KevinMD.com

March 4, 2017Mar 4, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated for a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps,…

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

A 30-year-old woman is evaluated for a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps, bloating, intermittent nausea, and mild anorexia that has resulted in the loss of 2.3 kg (5.0 lb). She has had no fever or blood in the stool. She works …

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MKSAP: 30-year-old woman with diarrhea

Health Policy

How a smoking ban is regressive policy

Saagar Pandit

March 3, 2017Mar 3, 2017

Imagine a smoking ban in the privacy of your own home? For over 2.3 million residents of public housing, this will be their reality. On November 12, 2015, former Secretary of Housing and Urban Development (HUD), Julian Castro, announced HUD’s policy for “smoke-free” federally funded public housing. The policy requires that residents refrain from “using tobacco products in their units, common areas, and within 25 feet of public housing and …

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How a smoking ban is regressive policy

Physician

Where will disrupted primary care physicians go?

Michael Breen, MD

March 3, 2017Mar 3, 2017

As a physician and businessman, I wish the future looked better for PCPs. But history suggests things will get still worse. The history of business teaches us disruptive innovation always starts from below. The “untouchable” market leader is threatened by…

As a physician and businessman, I wish the future looked better for PCPs. But history suggests things will get still worse.

The history of business teaches us disruptive innovation always starts from below. The “untouchable” market leader is threatened by a less expensive version of its own product. The smug incumbent ignores the unprofitable downscale threat. Then the new competitor decides to go upscale, is forced to innovate as a result, and …

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Physician

The top 3 questions hospital administrators ask

Suneel Dhand, MD

March 3, 2017Mar 3, 2017

A few years ago, I was in a position where I was quickly going down the route of hospital administration. I thought it was interesting at first, but realized it wasn’t quite my cup of tea, at least in the circumstances that I was exposed to. What I didn’t like about it was the feeling that I was losing touch with the front lines. And wherever my career takes me, …

Conditions and Diseases

Chrissy Teigen’s IVF backlash

Jessica Celine Morgan

March 3, 2017Mar 3, 2017

When it comes to the uterus, people tend to have incredibly strong opinions. In fact, many of the people with strong beliefs don’t even have a uterus of their own. I would venture even further to say that if you asked many of these “opinion-havers” where the uterus was in a woman’s body or exactly what its function was, they would have no idea.

Yet, here we find ourselves, 44 years …

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Chrissy Teigen’s IVF backlash

Physician

His power over her was cultural. How could I do the right thing?

Andrea Gordon, MD

March 3, 2017Mar 3, 2017

She burst into tears when I asked if she wanted to get pregnant. Eman, a beautiful young woman from Jordan, sat in my family-practice office with her husband, Ali, and two adorable children about one and two years old. With…

She burst into tears when I asked if she wanted to get pregnant.

Eman, a beautiful young woman from Jordan, sat in my family-practice office with her husband, Ali, and two adorable children about one and two years old. With her scarf and dark clothing covering all but her pale face and enormous sable-brown eyes, Eman looked closer to fourteen than twenty-four, and scarcely old enough to have any children.

“How can …

Medical Education

A medical student confronts the injustices of our immigration system

Kevin Diasti

March 2, 2017Mar 2, 2017

We long for the moments in our life that justify our course, that illuminate the banalities of our daily routine, and that instill within us a mission that suddenly harmonizes all that you have done and all that you hope…

My first year as a physician-in-training consisted of an insurmountable study load, a constant quarrel with the torturous alliance of fatigue and self-doubt, and the simple reality being a …

Physician

How religion influences the doctor-patient relationship

Sarita Khemani, MD

March 2, 2017Mar 2, 2017

It was my turn to be on call during Christmas. I held the long list of patients signed out to me, and began my rounds early that morning in the hopes that I could be home in time to open…

It was my turn to be on call during Christmas. I held the long list of patients signed out to me, and began my rounds early that morning in the hopes that I could be home in time to open presents with my family that evening.

I went from room to room on the surgical floor, talking to patients. I knocked on one door and pushed it open. A white male …

Medications

Did doctors who cared too much lead to the opioid epidemic?

Edwin Leap, MD

March 2, 2017Mar 2, 2017

Sometimes medicine offers us wonderful, almost unimaginable gifts. Heart attacks that were devastating, life-altering events a few decades ago are now treated with expediency and skill that our grandparents couldn’t imagine. A couple of days pass, and the victim is home with stents in occluded arteries and directions to modify activity and diet. Pneumonia, once the “old person’s

friend” (so called because it took the aged to eternity), is far less …

Physician

Compartmentalization failed me, and I’m forever grateful

Jeffrey McWilliams, MD

March 2, 2017Mar 2, 2017

I’m humbled by the honor to practice medicine. We have the opportunity to be frontline participants in an ever evolving cascade of events in the lives of others. Our decisions, directions, and split second actions have the ability to unite families, sustain breath or literally a beating heart. Although biased, I can’t think of many professions more fulfilling and honorable. There are issues and concerns, but they pale in comparison …

Physician

What’s the fix for the care disparity in corporate-owned health care?

Jaan Peter Naktin, MD

March 2, 2017Mar 2, 2017

“We must not allow a mineshaft gap!” famously spoken by George C. Scott as General Turgidson in Dr. Strangelove as the post-nuclear holocaust planning begins in earnest. For some reason, this quote goes through my mind as I sit through meetings, assemblages and retreats that talk about the future state of medicine in a large gobble-gobble network that has aspirations to provide population health as an Accountable Care Organization to …

Physician

How practicing mindfulness between patients makes you a better doctor

Aparna Iyer, MD

March 2, 2017Mar 2, 2017

Mukhwas are the Indian equivalent of an after-dinner mint. Sweet and flavorful, but typically only distributed through one tiny spoonful at a time, mukhwas are the perfect way to completely clear your palate, wiping clean the last remnants of a tantalizing meal. A small dosage of the mukhwas completely nullifies the aftertaste, so that the attention is no longer on the meal that has just passed. It’s the gustatory equivalent …

Medical Education

The medical student’s ultimate challenge: children

Nathaniel Fleming

March 1, 2017Mar 1, 2017

During the first year of medical school, one of the most nerve-wracking, but exciting, experiences was learning how to interview and examine patients. At that time, we mostly worked with “standardized patients” — people who are trained specifically to play the role of a scripted medical case. Although working with them seemed incredibly challenging at the time, the rules of engagement were in fact very favorable to us. Asking a question …

Health Technology

What’s the role of telemedicine in primary care?

Fred N. Pelzman, MD

March 1, 2017Mar 1, 2017

As part of trying to figure out where telehealth and video visits fit into the primary care setting, this week I got an amazing tour from the director of our emergency department, during which he showed me the program they've…

An incredible system, they take patients from triage who report to the emergency department with nonemergent issues, and move them to a consultation room off to …

Physician

We must remember to humanize our patients

Kjell Benson, MD

March 1, 2017Mar 1, 2017

I’m probably crazy. I ride my motor scooter to and from work at the hospital. Some consider it unsafe. Perhaps it is, but feeling the wind and rain, those unfiltered elements. And after 12 hours inside a controlled environment, it’s too refreshing to pass up. So at 2 a.m. Friday night, I’m zooming (you always “zoom” on a scooter) through the industrial district after a tiring admitting shift. I see …

Physician

The medical profession has a bad reputation. Here’s why.

Samer W. Cabbabe, MD

March 1, 2017Mar 1, 2017

It is no secret that physicians are disenchanted with the changes in medicine and can be overheard saying that they do not want their children to go into the profession. Has the practice of medicine deteriorated to the extent we…

According to a Doctors Company survey of 5,000 physicians, 9 out of 10 physician respondents indicated an unwillingness to recommend health care …

Physician

The malpractice environment doesn’t influence doctors to provide better care

Skeptical Scalpel, MD

March 1, 2017Mar 1, 2017

A study of over 890,000 Medicare beneficiaries shows that states with malpractice environments unfavorable to physicians do not see improved postoperative outcomes for 11 different types of mostly elective major operations. States with higher general surgery malpractice insurance premiums had…

States with higher general surgery malpractice insurance premiums had significantly more episodes of postoperative sepsis, pneumonia, acute renal failure, and gastrointestinal bleeding.

Those with higher numbers of paid claims per 100 physicians had more postoperative myocardial infarctions, surgical site …

Physician

What this physician learned from a dying patient

Jalal Baig, MD

February 28, 2017Feb 28, 2017

Propelled in part by the unalloyed hopes I cultivated in medical school, I got through my internal medicine residency training largely free of questions about medicine’s limitations. Ailing strangers entered my life in the hospital and I helped them leave…

That changed when …

Physician

Multiple choice tests in our post-truth world

Paul Marantz, MD, MPH

February 28, 2017Feb 28, 2017

It has been purported that one of the major take-home messages from the bizarre events of 2016 is that we are now living in a “post-truth” world. Indeed, that very phrase was dubbed the “word of the year” by Oxford Dictionaries, which defines it as “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.”

We are also …

Medical Education

Don’t forget that we’re not just women, we’re doctors

Jessica Celine Morgan

February 28, 2017Feb 28, 2017

“You’re too pretty to be a doctor.” “When will I see the real doctor?” “You’re just going to med school to meet a husband right? I’ve heard that’s what girls do.” If you’re a female medical student or physician, it's…

“You’re too pretty to be a doctor.”

“When will I see the real doctor?”

“You’re just going to med school to meet a husband right? I’ve heard that’s what girls do.”

If you’re a female medical student or physician, it’s likely that these phrases are not completely unfamiliar to you. Despite it being 2017 — a fact we continue to point out to highlight how far we should have come by now, but …

Real physician voices, twice a week

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