KevinMD.com

September 13, 2016Sep 13, 2016

I'm seeing a fifty-something with knee pain when I feel the curtain behind me erupt open. It's Roland, my last patient, and his breath is at my neck: "Why are you being so difficult?" he says. "Why can't you just…

I’m seeing a fifty-something with knee pain when I feel the curtain behind me erupt open. It’s Roland, my last patient, and his breath is at my neck: “Why are you being so difficult?” he says. “Why can’t you just give me the prescription?”

I turn, and wave my hand over Roland’s head.

“Call security.”

He’s swearing again, and I can hear security’s racing footsteps as a code white is called.

“I have nothing more to …

Physician

The inhumanity of medical residency programs

Natasha Deonarain, MD, MBA

September 13, 2016Sep 13, 2016

My mother-in-law died last week. She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the…

My mother-in-law died last week.

She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now …

Physician

To prevent burnout, physicians need less resilience, not more

Rebekah Bernard, MD

September 13, 2016Sep 13, 2016

With the latest data calculating physician burnout at greater than 50 percent, American medicine is at a tipping point. How to fix this crisis? Why, make physicians more resilient, of course! Except physician resiliency is exactly what got us into…

With the latest data calculating physician burnout at greater than 50 percent, American medicine is at a tipping point. How to fix this crisis? Why, make physicians more resilient, of course!

Except physician resiliency is exactly what got us into this problem.

Let me explain. Doctors are notorious people pleasers. We spend years of our life at study, sacrificing the fun and freedom of youth, deferring childbearing, and delaying …

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Physician

Medical eponyms: Where women are clearly underrepresented

Antoinette Rose, MD

September 13, 2016Sep 13, 2016

The month of September has been Women In Medicine Month (according to the AMA) since 1989. Statistics are always telling: Currently 65 percent of practicing physicians are men, and 35 percent women. According to the Medscape Physician Compensation Report of…

The month of September has been Women In Medicine Month (according to the AMA) since 1989.

Statistics are always telling:

Currently 65 percent of practicing physicians are men, and 35 percent women.

According to the Medscape Physician Compensation Report of 2016, male physicians still make substantially more than their female counterparts ($252,000 vs. $192,000 for primary care, $324,000 vs. $242,000 for specialties, on average)
47.5 percent of …
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Medical eponyms: Where women are clearly underrepresented

Physician

The ambiguity of diagnosing brain death

Gene Uzawa Dorio, MD

September 12, 2016Sep 12, 2016

Hospitals have always served as a lifeline to survival. Whether from pneumonia, heart attack, stroke, or trauma, they have been a community safeguard between life and death. Today, a cost of care has been added to the patient treatment discussion…

Hospitals have always served as a lifeline to survival. Whether from pneumonia, heart attack, stroke, or trauma, they have been a community safeguard between life and death.

Today, a cost of care has been added to the patient treatment discussion forcing medical decision-making to look closely at expense. Financial considerations have come to the forefront as preservation of resources will be important to national health care. This can be a threat …

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The ambiguity of diagnosing brain death

Conditions and Diseases

An inhumane way to help those in greatest need of immediate intervention

Ilene Benator, MD

September 12, 2016Sep 12, 2016

Imagine losing your grip on reality; your only place to turn is the local hospital. Once there, you give up your personal effects, your clothes, and often, your right to leave. You wear paper scrubs in a sparse room, lay on an uncomfortable bed, and have a guard nearby preventing your escape. In seeking help, you have become a prisoner. This is done for your and for the hospital personnel’s …

Medical Education

You can’t prepare for a rotation in the pediatric ER

Austin Beck

September 12, 2016Sep 12, 2016

Walking into Riley Pediatrics Hospital in Indianapolis, Indiana, and having just completed two prior rotations in emergency medicine at two different level 1 trauma centers, I thought I would be able to easily fit in with pediatric population here. I thought I would be able to slide fluidly from patient to patient, oral reports to consults, while staying connected with the rest of the team. I thought I would be …

Physician

Do white coats make us better doctors?

Lauren B. Smith, DVM

September 12, 2016Sep 12, 2016

It is 80 degrees in the exam rooms. The air conditioner is broken and despite calling and alerting our clients, almost none of them want to reschedule. I finish writing up a chart in the treatment room where the air conditioner from the kennels still has some influence. Despite the temporary respite from the heat, my skin is still glistening with a thin layer of perspiration. I look sullenly at …

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Do white coats make us better doctors?

Health Technology

Should you care which EMR your doctor uses?

Matthew Anderson, MD, MBA

September 11, 2016Sep 11, 2016

When you are looking for a physician, what kind of criteria do you use? Location is probably a priority as is whether or not the physician accepts your insurance. You might review your state’s medical board, make sure there are no issues with licensure. Reviewing a physicians medical school and residency training is important. Some people even like to go in for an appointment just to meet a physician. As …

Medical Education

Medical students are viewed as dollar signs

Justin Reno, MD

September 11, 2016Sep 11, 2016

From the moment I entered medical school, I have been viewed as dollar signs by many individuals. Every medical student is visualized this way. Let’s start from the beginning. Most medical students come from humble beginnings. My father is a…

From the moment I entered medical school, I have been viewed as dollar signs by many individuals. Every medical student is visualized this way. Let’s start from the beginning.

Most medical students come from humble beginnings. My father is a bluegrass musician, and my parents couldn’t pay for my medical school. So I had to take out loans. This was the same situation for the vast majority of my friends. In …

Medications

We must face some unpleasant truths about opioids

David Juurlink, MD, PhD

September 11, 2016Sep 11, 2016

Over the past year I’ve lost track of how many times the opioid epidemic has, in one incarnation or another (Prince, naloxone, fentanyl, newborns in agonizing withdrawal and so on) found its way onto the front page news. What distinguishes this epidemic is not only its catastrophic toll — hundreds of thousands dead, uncountable millions harmed — but also the fact that, unlike SARS, Ebola or influenza, this epidemic has …

Physician

Medi-Cal for all: It’s coming soon

Manuel Momjian, MD

September 11, 2016Sep 11, 2016

The Affordable Care Act has been touted as the answer to our country’s huge uninsured epidemic. There is no denying the fact that millions of uninsured people signed up for insurance through an expanded Medicaid program, which is called Medi-Cal in California. The blessings of a decrease in uninsured patients makes for a great sound bite and has been repeated over and over in the media. The only problem is …

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Medi-Cal for all: It’s coming soon

Physician

A surgeon remembers 9/11

Bruce Campbell, MD

September 10, 2016Sep 10, 2016

“We do not remember days, we remember moments.” - Cesare Pavese “A plane! A plane just crashed into the World Trade Center.” The surgical case was moving along steadily. Another surgeon had removed a skin lesion from the patient’s neck,…

“We do not remember days, we remember moments.”
– Cesare Pavese

“A plane! A plane just crashed into the World Trade Center.”

The surgical case was moving along steadily. Another surgeon had removed a skin lesion from the patient’s neck, and the pathologist had not been certain if it was a cancer. I had recommended removing the scar and several of the nearby lymph nodes. The surgery had just started and was going …

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A surgeon remembers 9/11

Physician

The battle against medical student and new-doctor burnout

Damon Tweedy, MD

September 10, 2016Sep 10, 2016

As the audience of medical students decried the experiences that defined their academic lives, my cohort of middle-aged doctors started to squirm. We knew these stories: Doctors mistreating medical students, nurses, and other doctors; learning to cope with brutally long work hours; the struggle to grasp vague and ever-changing expectations while quickly bouncing from one clinical rotation to the next.

The four of us had eagerly agreed to participate on the …

Conditions and Diseases

The perfect birth plan can change. And it often does.

Kim M. Puterbaugh, MD

September 10, 2016Sep 10, 2016

When a patient arrives in labor and delivery clutching her birth plan, I’ll admit, I want to escape immediately to a remote, uninhabited island with no modern form of communication. I’d crate the carrier pigeons, too, just to be safe.…

Many of us who deliver babies have an unshakable belief that women with birth plans unlock Pandora’s nether regions, releasing a huge flock of horrifying Kraken. The Kraken takes perverse glee …

Conditions and Diseases

MKSAP: 34-year-old woman with very dry, painful hands

mksap

September 10, 2016Sep 10, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 34-year-old woman is evaluated for very dry, painful hands. She works in a daycare center and washes her hands 15 to 20 times…

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

A 34-year-old woman is evaluated for very dry, painful hands. She works in a daycare center and washes her hands 15 to 20 times daily, often for 2 to 3 minutes at a time. She has been applying lotion multiple times daily with no relief of the pain. She has a history of …

Physician

The story of a neurologist who quit medicine and lives on a boat

Melinda Burnett, MD

September 9, 2016Sep 9, 2016

I write this while sitting in our sailing catamaran, swaying in the wind and current eight feet above sand and sea grass. I know this because I can see right through the water in the Bahamas. There is clarity here.…

When I started this journey thirteen months ago, I was burning with anger. I was angry at insurance companies for developing complex, mutable formularies, coverage policies, and appeal procedures, maximizing my …

Physician

6 steps to overcoming physician burnout

Anonymous

September 9, 2016Sep 9, 2016

Exercise. Growing up I competed in multiple sports. The physical enhancement of the human body through movement sparked my interest in human physiology and kinesiology. Consequently, my interest in physiology ultimately led me to medical school. It only felt natural,…

Exercise. Growing up I competed in multiple sports. The physical enhancement of the human body through movement sparked my interest in human physiology and kinesiology. Consequently, my interest in physiology ultimately led me to medical school. It only felt natural, when medicine became what felt like the bane of my existence, that I’d revert back to this pursuit’s humble beginning. Given the fact that time was a scarce resource during internship, …

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6 steps to overcoming physician burnout

Physician

Physician burnout may not happen. But “burn in” is guaranteed.

Jean Robey, MD

September 9, 2016Sep 9, 2016

I saw a new residency graduate post about how balanced she will choose to be and how not taking work home would keep her idealism alive. Like a woman who has been pregnant and gone through delivery and postpartum, I wanted to tell her the truth about how emotions get changed in practice and how the emotions become physical ailments at times. I wanted to tell her birthing and raising …

Real physician voices, twice a week

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