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How to find purpose in the age of burnout

Physician

March 19, 2018

A recent sports injury required me to have surgery. As a cardiothoracic surgeon, my experience as “the patient” reminded me of lessons-learned years ago on finding one’s purpose. You should never underestimate your capacity as a health care professional to dramatically impact the lives of your patients.

As a pre-med in college, I interviewed at Johns Hopkins Medical School under an early decision program. I was beyond excited. After my interview, …

The tiny gains of patient-centered medical homes. Are they worth it?

Richard Young, MD

Health Policy

March 19, 2018

First, a history lesson. Back in the mid-2000 oughts, the AAFP launched a wholly owned subsidiary called TransforMed. It was originally started to help practices implement the “new model of care” from the Future of Family Medicine Report. Soon after it was launched, the joint principles of the patient-centered medical home (PCMH) were announced, so TransforMed pivoted to help practices implement the PCMH model of care.

In …

How inflation will affect our health system

Robert Pearl, MD

Health Policy

March 19, 2018

All eyes are on interest rates as investors look for more signs of trouble ahead.

If their concerns over higher-than-expected inflation prove accurate, many players in the U.S. economy will suffer the burden of higher costs. But perhaps no sector would feel the strain more than health care. Higher costs would be just the start of many problems to come for providers, insurers and, eventually, patients.

Surging inflation would create a vicious …

The pain scale shares the blame for the opioid crisis in America

Vijay Rajput, MD

Conditions and Diseases

March 19, 2018

If you have ever had surgery or told your doctor about physical pain, no doubt you have heard the question: “How would you rate your pain on a scale of zero to 10, with zero being no pain and 10 being the worst pain you can imagine?” That sounds like a reasonable question, but everyone has a different pain tolerance. In extreme cases, there are individuals who are born with …

Science and medicine are seemingly at constant odds

Steven Zhang, MD

Conditions and Diseases

March 19, 2018

In the mid-1800s, Ignaz Semmelweis, then a professor at Johns Hopkins, proposed something outrageous: Doctors and medical students working in the maternity ward should wash their hands before delivering babies because doing so could reduce infant mortality. For proof, he performed a rigorous experiment that showed babies delivered by midwives, who traditionally did wash their hands prior to deliveries, had rate of death that was five-fold lower than those delivered by doctors.

He …

The public’s unrealistic expectations about CPR

Skeptical Scalpel, MD

Physician

March 19, 2018

A survey of 1,000 volunteer adults found 71% regularly watched medical television dramas, but only 12% said the shows “were a reliable source of health information.”

The participants were given some brief vignettes describing scenarios where CPR was administered: a 54-year-old who suffered a heart attack at home and received CPR by paramedics, an 80-year-old with a postoperative cardiac arrest in the hospital after surgery, and a post-traumatic arrest in an …

Physicians: Are you paying attention to your mutual fund fees?

Wall Street Physician, MD

Physician Finance

March 19, 2018

In the past, investors had to pay an actively-managed mutual fund to manage their money. The average actively-managed mutual fund charges about 1% of assets under management. Hedge funds typically charge 2% of assets and 20% of profits. And the worst of the worst mutual funds charge up to 3% or 4% of assets. Now, index funds can give you a diversified portfolio for less than 0.1%.

One of the easiest and high-yield ways …

Communication skills: a tale of 2 doctors

Suneel Dhand, MD

Physician

March 18, 2018

There are two doctors working at the local hospital. They are both around the same age, been in practice for several years, and in the same specialty.

Dr. Cooper grew up in Ohio and went to medical school in California, before moving to New York after his residency training. Dr. Steele grew up in Michigan, where he also went to medical school, before completing his residency in Florida, and then ending …

The FDA approval of 23andMe’s BRCA test: What it means for you

J. Leonard Lichtenfeld, MD

Conditions and Diseases

March 18, 2018

The approval by the Food and Drug Administration of 23andMe’s BRCA test is bound to create a discussion about the merits and pitfalls of direct to consumer genetic testing for cancer risk.

It is also going to add fuel to a growing fire about how we as a nation assess genetic risks for cancer, and whether society is prepared for what is inevitably going to become a …

What to do if you have huge student loan debt

James M. Dahle, MD

Physician Finance

March 18, 2018

Q. Where do I start? I have a huge student loan debt and don’t think I’ll ever be able to pay it off.

I am a physician assistant, and my partner is a physical therapist. We’re about two years out of school. I have only recently started to try and figure out how to be smart with my money. I owe $167K in student loans, and my partner owes $200K. Our combined …

How this emergency physician’s shift really went

Cindy Winebrenner, MD

Physician

March 18, 2018

She is 61, and she can’t help but smack her lips together repetitively. She has no teeth, and the curvature of her spine makes her a miniature version of what she once was. Her frizzy hair is a purple-gray tone, and there are dark particles of something in the knots alongside her left temple. Her clothes are too loose, and there are food stains on her shirt. The ambulance arrived …

The truth about plastic surgery chains

Jennifer Greer, MD

Physician

March 17, 2018

Over 17 million cosmetic surgery and minimally invasive procedures were performed in the U.S. in 2016. With the increasing popularity of cosmetic procedures, it seems nearly everyone is out to get a bite of the apple.

Cosmetic surgery chains are growing in size and popularity in an attempt to cash in on this market. Examples include: LifeStyle Lift in the U.S., which declared bankruptcy in 2015 …

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The truth about plastic surgery chains

Intern year is still universally hard. Intern year is also universally great.

Grace Faith Chao, MD

Physician

March 17, 2018

4:00 p.m. Right on time.

I am walking down the street with my brother on his first visit to me in residency; I’m only two weeks in.

I turn to him: “Wait a second.”

I place my hand on the cement wall next to us, and I start to heave.

“Um … are you OK?”

“Yeah. No worries. My body’s just adjusting.”

I go on to describe how every day at 4 p.m. after a 24-hour …

The AHRQ is in the line of fire. Here’s why you should care.

Kenneth Lin, MD

Health Policy

March 17, 2018

For the past 30 years, a little-known U.S. health agency has supported and produced volumes of groundbreaking research on how to make health care safer, less wasteful, and more effective. Dubbed “the little federal agency that could,” AHRQ has accomplished this feat with a small fraction of the budgets of its higher-profile cousins, the Centers for Disease Control and Prevention and the National Institutes of Health. …

MKSAP: 38-year-old man is evaluated during a periodic health maintenance visit

mksap

Conditions and Diseases

March 17, 2018

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

A 38-year-old man is evaluated during a periodic health maintenance visit. His friend was recently diagnosed with type 2 diabetes mellitus, and the patient expresses interest in being screened. He is asymptomatic and reports no symptoms of polyuria or polydipsia. He exercises regularly. Medical and family histories are unremarkable. He takes no medications.

On …

When medical coders blame physicians

Robert Donnell, MD

Physician

March 16, 2018

An interesting paper in CMAJ Open reports on a series of interviews with coders concerning their perceptions of their interactions with doctors. The study was done in Canada, but it rings true to what we experience in the U.S. The fundamental objective of coding is the same: to translate information about the patient’s story into a series of numeric ICD-10 codes for various administrative purposes. Several themes emerged from these interviews. Form …

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When medical coders blame physicians

When doing “nothing” really matters

Marianne Haughey, MD

Physician

March 16, 2018

She came up to me and said, “You saved my life.” I remember meeting this woman while I was walking my dog in a woody park near my home and I was taken aback. She didn’t look like someone who should be dead; she was young and vibrant and out for a hike. Then she added details. She had an ectopic pregnancy. She came to the ED in shock. She …

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When doing “nothing” really matters

Match Day: the perfect ending to the medical school experience

Valerie A. Jones, MD

Medical Education

March 16, 2018

The first week of medical school you became a new person. Assigned a cadaver and some partners in your first anatomy lab, the gravity of the endeavor struck you to your core as you slowly unzipped the cadaver bag for the first time and met “Ernie” (as you later named him) and wondered how he died. You looked to the table beside you where blue nail polish could still be …

How to have a life in residency

Angela Seabright, DO

Physician

March 16, 2018

Medical students and residents become accustomed to living life in year increments. Four years for medical school, three to five years for residency, a couple years for fellowship, research, and so on. While many of us like to think we are putting our life on “pause” as we complete our medical training this just isn’t possible. Life is happening all around us every day. Many physicians look back on their …

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How to have a life in residency

When your first food allergy reaction takes place in the air

Lianne Mandelbaum, PT

Patient

March 16, 2018

Can you imagine flying home from a family vacation and having a first-time anaphylactic reaction in the air? Did you know that airlines are not required to stock their planes with easy-to-use auto-injectors that any adult or child could operate?

Francine’s family was flying back home from vacation on American Airlines. Her 10-year-old son, who had no history of food allergy, ate the warm mixed nuts they served and immediately had stomach …

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