KevinMD.com

September 9, 2016Sep 9, 2016

Mom. She was a feisty 100 percent Italian, straight from New Jersey. Her dad, straight from Italy, was a tailor and made the finest suits for New York and New Jersey businessmen. Mom learned this trade well. She could sew some of the most beautiful tailored suits for herself. She loved to cook and every night was a banquet, a feast which required up to 2 hours of clean-up time …

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She asked for comfort

Physician

Why don’t more doctors apologize for their mistakes?

Skeptical Scalpel, MD

September 8, 2016Sep 8, 2016

“The unintended consequences of these seemingly well-intentioned laws are doctors who can’t apologize for harming their patients even if they want to …” A recent JAMA article about disclosing medical error described a hypothetical situation involving a dermatologist who, after…

“The unintended consequences of these seemingly well-intentioned laws are doctors who can’t apologize for harming their patients even if they want to …”

A recent JAMA article about disclosing medical error described a hypothetical situation involving a dermatologist who, after completing skin biopsies on two patients, discovered that the instruments had not been sterilized. He wondered if he should tell the patients and what he should say.

The authors …

Conditions and Diseases

The language you speak can affect how your baby cries

Christopher Johnson, MD

September 8, 2016Sep 8, 2016

I found this study to be absolutely fascinating. The link is to the abstract; the complete article is behind a paywall, but I can get it for anybody who’s interested in reading the whole study in detail. Its title is “Fundamental frequency variation in crying of Mandarin and German neonates.” I have always assumed, like most people I suspect, that babies cry the same the world over. When they’re uncomfortable or …

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Physician

A culture of rape: What can we do as doctors?

Linda Girgis, MD

September 8, 2016Sep 8, 2016

Around the U.S., millions of college age kids head back to start their fall semester in college. Their courses carefully selected months ago and their packing completed in a frenzy of activity. But, little thought is given to the most violent crime that happens on college campuses: rape and sexual abuse. Estimates show that approximately 25 percent of college women have been victims of rape. In fact, every 21 hours …

Physician

Exposing medicine’s secret underbelly: Physician suicide

Rita Losee, ScD, RN

September 8, 2016Sep 8, 2016

Pamela Wible MD’s book, Physician Suicide Letters Answered, is a devastating view of raw pain, the pain of young, energetic, highly committed young people motivated to help and heal. These healers themselves have been plunged into the spiritual, physical, emotional, and intellectual hell of suicidal thought and action. Iatrogenic illness in action (iatrogenic illness being that which is caused by medical practitioners). Unfortunately, and tragically, the iatrogenic illness that …

Physician

Fostering wellness: Tips and practical advice from front line physicians

Sima Pendharkar, MD and Tiffany I. Leung, MD

September 7, 2016Sep 7, 2016

“If physicians aren't happy, they can't heal others” - Vivek Murthy Last year, nearly 400 physicians committed suicide, a rate higher than other professions. Our nation is facing an epidemic of overwhelmed physicians subjected to increasing external stressors. Modern medical…

“If physicians aren’t happy, they can’t heal others”
– Vivek Murthy

Last year, nearly 400 physicians committed suicide, a rate higher than other professions. Our nation is facing an epidemic of overwhelmed physicians subjected to increasing external stressors. Modern medical practice has evolved into a system driven by incentives to meet care quality measure benchmarks, implement incomplete electronic systems, provide care that is satisfying to patients and more. To keep up, physicians …

Patient

Death by hospital: Who’s right?

Dan Walter

September 7, 2016Sep 7, 2016

Dr. Kaveh Shojania, a prominent patient safety expert who scoffs at the numbers and laughs at the tragedy inflicted on countless victims of medical error, should step down as editor of a leading hospital safety journal. About three years ago,…

About three years ago, a scientist named John James published a study proclaiming that — at minimum — 210,000 people die every year from hospital errors, making it the third leading cause of death in …

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Death by hospital: Who’s right?

Conditions and Diseases

How nurses and law enforcement can work together

Jason Lee, TCRN, CCRN

September 7, 2016Sep 7, 2016

The recent horrible events involving racial profiling, excessive force, and gun violence are deeply troubling but not new. Who can forget the Bronx shooting of Amadou Diallo in 1999 when 41 bullets rained down on his unarmed body. I can uniquely identify with the black experience because of my own numerous experiences of being pulled over for no other apparent reason except for being in the wrong neighborhood, wrong state …

Conditions and Diseases

Consider screening for BRCA more regularly

Nicholas Fogelson, MD

September 7, 2016Sep 7, 2016

When I talk to my patients, one of the greatest concerns I hear is regarding the fear that they might get a cancer at some point in their life. It is a very reasonable fear, as cancers of the female reproductive tract and breasts are not as rare as we might like. Perhaps educated by Angelina Jolie’s announcement of her BRCA mutation in 2013, many women now ask me about …

Physician

How the integration of behavioral and primary care treats pain

Hans Duvefelt, MD

September 6, 2016Sep 6, 2016

We are witnessing a strange migration of restless tribes, moving between doctors and clinics, traveling great distances in search of what no one wants to give them any more. This eerie movement is steadily gaining momentum in our community, in…

We are witnessing a strange migration of restless tribes, moving between doctors and clinics, traveling great distances in search of what no one wants to give them any more.

This eerie movement is steadily gaining momentum in our community, in our state, and across the country. We can hear it in telephone calls, we can read it in records of patients looking to switch their care, and we can see it …

Physician

I do not care what you say. I have to try.

James C. Salwitz, MD

September 6, 2016Sep 6, 2016

Smoking and drinking caused the cancer, which Ed ignored for a long time. By the time a doctor looked at the hole in his neck, the mass had congealed the base of the tongue to the right side of the jaw and burst through the skin. A steady drip of pink tinged, foul saliva ran down the side of Ed’s neck. Ed, not being able to chew for months, was …

Conditions and Diseases

What is the true utility of the DSM?

Steven Reidbord, MD

September 6, 2016Sep 6, 2016

Prior to the release of DSM-5 in 2013, I referred at times to the pocket copy of DSM-IV parked in my office bookcase. The main reason was to enter the right diagnostic codes on insurance forms. I also sometimes quoted DSM criteria to show a patient that ADHD can’t arise in adulthood, that daily mood swings are not characteristic of bipolar disorder, or that six months of sobriety is still “Read more…

What is the true utility of the DSM?

Health Policy

Accountable care organizations: Who are the winners and losers?

Ashish Jha, MD, MPH

September 6, 2016Sep 6, 2016

Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations. Here’s the tweet from Andy Slavitt, the acting Administrator of CMS: https://twitter.com/ASlavitt/status/768908822081667072 The link in the tweet is to a press release. The link…

Recently, CMS sent out press releases touting over $1 billion in savings from Accountable Care Organizations. Here’s the tweet from Andy Slavitt, the acting Administrator of CMS:

NEW ACO RESULTS: physicians are changing care, w better results for patients & are saving money. Over $1B. https://t.co/FEfe3QErb5

— Andy Slavitt 🇺🇦 (@ASlavitt) August 25, 2016

The link in the tweet is to a press release. The link in the press release citing more details is to another press release. There’s little in the way of analysis or data about how …

Medications

Your EpiPen is too expensive. These are your 4 options.

Roy Benaroch, MD

September 5, 2016Sep 5, 2016

EpiPens have gotten crazy expensive, yes: $600 for a two-pack. Here are some alternatives that might help you save a few bucks. 1. Wait a few weeks, and see what Mylan does. Mylan, the company that makes the “EpiPen” brand…

EpiPens have gotten crazy expensive, yes: $600 for a two-pack. Here are some alternatives that might help you save a few bucks.

1. Wait a few weeks, and see what Mylan does. Mylan, the company that makes the “EpiPen” brand of epinephrine auto-injector, has been under a lot of pressure lately to back off their unseemly price gouging. They’ve introduced a savings card that claims to lower your …

Conditions and Diseases

Bedpans to outcomes: Why can’t we quantify nursing care?

Amanda Anderson, RN

September 5, 2016Sep 5, 2016

“So, will you go get me a bedpan?” The bar was fancy, so I let it slide. This was not the first time my response to an occupational query was followed with a statement about bedside toileting; people just don’t…

“So, will you go get me a bedpan?”

The bar was fancy, so I let it slide. This was not the first time my response to an occupational query was followed with a statement about bedside toileting; people just don’t know what to do when an educated, confident woman says she’s a nurse.

I smiled tersely, as I have trained myself to. In past years, I’d offer varying responses: anger, heated debate. …

Physician

The psychiatrist as a double agent

Mark Rubinstein, MD

September 5, 2016Sep 5, 2016

I was treating John W., a psychiatric patient who was an insurance executive. He was angry about his work situation. He complained bitterly about his supervisor whom he felt singled him out for unfair criticism. Over the course of months, John’s complaints escalated to the point where he said, “I swear … if there was a chance I’d get away with it, I’d love to get rid of the guy.”

I …

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The psychiatrist as a double agent

Medical Education

Is burnout inevitable during medical training?

Anonymous

September 5, 2016Sep 5, 2016

Medical training in the United States is a long and tedious process. It begins in college, when one must complete the mandatory prerequisite curriculum and take a medical entrance exam; your score on which is directly compared to other applicants, immediately labeling you as a competitive candidate or not. The process of applying requires the completion of multiple comprehensive applications, the compilation of countless hours of research, clinical experience, letters …

Medical Education

The art of medicine cannot be measured by selecting letters on an exam

Amanda Breviu, MD

September 4, 2016Sep 4, 2016

You are currently on inpatient wards and notice your chief medical resident has been demonstrating erratic behavior, frequently muttering about MEN syndromes and antibodies associated with rheumatologic diseases and has been reciting gene translocations. What is the most likely cause…

A. Hospital-associated delirium
B. Conversion disorder
C. Symptoms related to completing an excess number of multiple choice questions in preparation for taking internal medicine boards

If you guessed C, you understand what I have been going …

Patient

The subtle arrogance of good health

Angelika Byczkowski

September 4, 2016Sep 4, 2016

Until my physical ailments began worsening rapidly in my late 40s, I was a high achiever, proud of my "kick ass" attitude, thinking I was so competent I could surmount any challenge life threw at me. Life appeared to be…

Until my physical ailments began worsening rapidly in my late 40s, I was a high achiever, proud of my “kick ass” attitude, thinking I was so competent I could surmount any challenge life threw at me. Life appeared to be straightforward, and I didn’t understand why this didn’t seem to be the case for so many other less fortunate folks.

Though I worked hard for my accomplishments and sometimes struggled, there …

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The subtle arrogance of good health

Medical Education

NEJM vs. the NYT: Which should medical professionals read?

Preeta Gupta

September 4, 2016Sep 4, 2016

Ever since I started medical school, my friends and family will often ask my opinion on a new medical recommendation they recently read online or heard on the radio. The trouble is, many times their query falls upon my clueless ears, as it is the first I am hearing about that medical study. In this last year, as I diligently pour through my medical textbooks, or almost exclusively answer my …

Real physician voices, twice a week

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