KevinMD.com

May 23, 2017May 23, 2017

The middle-aged man in my exam room wasn’t an alcoholic. At least, that’s what he declared to me as I asked him questions about his drinking. "I’m not like those people," he said, smiling nervously. "I go to work. I…

The middle-aged man in my exam room wasn’t an alcoholic. At least, that’s what he declared to me as I asked him questions about his drinking.

“I’m not like those people,” he said, smiling nervously. “I go to work. I don’t fall down the stairs. I don’t embarrass myself.”

As we spoke further about the consequences of drinking six to seven beers every night (and a few shots here and there), …

Physician

7 ways to not feel like an imposter

Rekha Chandrabose, MD

May 23, 2017May 23, 2017

If you are a physician reading this, please pat yourself on the back. You made it through medical school and residency so, de facto, you have both resiliency and grit (serious buzzwords, y’all). But as anyone who has gone through…

I am 44 years old and am faculty at a major public university and cis-gendered, heterosexual, married, two kids and have a full-time …

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7 ways to not feel like an imposter

Physician

Where money and the law intersect, truth can sometimes be the victim

Mark Rubinstein, MD

May 23, 2017May 23, 2017

Afterword from a story entitled “Litigation Lane,” excerpted from Beyond Bedlam’s Door: True Tales from the Couch and Courtroom (Thunder Lake Press). Forensic psychiatry involves the interface of psychiatry and the law. Over the years, I was asked to psychiatrically…

Afterword from a story entitled “Litigation Lane,” excerpted from Beyond Bedlam’s Door: True Tales from the Couch and Courtroom (Thunder Lake Press).

Forensic psychiatry involves the interface of psychiatry and the law. Over the years, I was asked to psychiatrically evaluate people in the context of civil litigation. Both plaintiff and defense attorneys retained my services to determine if an accident or incident that was the subject …

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Health Policy

It’s time we look at the Australian health system for lessons

Brian C. Joondeph, MD

May 22, 2017May 22, 2017

President Donald Trump in a recent press briefing with Australian Prime Minister Malcolm Turnbull announced, “Of course the Australians have better health care than we do - everybody does.” On the heels of the House narrowly passing the first in…

President Donald Trump in a recent press briefing with Australian Prime Minister Malcolm Turnbull announced, “Of course the Australians have better health care than we do – everybody does.” On the heels of the House narrowly passing the first in many steps toward Obamacare repeal and replace, President Trump’s comment caused a bit of a stir, to say the least.

MSNBC was all over it. Chris Hayes interviewed fellow socialist Senator …

Physician

When science ceases to be value-neutral, science ceases to be science

Dr. Saurabh Jha

May 22, 2017May 22, 2017

Recently, the Harvard Chan School of Public Health reported on the effect of surgical checklists in South Carolina. The press release was titled, “South Carolina hospitals see major drop in post-surgical deaths with nation’s first proven statewide Surgical Safety Checklist…

The Health News Review, for which I review, grades coverage of research in the media. Based on their objective criteria, the Harvard press release would not score highly.

The title exudes …

Physician

How are we supposed to deal with death?

Karla A. Viera, MD

May 22, 2017May 22, 2017

December 2012, three days before Christmas. It started as an ordinary day, but soon it would become the turning point of my career. As I entered my office, I noticed a different energy in the room. The receptionist looked at me and said, “Doc, one of your patients died last night.” As a psychiatrist, I am not used to the feelings generated when someone you cared for, passes in the …

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How are we supposed to deal with death?

Physician

Physicians are low-hanging fruit. Here’s why.

Michael Breen, MD

May 22, 2017May 22, 2017

When my children were growing up, I advised them, “Don’t choose any profession in which your worth is determined by knowing a body of information or using algorithmic thinking. If you do that, you’re toast.” ”Toast” because monopolies on information…

”Toast” because monopolies on information have been supplanted by the internet, and algorithmic thinking replaced by computers and artificial intelligence. Incredibly, this seismic shift in what society values has occurred in just a single generation.

And that’s …

Conditions and Diseases

5 ways to tell if a practice has integrity

Joy Eastridge, RN

May 22, 2017May 22, 2017

I stood in line behind a physician, slightly balding and in a long, starched lab coat at the coffee shop in our hospital. As he paid and took his coffee, I noticed that he smiled and called the clerk by name, “Thank you, Terri.” He went on about his day, and I was left to wonder about the man, his practice and what type of person he was.

My friend has …

Physician

I want to help him, but I need to know more about him

Jeremy Topin, MD

May 22, 2017May 22, 2017

I pause in front of the door. On the other side, you all wait. A spouse, sons and daughters, sometimes with their own small children in tow. Today, it’s your husband and father you have come for. Yesterday it was someone else’s mother. You have come from near and far, across the street and the country. Your weary eyes are unable to mask your sadness. Over the past week, you …

Physician

Mindfulness is the key to physician burnout

Maiysha Clairborne, MD

May 21, 2017May 21, 2017

Mindfulness has gained a lot of awareness and attention over the last few years as the medical community has set out to find strategies for prevention of physicians burnout. What has been coined “mindfulness-based stress reduction” or “mindfulness” is a principle proven long before medical researchers decided to reduce it to treatment strategy to promote acceptance among the physician community. This very useful tool today is becoming widely used in …

Conditions and Diseases

How President Trump may be radicalizing Muslim children

Jack Turban, MD

May 21, 2017May 21, 2017

“We don’t want them here.” President Trump could not have sent a clearer message to Muslim children around the world. In the eyes of our nation’s elected leader, these kids are not wanted in the United States. Trump’s immigration policies…

“We don’t want them here.”

President Trump could not have sent a clearer message to Muslim children around the world. In the eyes of our nation’s elected leader, these kids are not wanted in the United States.

Trump’s immigration policies have been focused on keeping “radical Islamic terrorists” out of the United States, but research in child psychiatry suggests that …

Physician

An obstetrician in the ICU

Ravi Chokshi, MD

May 21, 2017May 21, 2017

"This is the end, beautiful friend This is the end, my only friend, the end Of our elaborate plans, the end Of everything that stands, the end." - The Doors I am an obstetrician. My job, distilled to its essence…

“This is the end, beautiful friend
This is the end, my only friend, the end
Of our elaborate plans, the end
Of everything that stands, the end.”
– The Doors

I am an obstetrician. My job, distilled to its essence is to be present and assist during the birthing of a new life. Labor has its inherent risks, but with credit to those who came before me, delivering a child has never been safer for …

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An obstetrician in the ICU

Physician

What does your husband think about you being a surgeon?

Brad Herrin, MD

May 21, 2017May 21, 2017

Not once during my eight years of medical school and residency training was I ever asked the converse of the titular question, what was my wife’s opinion of my career choice. Not while scrubbed into a case on my surgery rotations, not in the middle of an overnight call in the neonatal intensive care unit and never once by an attending, fellow or co-resident. Even those who knew me best and …

Medications

How long can high drug prices last?

Robert Pearl, MD

May 20, 2017May 20, 2017

“Pigs get fat, but hogs get slaughtered,” the saying goes. And so may it prove to be true for the pharmaceutical industry. Three articles, all published May 3, illustrate the greed and egregious pricing by certain drug companies that are…

“Pigs get fat, but hogs get slaughtered,” the saying goes. And so may it prove to be true for the pharmaceutical industry.

Three articles, all published May 3, illustrate the greed and egregious pricing by certain drug companies that are gaining public recognition and scrutiny.

As an example, Marathon invested $370,000 to obtain the license for the data on “deflazacort,” a steroid available for about $1,200 a year in the United Kingdom. …

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How long can high drug prices last?

Physician

A medical student fails USMLE Step 1. Can he ever be a surgeon?

Skeptical Scalpel, MD

May 20, 2017May 20, 2017

I received these emails recently. The writer gave me permission to publish them. They have been edited for length, and some details have been changed to protect his anonymity. I'm a third-year medical student at an allopathic state medical school.…

I received these emails recently. The writer gave me permission to publish them. They have been edited for length, and some details have been changed to protect his anonymity.

I’m a third-year medical student at an allopathic state medical school. I’ve always wanted to do surgery. My problem is I failed USMLE Step 1 the first time and got a 207 on my second attempt. I hadn’t failed anything else throughout first …

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A medical student fails USMLE Step 1. Can he ever be a surgeon?

Physician

Losing that patient was one of my most traumatic experiences

Jennifer Adaeze Okwerekwu, MD

May 20, 2017May 20, 2017

The cadaver lab is a rite of passage in medical school — those few months early on when we dissect a human body to better understand our anatomy. It’s grotesque: peeling back skin, separating muscle sinews, and sawing through bone.…

It’s so emotionally jarring that young doctors in training often compartmentalize the experience, and this person before us …

Conditions and Diseases

MKSAP: 36-year-old woman with facial pain

mksap

May 20, 2017May 20, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old woman is evaluated for a 1-week history of recurrent episodes of facial pain that are 1 to 3 seconds in duration and…

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

A 36-year-old woman is evaluated for a 1-week history of recurrent episodes of facial pain that are 1 to 3 seconds in duration and occur spontaneously dozens of times throughout the day. The pain is sharp, severe, and located in the right infraorbital area. During this same period, she has developed worsening …

Physician

What do physical gait, movement, and apparent drive tell us about each other?

Greg Smith, MD

May 19, 2017May 19, 2017

Two sisters (religious order, not biological relation, as far as I know) live in one of the condos across from us. They are very nice, older ladies, warm and pleasant, always ready with a kind word and a smile as they see others in the complex come and go. They seem, at least on casual observation, to lead very busy lives. They rise early, heading out to do whatever it …

Physician

This physician won’t tell his alcoholic patients to stop drinking. Here’s why.

Michael Kirsch, MD

May 19, 2017May 19, 2017

When I am facing an alcoholic in the office, I do not advise him to stop drinking. Other physicians may advocate a different approach. We live in a free society and individuals are free to make their own choices. I…

When I am facing an alcoholic in the office, I do not advise him to stop drinking.

Other physicians may advocate a different approach. We live in a free society and individuals are free to make their own choices. I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that …

Medications

Here’s what opioid guidelines fail to mention

Cynthia Kay, MD and Joanne Bernstein, MD

May 19, 2017May 19, 2017

Opioids have become so closely associated with chronic pain that it is nearly impossible to talk about one without the other. When we look back just five years ago, when we were still in residency, news stories about chronic pain and opioid overdoses were not commonplace. Now, we find ourselves almost desensitized to each new opioid headline. We are general internists, primary care providers and junior faculty. We practice at …

Real physician voices, twice a week

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