible drop in lifestyle and great sacrifices that include turning back the clock to medical school days where they were living on peanut butter and ramen. When in fact, no sacrifice is required to become debt free. All it takes is to decide that becoming debt free is what you want and then stop borrowing …

Would you want to become a doctor again?

DocG, MD

Physician

February 18, 2019

There is a lot of grousing in the financial independence community. Especially from those of us above the age of thirty. We look at the young people in this community and shake our head knowingly. We grumble some version of the same slogan. If I only knew then what I know now. We repeat this refrain often but put little energy it to consider if it is true. Would I do …

Physicians should stop being afraid of getting audited by the IRS

Noah Kaufman, MD

Physician Finance

February 17, 2019

Not only is an audit unlikely to happen — if it does, it’s rarely a huge deal.

Few words inspire such fear in the hearts of Americans as “IRS audit.” But one of the biggest mistakes that taxpayers make is letting fear of the IRS stop them from taking advantage of tax savings they deserve. Especially for locums tenens docs and other 1099 income earners since the 67,000-page tax code favors …

Should we start screening for colon cancer at age 45?

Peter Ubel, MD

Conditions and Diseases

February 17, 2019

Here’s what most medical experts agree on: People 50 and older should be screened for colon cancer.

Here’s what is more controversial: Whether that screening should start, routinely, at age 45.

Recently, the American Cancer Society (ACS) recommended that colon cancer screenings start at age 45. Their recommendation was based in large part on an uptick in the number of people 45 to 50 years old who are being diagnosed with colon cancer …

When depersonalization is necessary in medicine

Valerie A. Jones, MD

Physician

February 17, 2019

I could hear the scream from across the room. It was shrill and filled with panic. Any parent can identify the difference between the cries of normal toddler discomforts and a true emergency.

I dropped what I was doing in the kitchen and found my three year old lying motionless on the ground, unable to move his left arm. My five year old was looking sheepishly down at the carpet, afraid …

How should physicians hear back about their diagnostic errors?

Ashley Meyer, PhD and Hardeep Singh, MD, MPH

Health Policy

February 17, 2019

Diagnostic errors (missed, delayed, incorrect diagnoses) are increasingly being recognized as a prevalent cause of harm to patients. At the same time, physicians are simultaneously under pressure to deliver high-quality, low-cost health care. How do physicians come to a balance between the competing demands of addressing underuse versus overuse, and consequently a balance between underdiagnosis from inadequate investigations versus overdiagnosis and resource waste? Can physicians learn from hearing about their …

Healers: Peel away the layers

Michele Luckenbaugh

Patient

February 16, 2019

The mud is deep and thick and black. The smoothness of its surface is deceiving, drawing me closer to it with promises of contentment. It lures those who dare to tread upon it into its hidden depths. Hopes are dashed as one struggles for freedom. It is tenacious: Lift one foot upward and the other sinks deeper into Mother Earth. A sense of futility in escaping its grasp erodes the …

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Healers: Peel away the layers

What this physician wish she knew about money as a young doctor

Nana Korsah, MD

Physician Finance

February 16, 2019

The tale of two physicians

There once was a physician who had no idea what personal finance was. She was living the American dream, but with lots of student loan and credit card debt. During her residency, she paid minimums on all her debts, but had neither a savings account nor a retirement account.

During fellowship, there was a slight jump in her income, and she used that as an opportunity to …

A physician defends Ayurveda: Is it the original personalized medicine?

Madhuri Sharma, MD

Conditions and Diseases

February 16, 2019

As more patients and clinicians are searching for holistic approaches to health care, Ayurveda, or the traditional medical system of India, has been gaining popularity in the Western world. Unfortunately, many allopathic physicians still view this system as “quackery” because of its focus on the “intangibles” of health. However, Ayurveda has contributed immensely to the foundations of modern medicine, which many may not know. Sushruta was an Indian scholar and …

MKSAP: 60-year-old woman with H. pylori gastritis

mksap

Conditions and Diseases

February 16, 2019

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

A 60-year-old woman is evaluated 1 month after completing a 14-day course of Helicobacter pylori eradication therapy consisting of amoxicillin, clarithromycin, and omeprazole. Initial upper endoscopy before treatment showed patchy gastric erythema with no ulcers or erosions, and biopsies revealed H. pylori gastritis. Currently, she reports alleviated symptoms. She is otherwise healthy and …

When a baby arrives dead in your emergency department

Cindy Winebrenner, MD

Physician

February 15, 2019

When a baby arrives dead in your emergency department …

… the world stops. You stop breathing. You are gasping for air. She is limp; she is cool; she is pulseless. Chest compressions on the tiniest six month old I have ever met are done with the finger pads of my index finger and middle finger. Quick, synchronized beats. I look at her blue, blue lips. It should never be like this.

Her eyes …

When you identify your Lyft driver as potentially having bipolar disorder

Anonymous

Conditions and Diseases

February 15, 2019

I remember September 27, 2018 like it was yesterday. When Ashley* picked me up from my apartment Thursday morning, I thought it would be like the 138 past Lyft rides I’ve taken since 2017. I was wrong.

After I waived to Ashley from the curb, I got settled into the right back seat. The doors locked, and she asked me the usual question.

“You from here?”

“Yes, I’m a local.”

“That’s great! I’m from …

Will medicine become a young person’s sport?

Richard Plotzker, MD

Physician

February 15, 2019

Six months have elapsed since exiting the pageant of my hospital via retirement. Like many people who devote countless hours to professional activities, some mandated, some by compulsion to detail, this windfall of unstructured time, no matter how well planned, can prove disorienting. My final destination was a small inner-city hospital, preceded by twenty years affiliation with an enormous comprehensive regional center. The people there, near where I live, have …

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