A few weeks ago, I saw a patient some gastro issues. So far, nothing newsworthy here since I am a gastroenterologist. I ordered a CT scan colonography, a special CT scan that is designed to view the colon in detail. It’s the CT scan version of a colonoscopy. Why didn’t I simply perform a colonoscopy, which, unlike a CT scan, would contribute to my retirement fund? That’s an easy one. …
The follies of health insurance preauthorization
We live in a pill-popping society. The first line treatment for many of the medical problems that walk through our doors is a medication. Have heartburn? Forget about avoiding the foods that cause your symptoms — just take a pill. New diagnosis of diabetes? We give lip service to lifestyle modifications and then start patients on Metformin. Hypertension? Diuretics, ACE inhibitors, ARBs, beta blockers — take your pick, and I …
Take 2 broccoli and call me in the morning
Tuesday morning. Sarah wakes up at 4 a.m., like every other morning, to go to clinic to get a medicine she cannot function without. But it’s not as easy as that. She has to take her three small children with her because she is a single parent and has no one else to stay at home with them. She does this six days a week. This is her life. This is the reality of …
Cutting the red tape with buprenorphine treatment for opioid use disorder
Now that the children have shouldered their muskets and taken aim — figuratively speaking, of course — against the gun lobby, maybe we can interest them in another partisan conflict that’s even more sweepingly about their survival: climate change. Not to minimize the horrific consequences of school shootings, but there are many more lives at stake from climate calamities. Threats from sea level rise, flooding, wildfires, and storms are multiplying …
A case for climate activism: but where are the medical students?
A guest column by the American College of Physicians, exclusive to KevinMD.com.
A number of years ago I had an older patient, John, who had just been diagnosed with acute myelogenous leukemia. In discussing his diagnosis, he asked me if I thought that his exposure to radiation in the past might be responsible for his …
“I had no idea”: the power of patient stories
Her: “So what do you do?”
Him: “Well, I’m applying to medical school. If I make it, I’ll spend the vast majority of my time studying for the next four years. You and I will be able to go on cheap dates occasionally, but even then I’ll feel guilty about not studying. I won’t have any money, so you’ll have to support me on your income. Otherwise, I’ll have to take …
First date with a medical student
Eye surgery is a delicate business. It involves operating within an orb the size of a large marble to remove a cataract or repair a retinal detachment.
Not only is superb eye-hand coordination a must, but also an awareness of the myriad other medical issues in the elderly population most in need of eye surgery.
Traditionally, patients undergoing cataract surgery had a preoperative medical evaluation, including blood work, chest X-ray, and EKG, …
Why cataract surgery is more complicated than it should be
I was on my honeymoon in Colombia when I first became aware of the true extent of my post-traumatic stress disorder. My husband and I were walking across a smooth, granite platform to take a closer look at a fountain in downtown Cartagena. As we neared the structure, mist from the fountain’s jets dampened the ground …
I experienced trauma working in Iraq. I see it now among America’s doctors.
The other day a colleague and I were discussing a topic to be presented at an upcoming conference: “How much wellness is too much wellness?” This got us contemplating. What exactly is “wellness?” Can you ever spend too much time pursuing wellness? Or is “too much wellness” merely a surrogate for a much bigger problem with the way we’re approaching wellness in the health care setting?
According to the 2018 Medscape …
Why your physician wellness programs aren’t working
Physician burnout rates hover around 50 percent, and the adverse consequences are serious. Burnout is associated with increased medical errors, suboptimal care, turnover and personal costs, including substance use, depression, and suicide.
The financial cost to health care organizations is significant: replacing a physician is estimated to cost at least $500,000. Plus, physician turnover results in care disruption, patient access issues and lost revenue for hospitals to which the physician referred …
Want a resilient organization? Address physician burnout now.
I am an assistant professor of health communication. Since 2008, as a volunteer, educator and researcher, I have been active in hospice care. As many people know, hospice teams (nurses, social workers, doctors, chaplains, volunteers) help dying patients and their families live as fully as possible during their remaining days together.
In November 2016, right before the presidential election, I started a project aimed at identifying the best practices in communicating …
Is compassion a two-way street?
It’s a question that reverberates in the minds of premeds around the country.
If you have a choice between multiple medical schools, should you go to the cheapest medical school available, or should you go to the more prestigious, more expensive medical school?
MD vs. DO vs. Caribbean
I think it is worth the investment to go to a U.S. allopathic (MD) school if at all possible.
It’s an unfair bias, because every medical …
Public vs. private medical school: Which should you choose?
Few people can argue that health care is a business these days. Medical services are attached a price tag and patients are now customers. However, intrinsic to health care is a very high ethical code that doesn’t exist in other sectors. For example, if a patient shows up in the ER, they cannot be denied service, whether they are wearing shoes or not. While McDonald’s and other top companies are …
These McDonald’s practices should be avoided in health care
ADVERTISEMENT
On my site, I spend a lot of time talking finances. And I’ve yet to mention what is by far the best investment that I have ever taken part in. It has provided my best return on investment and biggest annual interest growth. It also requires the most work, but this investment is what keeps me in the market and sticking to the plan. In fact, it is “my why” …
Find your why. It makes all the difference.
Today a physician told me she lost three colleagues to suicide in the last two months.
Loma Linda Hospital just lost three young doctors to suicide in 6 months.
Mount Sinai had 3 docs jump in less than 2 years — from the same building.
An anesthesiologist recently told me he lost 8 of his colleagues to suicide.
Each suicide should be fully investigated, …
Physician suicide is also a problem in India. Here’s what you can do.
Q. International stocks are doing really well, so I’m thinking about investing more money into them. What do you think?
A. I grew up playing ice hockey and continued to play in high school, college, and even now. Coaches often gave us the same advice that hockey legend Wayne Gretzky’s dad gave to him: “Skate to where the puck is going to be, not where it has been.”
Ice hockey is …
Don’t chase stock performance. Do this instead.
In 2017, the flagship multispecialty practice of Oregon Medical Group, moved into its new digs — a 46,000 square foot redesigned medical office building. Practice leaders and the 30-odd clinicians in six different specialties were committed to a coordinated patient experience. They wanted to ensure that patients could move smoothly between sequential visits with different care providers — on the same day. To this end, the group invested in a …
The many benefits of self-rooming patients
I need your help.
I’m trying to figure out how to get rid of something that’s terribly broken in our process of taking care of patients, and I can’t do it alone.
It’s time to kill the referrals process, get rid of them altogether.
Every day, a huge proportion of the messages we receive through the electronic health record are requests for us to “put in a referral.”
Patient has low back pain, has …
The referral system to specialists: It’s a nightmare
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 41-year-old woman is evaluated in follow-up after presenting to the emergency department 1 week ago for burning epigastric and chest pain. In the emergency department, a complete blood count and liver chemistry studies were normal, but a radiograph of the chest and upper abdomen demonstrated calcified gallstones. The pain resolved with administration …
MKSAP: 41-year-old woman with burning epigastric and chest pain
Two recent posts highlight the problems facing many medical students today.
The first was by an anonymous rising fourth-year student who has come to the conclusion that going to medical school was “a terrible, terrible decision.” It ended with a comment that medical school “is not fun. It’s jarring, scary, disappointing and absolutely depressing.”
The second was by another anonymous student who described how miserable he (or she) has been …
If you go to medical school, you will be stressed: bigly
Get free updates delivered free to your inbox.
