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Nocturia: the underdiagnosed condition patients find extremely distressing

Conditions and Diseases

December 12, 2018

As a family physician, I treat patients of all ages – children to those nearing 100 years old. One issue that plagues young and old alike is lack of sleep. In fact, according to the Centers for Disease Control and Prevention’s (CDC) 2016 Morbidity and Mortality Weekly Report, more than one-third of American adults do not get enough sleep on a regular basis. This is a common …

Too much of a good thing when it comes to medicine for older adults

John Muscedere, MD

Conditions and Diseases

December 11, 2018

Prevailing wisdom states that more is better — and it is no different when it comes to our expectation of medical treatments. With the help of the internet, patients and their families have come to expect intensive tests, treatments and therapies at every life stage.

But sometimes, too much treatment can do more harm than good. This is true in all ages but is especially relevant for older adults living with …

The day when the white coat can be worn with no hesitation at all

Shadi Ahmadmehrabi

Medical Education

December 11, 2018

It was my first day of orientation at medical school. In a hallway stood a coat rack overflowing with white garments. I set down my accumulated papers, reached for a hanger and — for the first time ever — shrugged first one arm and then the other into a white coat.

It was too large, but I had no other options. The unisex coats ran from XXS to XXL, but the …

4 financial stages of physicians

John Dameron

Physician Finance

December 11, 2018

As a medical student, you are thrilled to start your residency and to put your four years of studying and clinical rotations to the test. Now the time has come to begin earning a paycheck. This is the beginning of the financial stages of physicians.

As an attending who has transitioned into practice, you may be stressed and wondering if you are on track to meet your financial goals. You are …

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4 financial stages of physicians

The simplest treatment is sometimes the best

Naeem Rahman, MD

Conditions and Diseases

December 11, 2018

“I am really uncomfortable and in pain,” said Elaine tearfully as I met her in the preoperative area for the first time. She had a very sad and difficult history, dealing with complications from childbirth nearly two years ago. She had developed a communication between her rectum and vagina, which allowed feces to come out vaginally. Despite multiple surgeries from reputable medical centers in NYC, the problem recurred. And she …

The Wild West approach to PICU practice

Christopher Johnson, MD

Health Policy

December 10, 2018

I spent my early and mid-career years working in a pediatric intensive care unit (PICU) at a large academic center. We did almost everything except for a few things esoteric at the time — small bowel transplants, a few kinds of experimental surgery. I’m now in my late career (but have no plans to quit anytime soon!) and work in a smaller PICU. I am frequently confronted with the issue …

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The Wild West approach to PICU practice

The millions of dollars hospitals spend for inspections

Steven Reznick, MD

Physician

December 10, 2018

Two of my local hospitals just invested 3 to 4 million dollars in preparation for an inspection of the facilities by the Joint Commission. The cost of the inspection runs in the $10 million dollar range after the preparation costs. The inspection is a high-stress situation for the administration because if you fail, or lose your accreditation, the private insurers will void their contract with you and you won’t get …

A community-based program that brings patients and pathologists together

Matthew Katz, MD

Physician

December 10, 2018

When I was in medical school, I loved pathology. The visual learning and deep understanding of disease were attractive enough that after second year, I took an extra year before clinical rotations to work as a post-sophomore fellow, working as a resident cutting specimens and performing autopsies. I missed patient contact but it served as a great foundation for clinical medicine …

Is it possible for physicians to oversave? And what can you do about it?

James M. Dahle, MD

Physician Finance

December 10, 2018

Have you ever thought about doing a post on oversaving? I realize most docs probably have the opposite problem, but I bet there is a subset of the FIRE crowd that this may apply to. Does this ever come up in all the interactions you have?

It was no surprise to see this question come in as a direct message on the WCI Forum, rather than an email …

What you need to know about acute flaccid myelitis

Roy Benaroch, MD

Conditions and Diseases

December 9, 2018

You’ve probably seen it on the news – a rare, polio-like illness is causing cases of paralysis in children. Here’s the latest info, based on our best current knowledge from the CDC.

Acute flaccid myelitis (AFM) is a sudden illness that causes weakness in one or more extremities – one arm or (less likely) a leg, or any combination of arms and legs. The words in the name express the key …

Disability can be a devastating outcome to a doctor’s career. Here’s how handle it.

Smart Money, MD

Physician Finance

December 9, 2018

Disability can be a devastating outcome to a doctor’s career and self-image. Think about it: You busted your butt to learn how to do a Whipple procedure, end up getting into a skiing accident that ends your career right there. No worries, because you purchased the appropriate coverage of own-occupation disability insurance, right?

Having disability insurance certainly provides a protective cushion, especially you are the sole breadwinner. This is a no-brainer, …

Medical clinicians are being stress fractured

Calvin J. Maestro, MD

Physician

December 9, 2018

An excerpt from Leadership Lessons from History: A Study Guide Written for Physicians & Other Healthcare Leaders.

In June 1812, Napoleon invaded Russia along with an army of 600,000 men; fewer than 100,000 made it back. During their ignoble military withdraw, in the middle of a terrible winter, thousands of soldiers died of exposure to the intense …

Emergency physicians: You rock!

Sonali Mantoo, MD

Physician

December 9, 2018

I am a critical care physician and spend a good amount of time in the emergency room seeing consults. As an internal medicine resident, we were often in the ER, admitting new patients. In my three years of residency, we spent only two to four weeks working in the emergency room. It was the one time I had an insider’s view of life as an ER physician. And, man, was …

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Emergency physicians: You rock!

A medical student takes a look into the abyss. Here’s what he learned.

Evan Schauer

Medical Education

December 8, 2018

After my surgery rotation, I was in a very bad place. I felt like two months of grueling work hours and relentless studying were wiped away in an instant by a bad test score. That single number somehow mattered more to me than every positive comment I had received from my patients, colleagues, residents, and attendings. I felt like I had put my heart and soul into that rotation, constantly …

The blood of patients is not a rhetorical device

Andrew J. L. Smith

Health Policy

December 8, 2018

Recently, social media and news organizations have been awash in the physician-led backlash to the NRA’s now infamous “stay in your lane” tweet, and consequently, awash in images of the literal blood of seriously wounded or now deceased patients. Gun control is undeniably a cause near and dear to many physicians, who are duty-bound to try desperately, many times in vain, to save the lives of too many innocent Americans …

Why mentors are so important in medicine

Health eCareers

Physician

December 8, 2018

This article is sponsored by Careers by KevinMD.com.

After spending a decade in college and medical school, followed by internships and residency, seeking additional guidance at the beginning of your career may seem excessive. You’ve already taken direction from dozens of leaders; isn’t it time to cut your own path?

Yes and no. You’ll make plenty of your …

MKSAP: 53-year-old woman with hypertension and chronic active hepatitis B infection

mksap

Conditions and Diseases

December 8, 2018

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

A 53-year-old woman is evaluated during a routine follow-up visit. Medical history is significant for hypertension and chronic active hepatitis B infection. Her hepatitis B infection has been treated with tenofovir for the past 5 years with suppression of her serum hepatitis B DNA levels. She currently notes mild generalized weakness but otherwise …

During this holiday season, be aware that some people are really suffering

Linda Girgis, MD

Physician

December 7, 2018

It’s that time of year again when retail outlets start counting down the days to Christmas and deck their stores with holiday cheer. For many people, this time of year feels magical. Yet for others, it is a consumer competition to buy the absolute best gift at the lowest price. While both these groups love the holidays in their own way, there is a third group for which the holidays …

3 common complaints patients have

Suneel Dhand, MD

Physician

December 7, 2018

I enjoy talking to random people about their experiences with health care. As somebody who regularly travels all over the country, for both work and pleasure (I far prefer the latter), whenever I meet people in situations where you end up talking — be it on airplanes, a guided city tour, or at a social function — as soon as I say I’m a physician, the conversation invariably ends up …

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3 common complaints patients have

6 ways to smooth the journey to value-based care

Andrew Snyder, MD

Health Policy

December 7, 2018

I have had the fortune — both good and bad — of being at the forefront of reforming physician reimbursement as an advocate for physicians. I’ve worked on models spanning private practice, group employment, faculty practice plans, and independent physician associations.