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MKSAP: 36-year-old woman with refractory constipation

mksap

Conditions and Diseases

October 13, 2018

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

A 36-year-old woman is evaluated for a 12-year history of refractory constipation. Her symptoms began after a difficult childbirth. She has constipation marked by straining, bloating, and a constant sensation of incomplete emptying. She sometimes has 4 or more days between bowel movements. When she does have a bowel movement, the stool is …

How positive deviance can address clinician burnout

Diane W. Shannon, MD, MPH

Physician

October 12, 2018

I love the idea of turning a negative approach to improvement in health care — looking for problems — on its head. Appreciative inquiry, a process of focusing on a group’s inherent strengths and fostering positive interactions among group members, is one way of fostering change with a positive approach. Positive deviance (PD) is another.

Basically, PD involves identifying what’s working and usual local solutions owned by the people involved to make …

The key to this patient? Horseshoes.

Bruce Campbell, MD

Physician

October 12, 2018

“Those who suffer illness learn by hearing themselves tell their stories, absorbing others’ reactions, and experiencing their stories being shared.”
– Arthur Frank

We stand together at the clinic room door, preparing to enter.

“Tongue cancer. This is a 78-year-old man with an oral cavity mass and some memory loss. He had an ulcer on the side of his tongue for a few weeks which was biopsied by an outside doctor. No imaging …

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The key to this patient? Horseshoes.

Telemedicine should be easy. Here’s why it’s not.

Dennis Wichern

Medications

October 12, 2018

Who was Ryan Haight?

Ryan Haight was an 18-year-old honor student from La Mesa, California who died on February 12, 2001, from an overdose of hydrocodone ordered from an online doctor he never saw — and shipped to his home from a rogue online pharmacy during the beginning of the opioid epidemic.

The pharmacist, Clayton Fuchs, filled the online prescription …

5 fears physicians face today

Robert Pearl, MD

Health Policy

October 12, 2018

Like prep sports or prime-time television, medical meetings have seasons.

In the spring and fall, my calendar fills with invitations to speak. I try to get to the venue a few hours before I’m scheduled to speak, so I can “take the pulse” of fellow doctors, asking them about their practices, patients and the future of medicine.

Figuratively speaking, the industry’s pulse is racing with fear. I’ve observed that in just the past …

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5 fears physicians face today

How to ease men’s fear of mentoring in medicine

Stephanie Waggel, MD

Physician

October 12, 2018

There has been a recent surge in discussion about men’s fear to work alone with female colleagues in medicine. This reluctance puts both men and women at a disadvantage. Women are being excluded from career opportunities and men are missing out on the benefits of collaboration. As a victim of sexual misconduct during my own medical training, I find the recent increase of acceptance of reporting to be a step …

Stop stigmatizing medication-assisted treatment

Brandon Jacobi

Medications

October 12, 2018

Imagine yourself as a patient burdened with a chronic disease that necessitated daily medication adherence to function. Now imagine that medication has become so stigmatized by society that you feel judged and ashamed every time that you use it. That’s the world that individuals with opioid use disorder are forced to live in when they’re prescribed methadone or buprenorphine to get through the day. Without these medications, Read more…

Stop stigmatizing medication-assisted treatment

Is there parity in mental health or are we still dealing with a paucity?

Katherine Gantz Pannel, DO

Conditions and Diseases

October 11, 2018

With the recent 10-year anniversary of the Mental Health Parity Act being signed into law, comes the reminder that we still have so much work to be done. Unfortunately, blatant discrimination in health insurance coverage for mental health and substance abuse has continued despite this legislation. The Parity Act required that dollar limits on mental health benefits be no lower than the dollar limits for medical and surgical benefits offered …

At the top of patients’ wish lists: price transparency

Miranda Gill, MSN, RN

Medications

October 11, 2018

One of the most important factors on patients’ minds is affordability of care. According to a recent McKinsey study, 72 percent of consumers are concerned about at least one kind of health care expense, be it related to health insurance, routine medical procedures, end-of-life care or otherwise.

As it pertains to prescriptions, patients carry these affordability concerns from their providers’ offices to the pharmacy. More often than not, …

How health insurance contributes to our failing system

Edward Hoffer, MD

Health Policy

October 11, 2018

An excerpt from Prescription for Bankruptcy: A doctor’s perspective on America’s failing health care system and how we can fix it.

Many years ago, while I was involved in developing the pre-hospital emergency medical care system in Massachusetts, I went with a group to meet with the then-president of Blue Cross Blue Shield of Massachusetts, John Larkin Thompson. We were ushered into a magnificent office, larger than any I …

Evening eating: Are you a “light” eater?

Arlene B. Englander, LCSW, MBA

Conditions and Diseases

October 11, 2018

Anyone who has ever tried to lose weight or keep weight off realizes that evening can be the make or break time of day in terms of permanent success.

Consider this. In my community there currently is …

7 essential steps to take during (and after) a restructuring or layoff

Health eCareers

Physician Finance

October 11, 2018

This article is sponsored by Careers by KevinMD.com.

Employer consolidation due to the mergers and acquisitions of hospitals and health systems is becoming increasingly common within the health care industry. In fact, merger and acquisition activity doubled in the first half of this year, with the volume of value health care sector deals increasing to Read more…

7 essential steps to take during (and after) a restructuring or layoff

What my mother needs is a daughter, not a doctor

Sanjana Vig, MD, MBA

Physician

October 11, 2018

My mom was recently diagnosed with cancer. I can’t even begin to describe the shock I felt or how my heart just sank. In an otherwise healthy person with no family history, this is not something you ever expect to happen. My mind immediately jumped to so many different conclusions, and I immediately wanted answers. Is she going to beat this? How did this happen? Why did this happen? What …

My brother, a physician, died. Could I have done more?

Ki Park, MD

Conditions and Diseases

October 11, 2018

Healers, scientists, leaders — these are all terms that we equate with being a physician. As we spend our years if not decades in training, we strive to become all of these components. But when you miss something — the small details, the nuances of a history and these are the clues that could lead to healing it can be disheartening. When it comes to your own family member, such …

ACL injuries in middle-age athletes

Nancy Yen Shipley, MD

Conditions and Diseases

October 10, 2018

Over the last 20 years, physical fitness as a means to improve overall health has increased among the over-40 set. This is great, right? Yes, absolutely. Athletes who remain active as they age do a better job than non-athletes in retaining lean muscle mass. They also show improved bone density, bone structure and bone strength. However, what physicians are seeing are injuries related to the increased level of activity.

One area …

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ACL injuries in middle-age athletes

Physician well-being: lessons from positive psychology

Sanj Katyal, MD

Physician

October 10, 2018

The absence of burnout does not equal wellness. While the focus on physician burnout as an epidemic is finally gaining more attention, we may be missing a larger issue. Most physicians are not burned out. We are able to function. We get through our days, make it to some of our kids’ activities and even manage to go out to dinner on the weekends. We survive the work week as …

5 tips to medical resident success

Lisa Sieczkowski, MD

Medical Education

October 10, 2018

The glorious season is upon us. Yes, it is finally autumn. But it is also the season of ERAS with all of its letters of recommendation, USMLE scores, medical school transcripts, and personal statements.

I have dutifully reviewed dozens of applicants whose last names begin with the letters “T” through “Z.” I have noted the test scores and grades. I have considered the caliber of medical school and whether the LORs …

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5 tips to medical resident success

Do opioid contracts harm the doctor-patient relationship?

Michael Kirsch, MD

Conditions and Diseases

October 10, 2018

A contract is an agreement stipulating the rights and obligations of the signatories. In most cases, a contract is consulted when a dispute arises. When all is proceeding swimmingly, the contract remains dormant in a file drawer or in a digital file. In general, decent people resolve differences in the old-fashioned way utilizing the twin arcane legal techniques of reasonableness and compromise. Remember them? Yes, it is possible to settle …

Financial success as a doctor isn’t rocket science

Smart Money, MD

Physician Finance

October 10, 2018

We all know the importance of compound interest in building wealth. The fuel for compound interest is time — the longer you are committed, the greater chance your investments will grow. This applies not only to financial growth but also to essentially everything else. As a rule of thumb, the more you study for a test the better you ought to do. The longer you have practiced medicine, the more …

Doctors as the gatekeepers of marijuana is a race to the bottom

John Schumann, MD

Medications

October 10, 2018

This year Oklahoma voters made a clear choice to legalize medical marijuana, joining thirty other states that permit cannabis for medicinal use.

Unsurprisingly, immediately in the vote’s aftermath, patients began asking me to “prescribe” medical marijuana licenses, as the new law stipulates users must have as a precondition for legal purchase. The new law does not, however, specify qualifying diagnoses for which medical marijuana might be clinically …

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