KevinMD.com

This doctor stopped prescribing opioids. Other physicians should do the same.

Medications

April 14, 2018

Have you ever had a prescription altered? I have, several times — all opioids. Despite making copies of every prescription to prove what I actually wrote for, dealing with everything from patients who threatened to sue me for false accusations to time spent with the DEA was a real pain. The good news is that during the pre “pain as fifth vital sign” era at least — since my prescribing …

MKSAP: 28-year-old man with right knee pain

mksap

Conditions and Diseases

April 14, 2018

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

A 28-year-old man is evaluated for right knee pain that began 2 days ago. He was playing football when he stopped suddenly and pivoted to make a catch. He heard a popping sound and immediately developed severe pain in his right knee. Within 30 minutes, the knee became swollen. Since the injury, he …

Heal thyself before others

Shalu Ramchandani, MD

Physician

April 13, 2018

Alice wept in my arms as she described her father’s last days. He died of metastatic prostate cancer. She felt lighter as she shared beautiful memories of him. It will never be the same for Alice, nor will it be for me. I was running behind for my next patient, a healthy 86-year-old woman. I apologized for keeping her waiting. She did not mind; she knew I would give her …

Read more…

Heal thyself before others

When the doctor becomes the victim

Shaili Jain, MD

Physician

April 13, 2018

Years ago, the police brought a middle-aged man to the hospital for evaluation on a day when I was the on-call psychiatrist. Earlier that morning, the man had walked into his psychiatrist’s office without an appointment asking to see his doctor immediately. When his demand was not met, he caused a raucous in the waiting room, tossing over tables and chairs and alarming the other patients. He refused to leave, …

Read more…

When the doctor becomes the victim

Push back on toxic behaviors from other doctors

Todd Rice, MD, MBA

Physician

April 13, 2018

“Don’t get tired! Don’t f*cking move! Don’t you f*cking move, or I’ll f*cking die!”

That’s an excerpt from an OR in St. Louis on March 12th. This is just one of the outbursts that was reported from a single, multi-hour surgery — an attending’s toxic mandate to her resident, who was poised in a precarious situation under the drapes. The rest of the OR staff caught plenty of its own abusive …

Physicians and medical students: Unlearn helplessness

Jamie Katuna

Medical Education

April 13, 2018

Learned helplessness. It’s a psychological concept marked by a perceived loss of power, and it’s prevalent in medicine. We are taught early on how little we are in this colossal world. We are told what to do, when to do it, and what we will get for it. Our objections go unheard or—worse—ignored.

Let me quote a paragraph from The Paradox of Choice by Barry Schwartz:

They were conducting a series of experiments on basic …

Read more…

Physicians and medical students: Unlearn helplessness

Just care less: That’s something many doctors cannot do

Millennial Doctor, MD

Physician

April 13, 2018

For the last week and a half, I’ve been lost.

After experiencing compassion fatigue and realizing I wasn’t even close to pulling myself out of burnout, I’ve been racking my brain trying to rethink my situation yet again.

I reached for my old faithful habits. I became more consistent with my lunchtime mindfulness sessions and re-instituted exercise, yoga and hiking. I even went phone free for the weekend, though admittedly this …

Do whatever it takes to have fun and spend time with your family before it is too late

Cory Fawcett, MD

Physician Finance

April 13, 2018

Recently I had three important events happen during a three day period that reminded me of the brevity of our life and the need to live life to the fullest every day.

On July 4th, having planned celebratory events that day with friends and family, a CRNA in my home town awoke feeling poorly just before sun up. He was in great health the day before and lived a very active …

What this physician misses the most

Jordan Grumet, MD

Physician

April 12, 2018

Empathy

My eyes glare across the table. I can feel his shoulders hunch forward as he subconsciously recoils in preparation for my response. The room becomes thick. Nurses, social workers, a chaplain. Everyone waiting for the doctor.

Not just the doctor, but me. Sixteen years out of residency. Battle-scarred and warn by PTSD. The images from residency still so clear. A gasp, a gurgle, flat line. Wailing family members, angry nurses, and …

Read more…

What this physician misses the most

The drama of a C-section: It takes a team

Andrea Eisenberg, MD

Physician

April 12, 2018

She pushes her cleaning cart into the bright room. “Looks like the usual mess,” she mumbles to herself, pushing a loose piece of hair back into her blue cap. Methodically, she cleans the room beginning with the operating table, stripping off the bloody sheets. Then cleaning the floor of blood-stained shoe prints, amniotic fluid and bits of paper, needle caps and such, that managed to escape hands and land on …

Taking off the training wheels and becoming a real doctor

Nathaniel Fleming

Medical Education

April 12, 2018

Working in a clinic as a medical student is the best of all worlds. We have the opportunity to expand our knowledge and skills by working with some incredible patients, all while knowing that we have the support and backup of our fully trained, expert attending physicians every step of the way. This apprenticeship type of system is absolutely essential to medical training, allowing us to get our feet underneath …

A radical proposal to save America’s hospitals

Robert Pearl, MD

Health Policy

April 12, 2018

Hospitals serve as the economic lifeblood of their communities. They are the second-largest source of private-sector jobs in the United States, employing 5.4 million Americans who, together, embrace a virtuous mission to heal and help others in need.

And yet, every year, more and more of them are forced to shut their doors. With soaring costs, eroding margins and mounting pressure from competing providers, the American hospital industry is on life …

How writing fiction can free physicians

Sandra Miller, MD

Physician

April 12, 2018

Every person working in medicine has stories to tell, and sharing those stories is a great way to process grief or stress, celebrate triumphs, vent, move on or think more deeply.

Occasionally, writing about an experience helps others facing a similar situation. True narratives of and reflections on medicine are now encouraged, honored, promoted — and sometimes required of medical students.

This is a commendable trend, though the exercise can be affected by …

Read more…

How writing fiction can free physicians

Financial independence: the story of the 3 brothers

DocG, MD

Physician Finance

April 12, 2018

There was once three brothers who set off on the journey of a lifetime by embarking on three separate roads. Each brother was uniquely different, and quickly these roads diverged.

It was believed that the eldest brother was most wise because his path was clear and straight.

The middle brother was a strong walker but easily distracted. It was hard to keep him concentrated on the task at hand.

And finally, the youngest …

How physicians dress matters. Here’s why.

Suneel Dhand, MD

Physician

April 11, 2018

Anybody who has ever been to Europe, knows that fashion trends and the way people dress are very different from the United States, and generally more formal and fashion conscious (not to make a generalization — but it’s true). Growing up in England, every school has a uniform from an early age. (There are pictures of me wearing a tiny little shirt, tie, blazer, and hat to preschool when I …

A physician thanks those who made her who she is today

Maria Yang, MD

Physician

April 11, 2018

To the intern on the trauma surgery service when I was a medical student: Thanks for occasionally wearing leather pants to work. Thanks for smiling and having a sense of humor despite having to round on thirty patients. Thanks for teaching us medical students while running a significant sleep deficit.

To the internal medicine resident who wanted to become a cardiologist: Thank you for indulging me and telling me how you …

Betamax or VHS: EMRs are 100 times worse

Hans Duvefelt, MD

Health Technology

April 11, 2018

I can’t help myself from telling patients how things really work in health care. But I feel they have a right to know.

When I see new patients their jaw usually drops when I sit down with them next to the computer with a stack of papers held together with a rubber band or a gigantic clamp and with yellow sticky notes protruding here and there with words like LAB, ER, …

For those on the margins, access to cancer care is a struggle

Anne Katz, RN, PhD

Conditions and Diseases

April 11, 2018

Sarah* is a new patient, referred to me because she is having difficulty deciding on treatment for breast cancer. I don’t know much else about her, and a quick review of her electronic medical record tells me that she is 48 years old and has hormone-positive disease in her left breast. There are numerous missed appointments, and it appears that her …

What happens to the kids of child abuse when they grow up?

Linda Girgis, MD

Physician

April 11, 2018

As he sat in the driver’s seat and started to whistle that dreaded Willie Nelson song, my heart started racing, and my world started to spin. While most kids may be annoyed hearing their father whistling that toneless noise, terror started seeping into my very bones. I knew what that sound meant and it was no Pavlovian response, but rather a foretelling of the horror coming. Simply put, it meant …

The “problem” of dying with too much money

Passive Income, MD

Physician Finance

April 11, 2018

The fear of running out of money in retirement is very real. In fact, it’s the number one fear among older adults – even over declining health. According to the Transamerica Center for Retirement Studies, 43% of adults surveyed said their greatest fear about retirement was outliving their savings and investments.

This very fear is what keeps people working well past what might have been their retirement age. It also makes people take …