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A DEA agent explains how to fight the opioid crisis and mitigate DEA risk

Dennis Wichern

Medications

June 4, 2018

42,000. That’s the number of CDC reported overdose deaths in 2016 due to opioids.

Ten percent. That’s the percentage of the estimated 2.1 million opioid substance abusers receiving treatment help and even fewer afforded medication-assisted treatment (MAT) for their struggles.

Three percent or around 40,000. That’s the number of physicians out of a total of 1.3 million across the U.S. qualified by the Substance …

Finding a new doctor is like dating

R. Lynn Barnett

Patient

June 3, 2018

I agree wholeheartedly with a post by Annahieta Kalantari expressing the idea that finding a new physician job is like dating. A patient looking for a new MD can be just as uncertain, unnerving, intimidating and stressful.

First, you hear the dreaded words from a receptionist, often sorrowfully saying, “I’m sorry, we’re not in your network this year.” Then, the nerves begin. Maybe a friend recommends a doctor …

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Finding a new doctor is like dating

Why you should think twice about prescribing antibiotics

Rich Rodriguez, MD

Medications

June 3, 2018

A meme forwarded to me last year showed a chimp with the caption: “Monkey trained to dispense Z-Paks at urgent care.”

As one of the medical directors for a multi-office urgent care practice, one of the tasks is performing a chart review. One of the patterns we see too often is ubiquitous Z-Pak prescriptions for purported cough, sore throat, sinusitis and even an allergic rhinitis this last batch. Z-Paks are one …

How the Parkland shooting changed the way I feel about medicine

Ashira Klein, MD

Medical Education

June 3, 2018

February 14, 2018. It’s the “before.” My phone rang, and I stopped breathing as words poured straight from her heart about the most recent school shooting — Stoneman Douglas High School, where I had nervously walked the halls as a freshman and excitedly watched my sister cheer at football games in Parkland, a boring little town next to my equally boring hometown, as a teenager. Here, I protested the indignity …

Physicians aren’t necessarily better health care investors

Wall Street Physician, MD

Physician Finance

June 3, 2018

I strongly believe that clinical physicians do not have an edge on the rest of the market. Therefore, they should heed Warren Buffett’s advice — avoid picking individual stocks and invest in index funds.

Nevertheless, some doctors do believe that they have an edge when it comes to investing in health care stocks. They think that just because they are a doctor, they are better trained to invest in the stocks of the drug companies and …

It is time to reframe patients’ medical history?

Jeffrey H. Millstein, MD

Physician

June 2, 2018

It wasn’t long into my clinical training when I realized that most patients do not convey information the way templates are designed to record it.

Instead, they tell stories — which may weave from topic to topic, progress forward or backward in time or in patterns that may not be familiar or clear.

But they are told as the patient sees fit to convey them. David, a forty-year-old man who recently presented …

Physicians have become devalued in modern health care

Anonymous

Health Policy

June 2, 2018

I’m writing this piece because I’m finally at the point that I am truly angry. I am angry at how physicians have become devalued in modern health care. I’m angry at how systems of care have participated in this by replacing physicians with lesser trained mid-level practitioners. I’m angry at how our title “doctor” has been hijacked to allow patients to be misled or, in many cases, deceived.

It wasn’t that …

The painfully fine line of pain management

Michelle Dang, MD

Conditions and Diseases

June 2, 2018

I’ve been practicing as an interventional pain management physician for over six years. It was a long road to get here — four years of medical school, four years of residency in anesthesiology and one year of fellowship (in addition to the four years of undergraduate education). So people say, “You must really love what you do.” Sure, during residency there was light at the end of the grueling tunnel …

MKSAP: 29-year-old woman is evaluated during a routine follow-up examination of multiple sclerosis

mksap

Conditions and Diseases

June 2, 2018

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

A 29-year-old woman is evaluated during a routine follow-up examination of multiple sclerosis, which was diagnosed 3 years ago. The patient says she wishes to discontinue her oral contraceptive and attempt to become pregnant. She has no other personal or family medical history of note. Medications are fingolimod, vitamin D, and an oral …

An average day of tragedy in the hospital

Varun Verma, MD

Physician

June 1, 2018

Mr. F points a slender index finger to the heavens and states calmly: “It’s OK doctor. Jesus will protect me.” I had just said I was sorry there was nothing more we could offer, and he was going to die. He understood … right? It had been a difficult few months for my unfortunate patient. He smiles at me softly, nasogastric tube cascading over his right cheek and then closes …

It’s time to recognize the rights of medical students and residents

Thad Salmon, MD

Medical Education

June 1, 2018

Goodbyes were confusing during my third and fourth years of medical school. Even on my way to a 28-hour labor and delivery call, I tended to say, “I’m leaving for school.” Rather quickly, my wife trained me to say, “I’m leaving for work.” I was never quite reconciled to this, as I couldn’t forget the upcoming exams and tuition costs around $30,000 per year.

For the uninitiated, “work” as a medical …

My depression won’t defeat me

Ronna Edelstein

Patient

June 1, 2018

Announce to friends that you have cancer, and they will probably react with sympathy and compassion. Tell them that you’ve broken your leg, and they’ll offer to get your groceries and drive you to medical appointments.

Share that you suffer from depression — and the sound of silence will fill your head.

Depression has been my companion for as long as I can remember. My maternal grandmother, who immigrated to this country …

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My depression won’t defeat me

Life on the night shift at the hospital

Torree McGowan, MD

Physician

June 1, 2018

It’s 7 a.m. The hospital is just starting to wake up from its slumber, stretching arms and blinking eyes. I’m 54 minutes away from the end of another night shift.

Night shifts are curious creatures. They are a part of the fabric of emergency medicine life — one of the often hated aspects of our jobs. They steal us away from our families, cutting short bedtime snuggles and picture books so …

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Life on the night shift at the hospital

When private physician groups get acquired: Who loses?

Bimal Massand, MD, MBA

Health Policy

June 1, 2018

In the recent years, there is a growing trend in the health care industry whereby private practitioners and independent groups are being acquired by larger companies. This trend is a result of growing complexities of running a private practice and increased expectations of hospital administrators from hospital-based specialists such as anesthesiologists, radiologists and pathologists.

I will concentrate on anesthesia as it is my area of specialization, and I have some relevant …

This doctor retired from clinical medicine. Here are his tax surprises.

Cory Fawcett, MD

Physician Finance

June 1, 2018

Upon retiring from clinical medicine and becoming a full-time author/coach (I like to say I’m repurposed), I was uncertain as to the amount of taxes I needed to pay. I have a complicated tax return with several K-1s that don’t surface until March. My final return totals 32 pages for federal and 5 pages for state. After making an estimate of my tax bill at year end, I figured I …

Why this physician teaches first-year medical students

Mark Kelley, MD

Medical Education

May 31, 2018

I teach first-year medical students how to take a medical history and perform physical exams on patients.

These skills are the foundation of medicine. The history and physical exam (plus a few basic tests) are time-tested methods for diagnosing disease. Using these tools, a skilled physician can reach an accurate diagnosis more often than not.

We humans share a standard range of symptoms. Pain, weight loss, fever, cough, abdominal complaints: They are …

Money matters to how you experience medical training. It matters a lot.

Kristin Puhl, MD

Medical Education

May 31, 2018

Medical practice is a calling. It’s not a job, it’s not a career — it’s a vocation. And if you really love your vocation, you’ll let nothing stand in your way. Certainly not something as trivial and crass as money. After all, once you’re in practice, you’ll be raking it in, right? So why worry about that now, when you’re just beginning your medical education?

That attitude is pervasive, and it’s …

Physicians can’t ignore health risks posed by guns

Jen Baker-Porazinski, MD

Physician

May 31, 2018

I’m a family doctor in upstate New York. My patients include active NRA members and ardent pacifists. Most probably fall somewhere in the middle — they own guns for hunting or encourage neighbors to hunt the deer that feed on their lush gardens.

As a mother, I tried not to let my boys play with toy guns when they were little. In a young boy’s imagination, though, everything became a gun …

Fixing our health care system won’t make us healthy

Christopher J. Frank, MD, PhD

Health Policy

May 31, 2018

Like all doctors, I am frustrated when I see my patients missing out on what could be years of good health. And our medical system is so dysfunctional that it’s tempting for doctors and patients to blame poor health outcomes on how we pay for medical care. But, our ridiculous payment system is a symptom, not the cause of our problems, and fixing our medical system is not going to …

Medical professionals are uniquely positioned to provide a safe space for discussion

James G. Beckner

Health Policy

May 31, 2018

Gun safety, gun rights.

On reading these words, some have immediately assumed that I’m a far-left liberal who is proposing breaking into their homes, stealing their guns and melting them down to make a statue of a kneeling, gay football player to place on the National Mall.

Still others have immediately assumed that I’m a far-right conservative speeding by in my rebel-flag-waving, coal-rolling, king cab pickup with my loaded AR-15 in the …

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