KevinMD.com

May 30, 2017May 30, 2017

Every summer, medical schools around the country give out clean, crisp, new white coats. On the shoulder is the school’s signature emblem, with the new medical student’s name neatly etched above the pocket. A White Coat Ceremony commences where established physicians gown the new generation of doctors. It is a treasured, picturesque, and proud time. The ceremony ends with taking the Hippocratic Oath including the well-known verse “do no harm.” …

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Is your physician a doctor of debt?

Medical Education

Congratulations medical school graduate! It’s time to find a therapist.

Elisabeth Poorman, MD

May 30, 2017May 30, 2017

To the graduating medical school class of 2017: Welcome to the profession. Many of you will be moving, planning long vacations, and preparing for your life as a medical resident. Right now, you're probably furiously reviewing handbooks on being a…

To the graduating medical school class of 2017: Welcome to the profession.

Many of you will be moving, planning long vacations, and preparing for your life as a medical resident. Right now, you’re probably furiously reviewing handbooks on being a medical intern as you sit on a beach.

(Or, like me, promising yourself you will — right after you finish “The Fault in Our Stars.”)

Forgive me, but I have something to add …

Conditions and Diseases

The only perfect cancer statistic is an imperfect one

Stephanie Graff, MD

May 30, 2017May 30, 2017

As an oncologist, I spend my days with women and men diagnosed with cancer. My patients, particularly my advanced-stage or Stage 4 (metastatic) patients, often ask what they did wrong. How did they end up with metastatic cancer? They share with me the subtle accusations made by friends, family and acquaintances that somehow they brought this on themselves. “If only Susan had done her screening mammograms faithfully, she never would …

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Medical Education

When the medical student isn’t the most important person

Nathaniel Fleming

May 30, 2017May 30, 2017

For the first two years of medical school, everything was all about us. Day one was our white coat ceremony. Our family and friends traveled from near and far to come celebrate our achievements; the school gifted us stethoscopes and…

For the first two years of medical school, everything was all about us.

Day one was our white coat ceremony. Our family and friends traveled from near and far to come celebrate our achievements; the school gifted us stethoscopes and white coats to mark the beginning of our journeys. We had already accomplished amazing feats to get here, we were told, and we were expected to continue to do great things. …

Medications

6 tricks that pharmaceutical marketers use

Martha Rosenberg

May 30, 2017May 30, 2017

Long before the Internet and direct-to-consumer advertising, the medical profession tried to reassure people about their health concerns. Remember “take two aspirins and call me in the morning?" Flash forward to today’s online “symptom checkers.” They are quizzes to see…

Long before the Internet and direct-to-consumer advertising, the medical profession tried to reassure people about their health concerns. Remember “take two aspirins and call me in the morning?”

Flash forward to today’s online “symptom checkers.” They are quizzes to see if someone has a certain disease and exhortations to see their doctor even if they feel fine. Once drug makers discovered that health fears and even hypochondria sell drugs, there seems …

Physician

Why we shouldn’t pigeonhole patients into groups

Hans Duvefelt, MD

May 30, 2017May 30, 2017

I was scheduled to attend a medical director's retreat the other day, but because of a horse emergency the day before, I had to stay home, so I offered to skip the retreat and see patients instead. It would have…

I was scheduled to attend a medical director’s retreat the other day, but because of a horse emergency the day before, I had to stay home, so I offered to skip the retreat and see patients instead.

It would have been almost an entire day hearing about trauma informed care and the lifelong impact of adverse childhood events. As a primer, the conveners of the seminar emailed a “dear doctor” letter …

Physician

It is easy to pass judgment and much harder to pass empathy

Linda Girgis, MD

May 29, 2017May 29, 2017

Being the intern on the team, I knew the scut work belonged to me. Every medical student understands the hierarchy of the medical team, and there was just no way around that. If a patient needed urgent blood work drawn at 3 a.m., call the scut monkey as we were called. Any patient requiring a rectal exam required an intern to perform the test. Scut basically was any work that no …

Physician

Memorial Day thoughts from a physician

Shannon Tapia, MD

May 29, 2017May 29, 2017

Truthfully, I am not from a military family. Naturally, my grandfathers were in the service, but they didn’t die serving. Also, my birthday has always fallen on Memorial Day weekend, or near it. So rather than visiting a cemetery, we usually have a small party. For some reason, perhaps it’s the political divisiveness in my beloved country, I have been thinking more and more about Memorial Day.

To my understanding, Memorial …

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Memorial Day thoughts from a physician

Health Policy

Listen up GEHA: Vaccines should not be an out of pocket cost

Niran S. Al-Agba, MD

May 29, 2017May 29, 2017

In a little piece of legislation known as the Affordable Care Act, preventive services are mandated to be covered with no out-of-pocket expense to consumers. According to the Healthcare.gov website, approved insurance plans must cover a “list of preventive services…

Number 18 on that preventive care list is childhood immunizations for children from birth to age 18, acknowledging regional variation in the standard …

Medications

Is there a medication that can combat rigid and robotic thinking?

Michael Kirsch, MD

May 29, 2017May 29, 2017

I had an interesting conversation with a patient in the office some time ago. He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel. I did not think that these laboratory abnormalities…

I had an interesting conversation with a patient in the office some time ago.

He was sent to me to evaluate abnormal liver blood tests, a common issue for gastroenterologists to unravel. I did not think that these laboratory abnormalities portended an unfavorable medical outcome. Beyond the medical issue, he confided to me a harrowing personal tribulation. Often, I find that a person’s personal story is more interesting and significant than …

Physician

Seeing your gynecologist is not just for a Pap smear

Andrea Eisenberg, MD

May 29, 2017May 29, 2017

Some days, I get so frustrated at work. Yes, we all have our frustrations. Maybe traffic is slow, and you get to work late. Maybe you spill your coffee on your work clothes as you walk into your office. Maybe someone calls in sick, and you are short help at work. But this is big! Like so big, it can impact the trajectory of someone’s life. They, in turn, are forced …

Physician

To help patients, doctors should consider going on strike

Matthew Hahn, MD

May 28, 2017May 28, 2017

Last fall I was witness to a miraculous event. I rarely take off from work, but did so on a Friday to go to Baltimore to lend moral support to my family doctor friend, Cathy Maslen. She and her workmates at Chase Brexton Health Care (a community health clinic in the Baltimore area with a focus on the gay and transgender community and the inner-city poor) were doing something that …

Health Policy

We can reinvest in social justice by observing our children

Ami B. Bhatt, MD

May 28, 2017May 28, 2017

We are visiting the grandparents in New York City for spring break. Spring has been sporadic thus far, more of a series of trailers rather than the feature presentation. The overhead warming lights and warm air greets us as we escape from the cool evening into the grandparent’s glittery apartment building. Although this specific location is not near Times Square, it has the gold leaf on the ceiling and lights …

Health Policy

From clinic to Congress: How you can use your skills to advocate

Shubha Srinivas, MD and Lekshmi Santhosh, MD

May 28, 2017May 28, 2017

It’s been a long day at the hospital. Between rounds and writing notes, you’ve already skipped lunch. In a spare moment, you manage to scroll through the news on your phone, and for once aren’t interrupted by a call or page. What you read makes you anxious, confused, or relieved — or all of that and more. You like, retweet, share, maybe donate, and then return to your last chart …

Health Policy

Reflections from the Hill: How residents participate in advocacy

Luming Li, MD

May 28, 2017May 28, 2017

Advocacy on the Hill can be a challenging, since it’s never clear how much a single person or small group of people can impact an issue. However, that fact alone should never stop anyone from doing advocacy work. Jessica Isom,…

Jessica Isom, Nkemka Esiobu, and myself had met with Dr. John Krystal (chair of the Yale psychiatry department) regularly to discuss about an advocacy day at the Capitol. We were three psychiatry residents, …

Physician

You want doctors to be doctors again? Get out of the way.

Jordan Grumet, MD

May 27, 2017May 27, 2017

I have a confession to make. I don't understand the concept of burnout. I mean, I get the idea. Medicine is, at least when you are the kind of doctor who deals with life and death, inherently stressful. And I…

I have a confession to make. I don’t understand the concept of burnout. I mean, I get the idea. Medicine is, at least when you are the kind of doctor who deals with life and death, inherently stressful. And I feel the stress. It’s as if someone applied a vice grip to my insides in the middle of medical school, and it has never let up since. The pressure is …

Physician

This is what practicing medicine in rural America is really like

Edwin Leap, MD

May 27, 2017May 27, 2017

“So tell me why you think you you’re having a stroke?” The nice lady, mid 40s, sat on the ER exam table in work-clothes, an anxious look on her face. “Well, I was working the cattle up in the timber,…

“So tell me why you think you you’re having a stroke?”

The nice lady, mid 40s, sat on the ER exam table in work-clothes, an anxious look on her face. “Well, I was working the cattle up in the timber, and when I got back to my 4-wheeler my heart was racing, and I was short of breath. My arms were tingling, and so was my face. I’m concerned it might …

Physician

Bearing witness: An oncologist’s role at the end of life

Jennifer Lycette, MD

May 27, 2017May 27, 2017

My patient was sitting in a wheelchair. He was in his mid-forties, and before the cancer, had held a physically demanding job that he loved. Now, the cancer in his spine had ended not only his ability to work, but…

His wife was devoted to him in a way that seemed as natural and understated and unobtrusive as breathing.

In order for me to examine him, she …

Conditions and Diseases

MKSAP: 57-year-old woman is evaluated after a recent screening colonoscopy

mksap

May 27, 2017May 27, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old woman is evaluated after a recent screening colonoscopy. The colonoscopy disclosed a 12-mm polyp in the ascending colon, which was removed. No…

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

A 57-year-old woman is evaluated after a recent screening colonoscopy. The colonoscopy disclosed a 12-mm polyp in the ascending colon, which was removed. No other lesions were noted. On pathology, the lesion was found to be a sessile serrated polyp.

Physical examination findings are unremarkable.

Which of the following is the most appropriate time …

Conditions and Diseases

The unhappy couples after a cancer diagnosis

Anne Katz, RN, PhD

May 26, 2017May 26, 2017

The couples I see for counseling are not always perfect, not that any couples ever are. But when cancer enters the relationship, for some couples, things get ugly and get ugly fast. I believe that we like to think that cancer makes people “better”; that people rise to the challenge and become the best they can be. I think that we …

Real physician voices, twice a week

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