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You can’t put metrics on purpose and resilience

Sam Kant, MD

Physician

April 23, 2018

An unusually calm morning in the ICU led our amiable attending start rounds by asking how we took care of ourselves so that we could look after others. While scrambling to gather patient details, we all struggled to answer them, except for my eccentric British-Canadian friend (who is still confused about his nationality since Brexit) who said he did so by reading Hemingway.

In medical school, board scores seem to be …

Computer algorithms don’t think like doctors

Richard Plotzker, MD

Physician

April 23, 2018

Too often, residents want you to address something, so they don’t have to — except for infectious problems where they putz around with antibiotics until lunchtime on Friday, then call ID.

For me, one example seemed rather routine: a diabetic with another medical illness. It wasn’t terribly well defined in the hospital records, but included atrial fibrillation and congestive failure at presentation. At day nine, with pressure from the DRG lady …

How physicians can calculate their savings rate

Wall Street Physician, MD

Physician Finance

April 23, 2018

The savings rate in America is abysmal. As a result, many Americans rely on Social Security and pensions to fund their retirement.

However, physicians would not be able to maintain their lifestyle on Social Security payments alone. And few physicians receive pensions from their employers. Therefore, they have to fund the majority of their retirement through savings.

But how do you define savings rate? Let me count the ways. Do you use gross …

The intensity of EMR warnings: Who do they really help?

Michael Kirsch, MD

Health Technology

April 22, 2018

Eons ago, there was a television show where a non-human character would yell out, “Warning, warning,” when he sensed imminent danger. The series was called Lost in Space where we were entertained by a set of quirky characters on a cheesy set. We loved that stuff. It’s hard to imagine today’s millennials and younger folks being transfixed, as we were, with the deep television dramas of our day. Who could …

Benefit vs. social responsibility: a profound ethical dilemma in medicine today

Hans Duvefelt, MD

Health Policy

April 22, 2018

Brilinta, at $6.50 per pill, twice a day, reduces cardiovascular events more than generic Plavix, which costs 50 cents per pill, once a day. But only a little: 20% relative or 2% absolute risk reduction. The event risk was 10% with the more expensive drug and 12% with the one that costs 82% less.

Put differently, if 100 patients were treated with Brilinta for a year, at a cost …

A physician-entrepreneur’s typical clinical day

Suneel Dhand, MD

Physician

April 22, 2018

I frequently get asked how I balance my schedule as a physician who is also involved in lots of different things outside of clinical medicine. As any reader of my blog knows, I like to stay busy! As well as my work as a frontline physician (which I absolutely love and have no intention of ever leaving)- – doing a mixture of inpatient and outpatient work, I also am involved …

Why physicians should beware of 0% financing deals

James M. Dahle, MD

Physician Finance

April 22, 2018

A frequent topic seen on this site and many other sites, blogs, and forums are the merits of using very low-interest financing for various things. The attraction is obvious. Not only do you not have to have the cash up front, but even if you do, surely you can do better investing than 0%, and if you borrow at 0% and earn at anything better than 0%, then you come …

Bedside ultrasound is not yet the standard of care. But it will be.

Janice Boughton, MD

Conditions and Diseases

April 21, 2018

I just read a Clinical Problem Solving case from the New England Journal of Medicine (NEJM). It was entitled “Stream of Consciousness“and it told the story of a 65-year-old man who was a patient at the Brigham and Women’s Hospital of Harvard Medical School, arguably one of the finest medical institutions in the world.

These cases are presented in single paragraphs to a clinical expert physician who then …

How to raise a doctor

Dr. Dale

Physician

April 21, 2018

An excerpt from How to Raise a Doctor: Wisdom From Parents Who Did It!

I know what you’re thinking, I thought this book was about how to raise a doctor, and now this guy is telling me not to raise a doctor! That’s exactly right. I’m telling you to not raise a doctor. Instead, raise a leader, …

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How to raise a doctor

Empowering young women to use their voices in health care

Damian P. Alagia, MD

Conditions and Diseases

April 21, 2018

Women’s voices are finally being elevated on a national level to the prominence they deserve on workplace, political, and social issues.

But as a physician (and father of two adult daughters), I’m concerned that women may not feel empowered to use their voices for their own health care. A 2015 survey found that only 22 percent of women in the United States possess health literacy skills, although health literacy is critical …

MKSAP: 62-year-old man is evaluated during a routine visit

mksap

Conditions and Diseases

April 21, 2018

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

A 62-year-old man is evaluated during a routine visit. He is asymptomatic and walks 1 mile most days of the week. Medical history is significant for aortic stenosis, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications are aspirin, metformin, lisinopril, metoprolol, and rosuvastatin.

On physical examination, the patient is afebrile, blood pressure is 130/66 …

Advice for graduating medical students

R. Lynn Barnett

Medical Education

April 20, 2018

Since graduations will soon be upon us, this is a graduation speech that I’d like to give one day:

Hello everyone, and welcome. To the practicing doctors in the audience, I hope you can look back on your own graduations. To the med students, I hope you can look ahead. And, hopefully, everyone can look forward to what are some heartfelt insights.

To the graduating class: As you’re sitting here ruminating about …

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Advice for graduating medical students

A call for cost transparency

Mukul Mehra, MD

Health Policy

April 20, 2018

Physicians are the building blocks of value-based care, yet the cumulative human and financial cost of our decisions are mostly hidden from us. Instead, our reality is analogous to being on a diet and a budget at a restaurant that doesn’t put prices or calorie counts on the menu.

We need and want cost transparency. A survey from Deloitte University discovered cost is a part of …

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A call for cost transparency

My first objective structured clinical examination

Johnathan Yao, MD, MPH

Medical Education

April 20, 2018

After a semester of studying and taking written exams, we had our first OSCE in medical school. An OSCE — or an objective structured clinical examination — is the real deal. Instead of filling out multiple choice boxes, we instead work with a real human being, which for me is a welcome change.

The actor is given a script with their unique condition and story — it’s a simulation of what …

6 things this physician learned after retiring

Cory Fawcett, MD

Physician Finance

April 20, 2018

In February 2017, I saw my last patient and left clinical medicine. Most people would say I retired. I have chosen to say I have repurposed. I no longer see patients, but I still work. I am writing the Doctors Guide series of books, keeping up a blog and working with physicians who need help with a financial makeover, usually to eliminate their debt, set themselves up for retirement or …

Breaking the silence: 3 stories of opioid abuse

Ariel Hurley

Conditions and Diseases

April 19, 2018

When I was 12, my father got into a bicycle accident resulting in traumatic brain injury. Although I was unaware of it at the time, this day became the first day of the rest of my life.

Despite having never seen either of my parents so much as have a sip of wine with dinner, I watched my father spiral into a crippling alcohol addiction that wreaked havoc on our lives.

As …

Why can’t my doctor get it right? Here are 4 reasons.

Irene Tien, MD

Physician

April 19, 2018

When you see your doctor, you want to know what’s wrong, follow the steps to recovery and get predictable results. Sadly, this is not always possible. Medicine is an art based on science that is constantly changing and full of things we don’t know.

Here are four reasons why it seems like your doctors didn’t get it right — when we actually did:

Your symptoms or exam findings were not typical …
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Why can’t my doctor get it right? Here are 4 reasons.

A medical intern’s 3 greatest fears

Kirk Sidey, MD

Medical Education

April 19, 2018

A 76-year-old gentleman with a history of kidney failure, myasthenia gravis and recently diagnosed with esophageal cancer presented for evaluation of melena and hypotension.

The patient was my first admission to the medicine team as an intern, and he was as near to an ICU admission without actually being admitted to the ICU as one could come. After examining the patient, I briefly staffed with the busy attending physician, placed the …

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A medical intern’s 3 greatest fears

How physicians can start lazy side hustles

DocG, MD

Physician Finance

April 19, 2018

How do I start a side hustle?

I have heard this plea so often, It is no wonder there are many how to blog posts trying to answer this exact question. As helpful as they may be, most of the ideas espoused are both time and energy-consuming. For instance, starting a blog is great! But if you want to truly make money, be prepared to put in full-time hours. Or Read more…

How physicians can start lazy side hustles

Outrage at how the health care system “cares” for women

Jenna T. Nakagawa, MD, MPH

Physician

April 18, 2018

On a weekend night, I received a strange phone call from an emergency room resident. “This is an emergency,” he said, adding fragments of details, “… vaginal bleeding … her heart rate is in the 150s.” It was hard to figure out what was happening and his tone was oddly calm. “Is she in an exam room?” I asked. “No,” he replied, “we’re in the trauma bay.”

I ran downstairs with …

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