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A missed opportunity to fix drug pricing

Medications

May 27, 2018

President Trump recently unveiled a plan to, “Bring soaring drug prices back down to earth.” Acknowledging that the current system is broken, with drug prices beyond the reach of many patients, the President’s plan targets drug patents, pharmacy benefits managers, and drug pricing negotiated by foreign countries.

Yet he misses one of the big elephants in the room, the fact that here in the U.S, Medicare is forbidden to negotiate …

The struggles of women in recovery during pregnancy

Rachel Alinsky, MD

Physician

May 27, 2018

“I just don’t get it,” sighed the young mother, who was propped up in a hospital rocking chair, nursing her beautiful two-day-old infant. Mary (not her real name) continued, “I’ve been doing everything right. I have a job, an apartment, I pay my bills, and look” – Mary nods towards a shiny new black and pink infant car-seat sitting in the corner, “I even have a car seat. I’m ready.” …

We are sorry, you did not match to any position

John Brewer Eberly, Jr., MD

Medical Education

May 27, 2018

When I was in fourth grade, I won our school’s spelling bee. This meant that I went on to the next tier of the local spelling world — the sort of prestigious competition that takes place in a gymnasium somewhere with a makeshift stage and a bunch of flags.

I was the first kid disqualified. I misspelled veterinarian “veterenarian” and battlement “battlemint.” I remember feeling, in the moment the announcer said, …

Those who try to solve health care don’t know the reality on the ground

Peggy A. Rothbaum, PhD

Health Policy

May 26, 2018

Because I wrote my book, I was recently asked to summarize the health care crisis. I have focused almost 25 years of research and writing about health care on what is happening on the ground, every day, with doctors and patients. I’m not an economist or financing expert or technology geek, so I can’t offer anything there. I am a practicing psychologist with advanced training in health care research …

Your first meeting with a mentor

Joannie Yeh, MD

Physician

May 26, 2018

You extend a firm handshake and get ready to sit down at the table across from your mentor for the first time.

Woah, wait. Let’s back up to the legwork that should have happened prior to this meeting. First step, you found the mentor (see this post for practical ideas on how to find a mentor). Neither you nor the mentor have a lot of time — a frequent obstacle often …

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Your first meeting with a mentor

Let’s talk about guns as a health crisis

Aldis Petriceks

Health Policy

May 26, 2018

In the long weeks since Valentine’s Day 2018, when those 17 students were killed in a mass shooting at Marjory Stoneman Douglas High School, justified outrage has flowed from all corners of society. In New York, high school students have marched through Manhattan streets. On Capitol Hill, others have protested for tighter gun legislation. Recently, at Stanford University, our medical community held a community health panel, titled “Gun Violence and …

MKSAP: 47-year-old man with hypertension, type 2 diabetes mellitus, and obstructive sleep apnea

mksap

Conditions and Diseases

May 26, 2018

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

A 47-year-old man is evaluated during a follow-up examination. He is obese and has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. He reports that he has always has been overweight, and over the years, his weight has gradually increased to 123 kg (271 lb). During the past 2 years, he has …

How to ask for a great letter of recommendation for residency

Ted O’Connell, MD

Medical Education

May 25, 2018

Strong letters of recommendation are essential for supporting your residency application and matching well. This article details how to ensure you get great letters of recommendation.

Knowing what constitutes a great letter of recommendation is crucial to obtaining outstanding letters. A strong letter of recommendation clearly conveys knowledge of the medical student, how that student performed and qualities that predict excellent performance in residency. Strong letters of recommendation include the following:

We must advocate for our most vulnerable patients

Ton La, Jr., MD, JD

Conditions and Diseases

May 25, 2018

On a Sunday afternoon, I arrived at the hospital for my psychiatry ER shift. As medical students, we keep an eye on the track board for new patients to see. Two names turned bright red, and I chose to follow Jackie Swanson*. Her initial ER evaluation read “Patient is a 30-year-old female here for SI, HI, and AVH in context of recent sexual assault and cocaine use.” She was brought …

A surprising example of how medicine is learned from our patients

Aaron Grubner, MD

Medical Education

May 25, 2018

“The patient in room 17 needs an IV line! Hey, have you ever put in an IV before?!”

Everybody looked at me at once. I tried my best to maintain a confident outer appearance. But I’ll admit, I was caught off guard. I thought back to my attempted IV insertions throughout my anesthesia rotation earlier in the year. I struggled with getting the IV line smoothly into the vein. I followed …

6 steps to stop your smartphone from going viral. Literally.

Matthew Katz, MD

Conditions and Diseases

May 25, 2018

I recently went to an infectious disease educational session sponsored by the Massachusetts Medical Society and the New England Journal of Medicine called “Epidemics Gone Viral.” The focus was preparedness for the next epidemic, which may come from anywhere. John Brownstein talked about how its arrival will be monitored and reported using Twitter and artificial intelligence.

With the meeting going viral with excitement as Bill Gates got on …

This burned out physician was happier as a resident

Anonymous

Physician

May 25, 2018

I log onto KevinMD every day to get my much-needed dose of physician commiseration. At least once a day, one of us writes an article about burnout. It typically leaves me feeling quite validated. I particularly enjoy reading the comments section, as many of you make me laugh with your physician reality-based humor.

I am more burned out than I ever hoped to be. I work in primary care, have a …

What to do if you want to be a cruise ship doctor

Cory Fawcett, MD

Physician

May 25, 2018

In 2013 I began searching for ways I could change my career to reduce my workload, but not give up medicine altogether. During that time I took a cruise and looked at various jobs I could do on a cruise ship. One of the jobs I was qualified for, I thought, was to be a Cruise Ship Doctor.

After talking with the ship’s doctor to find out what it was like …

The skinny on skinny health insurance

Mark Kelley, MD

Health Policy

May 24, 2018

The Affordable Care Act (ACA), widely known as “Obamacare,” has survived several repeal attempts by Congress. Storm clouds, however, are still on the horizon.

The ACA’s individual mandate obligates every American to be covered by comprehensive health insurance. This requirement has been the most unpopular feature of the law. That’s because healthy people, especially those who are self-employed or between jobs, have found the ACA premiums too expensive.

They are not alone. Health …

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The skinny on skinny health insurance

A physician’s personal crisis with pain

Heather Finlay-Morreale, MD

Physician

May 24, 2018

Six months ago, I had severe right flank pain. In the ER, I had an ultrasound showing a possible kidney stone. I deferred a CT scan and went home with medication. I fit the textbook picture: I had abnormal imaging, and I was given a treatment and discharged. I was advised to return if the pain worsened or failed to resolve. I briefly improved, but then the pain returned much …

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A physician’s personal crisis with pain

How to deal with devastating criticism

Varun Verma, MD

Medical Education

May 24, 2018

“Why don’t you just get a shotgun and blow his brains out next time? Better yet, next time stay the hell away from my patient!”

I was frozen, and the ICU attending wasn’t even talking to me. My co-intern had barely started her presentation when she met damnation. Mind you — there was a senior resident, a pulmonary fellow, and a team of nurses caring for the patient also. Yet the …

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How to deal with devastating criticism

Cushioning the fall of bad news

Meghan Gaffney Liroff, MD

Physician

May 24, 2018

Angela Harris has been here in the hospital for six hours, awaiting the results of her CT scan. I won’t take responsibility for all of that wait time: complicated CT scans and labs do take a significant amount of time to perform. But she didn’t need to wait the last hour.

She was waiting on me — her emergency physician — because I needed to confirm her cancer diagnosis with radiology, …

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Cushioning the fall of bad news

The dangerous precedent of Alfie Evans

Vamsi Aribindi, MD

Health Policy

May 24, 2018

The tragic case of Alfie Evans has roiled Great Britain and the world. Alfie was a two-year-old child in the United Kingdom with an unknown degenerative brain disease who eventually deteriorated to the point that he required life support. His brain had become mostly liquid, and he could not see, speak, or hear. Alder Hey Hospital decided his condition was terminal and irreversible and wanted to stop …

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The dangerous precedent of Alfie Evans

The good, bad, and the ugly of being a medical expert witness

DocG, MD

Physician Finance

May 24, 2018

I have spent a good part of my career investing time and energy towards side hustles. I generally categorize them into two distinct types of ventures. The lazy side hustle involves starting a business or consulting in a field tangential to ones main hustle. For example, an accountant who works normally as an auditor may do a few tax returns on the side during tax season. I call his …

Don’t be mean: Treat your team members with respect

Aaron Lacy

Medical Education

May 23, 2018

“Those emergency room residents are f**king retarded!” This was the comment that rang through the workroom. I had only been on this hospital service for three days, and I was having a discussion about a patient with my attending when the on-call resident had burst into the workroom and sat down next to me. He was fuming.

“Why the f*** would they think I need to be consulted for this? Only …