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A psychiatrist’s perspective on the digital pill

Maria Yang, MD

Health Technology

December 2, 2017

One of my readers, Natalie, wondered about my thoughts about the digital pill.

My initial reactions were similar to several of those who were interviewed for the article. The digital pill, which provides electronic information to confirm whether someone has ingested the medication, has great potential to become a tool of coercion. Aripiprazole (Abilify) is classified as an antipsychotic medication, which is often prescribed to people who have beliefs that machines …

The accused physicians who are my colleagues

Richard Plotzker, MD

Physician

December 2, 2017

From the earliest days on the clinical wards, everyone probably worked with a senior physician who knew how to game the system. It might be doing a rigid sigmoidoscopy on admission for every patient who had a rectum — something not the standard of care forty years ago. Or maybe it was accepting a pharmaceutical company subsidized tax-deductible junket under the guise of CME at a place with sparkling white …

MKSAP: 25-year-old man positive for hepatitis B surface antigen

mksap

Conditions and Diseases

December 2, 2017

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

A 25-year-old man is evaluated in follow-up after recently testing positive for hepatitis B surface antigen. He underwent testing as part of the immigration process from Somalia. Two other siblings also have hepatitis B virus (HBV) infection.

On physical examination, he is a young, healthy-appearing man. Vital signs are normal. No jaundice is …

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The real reason why the National Health Service survives

Dr. Saurabh Jha

Health Policy

December 1, 2017

When Aneurin Bevan was asked how he convinced doctors to come on board the National Health Service (NHS) he allegedly replied, “I stuffed their mouths full of gold.” Bevan recognized that to conscript doctors to the largest socialist experiment in health care in the world he had to appeal not so much to their morals, but their pockets.

There is much piety about the NHS. It is the envy of the …

Teaching residents to teach will improve medical education

Kristin Puhl, MD

Medical Education

December 1, 2017

Medical residents take on a variety of responsibilities. Some are clear, upfront, and obvious: the responsibilities they have been training for since entering medical school. Coming up with a treatment plan and carrying it out is first and foremost their raison d’etre, and they put an enormous amount of effort into it. However, they also acquire a host of other duties. They run interference for attendings. They coordinate with nursing. …

What happens to our brains in space?

Christopher Johnson, MD

Conditions and Diseases

December 1, 2017

Humans evolved with the constant force of the earth’s gravity. This is relevant to several of our organs, but the brain’s anatomy makes it especially important. The brain floats in spinal fluid encased inside the closed box of the skull. Gravity would be expected to affect the details of that. Indeed, studies of people who spent prolonged periods of time in bed in a head down position indicate this abnormal …

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What happens to our brains in space?

If we are serious about addressing the opioid epidemic, this is what we should do

Justin Berk, MPH, MBA

Physician

December 1, 2017

Multiple state leaders, including Maryland Gov. Larry Hogan, and even President Trump have declared states of emergency in response to the opioid epidemic. Policymakers claim to be battling this public health crisis on all fronts, but one arena continues to be conspicuously ignored: our prisons and jails.

Roughly half of all incarcerated individuals suffer from addiction. And in the two weeks following their release, former prisoners are 129 times more likely …

3 ways to fix end-of-life care

Suneel Dhand, MD

Physician

December 1, 2017

Anyone with even the slightest passing interest in health care, has heard the mind-blowing statistics. As a nation, we spend almost 3.5 trillion dollars on health care. To put that into perspective, that is more than the total GDP of every country in the world apart from China and Japan! Germany, next on the list, has an entire GDP of 3.4 trillion dollars. At 18 percent of the economy, we …

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3 ways to fix end-of-life care

How being an immigrant shaped the way I treat patients

Saisai Chen

Medical Education

November 30, 2017

I was born in Shanghai, China. In September 2000, my parents and I left behind our family and friends, a language and culture dear to our hearts and social and financial stability to immigrate to the United States. I was six at the time. Although I don’t claim to have fully understood the weight of their decision to start a new life, I knew that my parents were making a …

Make more than your spouse? Here’s how to save money on taxes.

Foreign BornMD

Physician Finance

November 30, 2017

The only time my husband outearned me was during our first three years of marriage when I was still in residency and working 80-plus hours per week earning less than minimum wage per hour. Since then, despite graduating in a professional degree, we have made relocation moves that primarily help with my career growth, to the detriment of his.

In 2015, an NPR article quoted statistics showing that 38 percent of …

This is the deadly virus you need to look out for

Melvin Sanicas, MD

Conditions and Diseases

November 30, 2017

Days are getting shorter and evenings are getting cooler in temperate regions in the Northern hemisphere. This also means that the flu season will be around the corner soon. Most people group influenza (flu) and cold together and refer to the “cold and flu season” as the time of the year when we expect to come down with a “flu bug” and consider it “normal” or customary. Some are even …

Do medical experts really know best?

Stephen C. Schimpff, MD and Harry Oken, MD

Conditions and Diseases

November 30, 2017

“In the beginner’s mind there are many possibilities, but in the expert’s view, there are few.”

Shunryu Suzuki was writing about Zen beginners and masters, but this concept applies to the practice of medicine as well. Experienced physicians are slow to accept a new paradigm, while medical students and new physicians are more open.

Sometimes, what we “know” to be true is not. Despite clinical trials to the …

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Do medical experts really know best?

An emergency physician travels to Puerto Rico. Here’s what she saw.

Amelia Breyre, MD

Physician

November 30, 2017

“In Puerto Rico, we call those plants morir vivir,” said a patient who sat by the side of the road while we checked her blood sugar. When I reached to touch the small fern, it swiftly closed its leaves shut, and then after a few minutes cautiously reopened. As a young doctor I was fascinated with the poetry of the name. “It’s just like us Puerto Ricans,” she smiled.

For two …

What it’s like to practice medicine behind bars

Torie S. Sepah, MD

Physician

November 30, 2017

I hear many comments and genuine inquiries about being a physician in a prison. They’re all well-meaning yet hint at how little is known about this world on the “inside” and those who inhabit it.

I take my time answering questions about the complexities of practicing behind bars, yet also highlight that despite the challenges, it’s difficult to see myself working anywhere else.

The “why” is tough to answer. I’m not a …

There shouldn’t be a debate about funding CHIP

Nathanael Smith

Health Policy

November 29, 2017

On September 30th of this year, the Children’s Health Insurance Program (CHIP) ran out of federal funding. While CHIP has not received as much publicity as the Affordable Care Act (ACA), it has had a major impact on the American population: providing health insurance for 9 million children who would otherwise not be insured. Despite its success, there is currently a debate about the funding of CHIP.

CHIP, which was passed …

How to stay out of the ER this holiday season: advice from an emergency medicine doctor

Irene Tien, MD

Physician

November 29, 2017

The holiday season is stressful enough without having to try to fit a visit to the emergency department (ED) in your schedule. Getting medical care on a major holiday can be especially difficult because most, if not all, offices and urgent cares are closed. This can make the ED wait longest around the holidays. Here are some tips to keep you out of the ED this holiday season.

1. Make sure …

5 shifts to move health care in the right direction

Halee Fischer-Wright, MD

Health Policy

November 29, 2017

The truth about change in health care was never more perfectly captured than in an episode of Sex and the City, when Carrie Bradshaw lamented that we keep “should-ing all over ourselves.”

In the past decade, those of us on the front lines of health care have seen the passage of nine major pieces of federal legislation that, combined, have profoundly affected how they work. We’ve seen the number of people …

What baseball can teach doctors

Michael L. Millenson

Health Policy

November 29, 2017

Baseball, like medicine, is deeply imbued with a sense of tradition, and no team more so than the New York Yankees, disdainful of innovations like placing players’ names on the backs of their jerseys and resistant to eroding strict standards related to haircuts and beards.

It’s why doctors and patients alike should pay special attention to why the Yankees parted ways with their old manager and what they now seek instead. In …

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What baseball can teach doctors

How to inspire medical students to pursue primary care

Natalia Maria Calderón

Medical Education

November 29, 2017

I distinctly remember the excitement I felt during my first year of medical school when exposed to the breadth of general and specialty fields that seemed all so equally rewarding and medically influential. I envisioned myself holistically understanding my patient, seeing the problem in the context of her other medical issues, her personality, her family and her environment — an approach I considered at the heart of the oath we …

Recognize the many accomplishments of black men in medicine: #BlackMenInMedicine

Cedrek L. McFadden, MD and Heather Logghe, MD

Physician

November 29, 2017

There were fewer black men enrolling in medical school in 2014 than in 1978.

In a world where the first black president of the United States was elected nearly a decade ago with many declaring it to be a new day of progress for blacks in America, statistics such as this one come as a surprise. Fifteen years ago only 677,000 blacks held an advanced degree. Today that number is 1.6 …

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