KevinMD.com

December 31, 2016Dec 31, 2016

The Affordable Care Act is perhaps the biggest overhaul of the U.S. health care system in many decades. Enacted by President Barack Obama in 2010, it made health care attainable and affordable to millions of Americans. Individuals with pre-existing medical conditions cannot be denied health care coverage; insurance companies have to cover essential health care needs including mental health and preventive services, children can be covered under their parents’ plans …

Physician

David Newman betrayed patients and emergency medicine

Steve Carroll, DO

December 31, 2016Dec 31, 2016

I remember that morning in January 2016 very well. I opened up my Twitter feed to find many people linking to an article that made me stop dead in my tracks. The New York Post was reporting that Dr. David Newman had been accused of sexually assaulting a patient in his emergency department. He was accused of giving the patient a dose of propofol and then sexually …

Conditions and Diseases

MKSAP: 40-year-old man with type 1 diabetes mellitus

mksap

December 31, 2016Dec 31, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man with type 1 diabetes mellitus presents to the office. He seeks advice on his diabetes management as he intensifies his exercise…

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

A 40-year-old man with type 1 diabetes mellitus presents to the office. He seeks advice on his diabetes management as he intensifies his exercise routine in preparation for participation in a 10-K race. He reports prolonged hypoglycemia during intense exercise, despite eating a meal prior to the activity. His insulin regimen is insulin …

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Medical Education

Are the new work-hours restrictions pushing people out of medicine?

Anonymous

December 30, 2016Dec 30, 2016

Dear patient, I may never get to meet you, which is a real shame. I think I would have enjoyed getting to know you and working together with you to overcome whatever particular medical issue with which you had come…

Dear patient,

I may never get to meet you, which is a real shame. I think I would have enjoyed getting to know you and working together with you to overcome whatever particular medical issue with which you had come to meet me. We might have learned about each other. We might have learned about our community. We might even have made some kind of change together.

I myself am a patient, …

Physician

The American system for training doctors is broken

Elisabeth Poorman, MD

December 30, 2016Dec 30, 2016

"I did a weekend of 72 hours in which I only got four hours of sleep. I would also secretly hope to get in a car accident and maybe break a leg so that I would be force to take…

“I did a weekend of 72 hours in which I only got four hours of sleep. I would also secretly hope to get in a car accident and maybe break a leg so that I would be force to take off from work … just so I could get some rest. Thank God, I never got in an accident, but I have had colleagues fall asleep at the wheel.”
– Dr. …

Physician

The case against a surgery volume pledge

Vamsi Aribindi, MD

December 30, 2016Dec 30, 2016

Dr. Pronovost is a leading figure in the patient safety movement, and is someone I greatly admire. His work with surgical checklists is touted by Dr. Atul Gawande as having saved more lives than any researcher in the past decade. However, I disagree with his latest initiative: to get hospitals who perform certain procedures at very low rates to stop performing them altogether.

On the surface, it seems like …

Physician

Why is this physician here? Because of connection.

Beverly A. Zavaleta, MD

December 30, 2016Dec 30, 2016

Why am I here? It’s already a half hour past the end of my 12-hour hospitalist shift, and I’m hustling to finish admitting a new patient from the ER. Once I finish, I still need to see patients at another facility before I finally wrap-up for the night and head home. Staying late is a professional courtesy for tonight’s nocturnist nurse practitioner. Nocturnist mid-level practitioners are a unique breed of …

Physician

What CME isn’t doing today to align and empower patient outcomes

Linda Girgis, MD

December 29, 2016Dec 29, 2016

We live in a world that is rapidly evolving and changing. The future is uncertain as policies change, as well as politicians. No one can predict what 2017 or future years will herald. We watch as dozens of news stories pour into our mobile apps every time we check in. And for those of us that practice medicine, health care research, and news coverage can change the way we approach …

Physician

Place patients above politics

Courtney McMickens, MD

December 29, 2016Dec 29, 2016

Anti-immigration policies are hazardous to the health of immigrant patients. In the last ten years, there have been over 1,500 anti-immigration laws adopted by states across the country. These laws have come with discriminatory, racist, and xenophobic undertones, which has…

Patients don’t need to be deported or detained to be harmed by these policies, laws, and language. Research shows an …

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Place patients above politics

Physician

We cannot afford to lose our physicians to suicide

Joseph P. Merlino, MD

December 29, 2016Dec 29, 2016

In January, the National Academy of Medicine is launching a new committee to address the high rates of depression and suicide among physicians and other health care workers in the United States. They plan to bring together medical professionals, educators and hospital administrators, and I hope they will also bring to the table professionals who have experienced burnout, and who may have attempted suicide due to burnout. I say this …

Physician

Does racial bias compromise patient care?

Dowin Boatright, MD, MBA

December 29, 2016Dec 29, 2016

Recently, Dr. Michelle Herren, a professor of pediatric anesthesiology at the University of Colorado and Denver Health Hospital, resigned after posting racist comments on her Facebook page. In particular, she wrote that Michelle Obama speaks “ebonics” and stated that our first lady has a “monkey face.” Dr. Herren ended her post by affirming that she is not racist but was “just calling it like it is.” This post remained on …

Physician

One year later: A physician’s letter to Medicare patients

Rebekah Bernard, MD

December 28, 2016Dec 28, 2016

Dear patients, One year ago, I wrote to you about my concerns for the future of my practice in light of upcoming changes to the Medicare system. I explained my anxiety about the Medicare Access and CHIPS Reauthorization Act (MACRA),…

Dear patients,

One year ago, I wrote to you about my concerns for the future of my practice in light of upcoming changes to the Medicare system. I explained my anxiety about the Medicare Access and CHIPS Reauthorization Act (MACRA), a change in fee structure from fee-for-service (I treat you in the office, submit the bill to Medicare, and they pay the bill), to “value-based” payment (I …

Physician

A letter to her physician husband

Charity Williams

December 28, 2016Dec 28, 2016

Dear Husband, MD I see you. I hear you cough all night, knowing your flu vaccine has failed and you have it. I hear you wheeze with your post-flu pneumonia. I feel you shiver in the bed beside me while…

Dear Husband, MD

I see you. I hear you cough all night, knowing your flu vaccine has failed and you have it. I hear you wheeze with your post-flu pneumonia. I feel you shiver in the bed beside me while you sleep for 5 hours before you get back up and start getting ready for the next “shift.”

I put quotations around “shift” because we both know you will not work 8 …

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A letter to her physician husband

Medical Education

The word that best describes this medical student’s experience

Anonymous

December 28, 2016Dec 28, 2016

It’s 4:17 a.m. as I begin this entry. I’m scheduled to be at the hospital in 43 minutes for one of my last days on surgical rotation, and I’ve been working on the following text message since 3 a.m.: “Hi,…

“Hi, team. Im afraid that im burned out and anxious. I will be taking today off. Sorry to be blunt but i felt it better than to make up an excuse. Thanks …

Physician

Burnout left its mark on this physician

Franklin Warsh, MD, MPH

December 28, 2016Dec 28, 2016

In a previous piece, I described the killer B's of burnout in medicine, namely, bleakness, boredom, and bureaucracy. Both times I went through burnout, the cycle started with boredom. I found medicine so full of the mundane most days, after…

In a previous piece, I described the killer B’s of burnout in medicine, namely, bleakness, boredom, and bureaucracy. Both times I went through burnout, the cycle started with boredom. I found medicine so full of the mundane most days, after about five years in practice, I grew restless. There’s only so much time after your office is done, the kitchen is clean, and the kids are in …

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Burnout left its mark on this physician

Physician

How this psychiatrist handles burnout

Greg Smith, MD

December 27, 2016Dec 27, 2016

I listened to a Planet Money podcast recently titled, Burnout. It dealt with the origin and characteristics of burnout, and I would highly recommend it. You’ve all heard the term and have a vague knowledge of what burnout is, I’m…

I listened to a Planet Money podcast recently titled, Burnout. It dealt with the origin and characteristics of burnout, and I would highly recommend it.

You’ve all heard the term and have a vague knowledge of what burnout is, I’m sure. You may have experienced it yourself. It affects call center employees (as in the podcast), all sorts of service workers, doctors and other health care providers and countless others.

Looking back …

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How this psychiatrist handles burnout

Health Policy

The potential costs of Tom Price as HHS secretary

Miranda Yaver, PhD

December 27, 2016Dec 27, 2016

President-elect Donald Trump has repeatedly vowed to “repeal and replace Obamacare.” A logical question is: With what? The announcement of Rep. Tom Price (R-Ga) as Trump’s nominee for secretary of health and human services provides some answers. Unlike other Republican…

Unlike other Republican critics of the Affordable Care Act (ACA), Price, an orthopedic surgeon, has offered many replacement plans of unmatched detail. His Empowering Patients First Act was 242 pages …

Physician

An oncologist experiences the joy of being wrong

Don S. Dizon, MD

December 27, 2016Dec 27, 2016

I believe in miracles. That might sound odd coming from an oncologist --especially since our field is driven by the data. Our path forward continues to be built through trials and the collaboration between clinicians and patients, working together to…

I believe in miracles. That might sound odd coming from an oncologist –especially since our field is driven by the data. Our path forward continues to be built through trials and the collaboration between clinicians and patients, working together to forge a better way to treat cancer. I certainly believe in evidence, but still … I believe in …

Health Technology

Tech-savvy docs need to be on the forefront of EHR reform

David Mann, MD

December 27, 2016Dec 27, 2016

I remember the disdain some of the EHR trainers had for their trainees back when our hospital system “went live” several years ago. Of course, this disdain was tempered by their knowledge that if docs weren’t so computer illiterate, or the user interfaces of the EHR systems weren’t so awful, or if the EHR software wasn’t so bug-ridden, their jobs wouldn’t exist.

So they soldiered bravely on, undaunted by grumpy old …

Physician

A different consequence of 28-hour shifts

Stephanie Waggel, MD

December 26, 2016Dec 26, 2016

Sleep deprivation and medical errors are not the only issues that arise from long shifts. Aside from being dangerous, working 28 hours straight can teach new doctors that their health and even their life is not a priority. With extremely high rates of depression and suicide in this field, increasing work hours is not the step we should be taking. When I was interviewed by Public …

Real physician voices, twice a week

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