KevinMD.com

August 30, 2016Aug 30, 2016

She smiled fetchingly and threw her arms around me. She was so happy to have someone to hug. She was large, obese, kyphotic and almost bent double while edging slowly with her walker toward the examining room. She had sent a Christmas card and a birthday card, and I thanked her for them, while secretly praising myself for remembering she had sent them.

She was diabetic and hypertensive and 88 years …

Health Policy

Why are ERs so busy? It’s really no surprise.

Manuel Momjian, MD

August 29, 2016Aug 29, 2016

If the emergency room is the most expensive place to receive health care, then why are more patients visiting the ER than ever before? There are no local doctors’ offices that can charge $1,000 to put a Band-Aid on your finger or $8,000 to tell you that your abdominal pain is due to drinking too much coffee. But, I don’t think you would mind paying this premium if you were having …

Physician

Jess Jacobs: Thank you for what you taught me

Fatima Z. Syed, MD

August 29, 2016Aug 29, 2016

I never knew Jess Jacobs, and she never knew me. Everything I know about her I have learned from her Twitter feed, her website, and articles written about her. She was the same age as me when she died recently. She was educated. She knew the health care system inside and out, as an expert in insurance and policy and as a patient. But she was more than …

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Physician

We are nurses: Stop the bullying in health care

Debbie Moore-Black, RN

August 29, 2016Aug 29, 2016

The surgeon is doing a tonsillectomy on a 4-year-old boy. Dr. Jones drops an instrument on the floor of the OR. The instrument is now contaminated and has to be sterilized by a special machine called an autoclave. This was a small hospital, so they did not have a large inventory of duplicate surgical instruments. So the circulating nurse put the instrument into the autoclave. As this machine locked in …

Physician

Instead of training more doctors, why don’t we keep the ones we have now?

Jaclyn van Nes, MD

August 28, 2016Aug 28, 2016

In an article from the Pew Charitable Trusts, an upcoming scarcity of OB/GYNs in the U.S. is predicted with a potential shortage of 22,000 OB/GYNs by the year 2050. Reasons given for the shortage are a growing population, female OB/GYNs retiring early and working part-time, residents entering sub-specialties and changing physician attitudes about work-life balance. Suggestions in the article to combat the shortage are increasing OB/GYN residency spots and supporting …

Physician

Physicians will rise to take back the bedside

Jean Robey, MD

August 28, 2016Aug 28, 2016

Art explains medicine by explaining human needs. In December of 2015, Dr. Michael P. Jones wrote a piece that had 27K shares: "We’ve killed the way physicians should be." It is interpreted that 27K readers or more identified with what…

Art explains medicine by explaining human needs. In December of 2015, Dr. Michael P. Jones wrote a piece that had 27K shares: “We’ve killed the way physicians should be.” It is interpreted that 27K readers or more identified with what Dr. Jones wrote.

In his essay, he claimed the identity of a physician was being “killed” by the reality of practice demands. The essay referenced an image of the …

Physician

A failure in transition of care

Hans Duvefelt, MD

August 28, 2016Aug 28, 2016

Alvion Barr had a four-month delay in his diagnosis. He is technically a patient of my colleague. But he had drifted between two of our regular doctors and a locum tenens physician we hired to work during March, when both…

Alvion Barr had a four-month delay in his diagnosis.

He is technically a patient of my colleague. But he had drifted between two of our regular doctors and a locum tenens physician we hired to work during March, when both other doctors were on vacation.

I saw him late Thursday afternoon for a rash, but he also asked what he could do about his heartburn.

“Tell me more about your heartburn,” I said.

What followed …

Read more…

A failure in transition of care

Physician

How words create bridges to a therapeutic relationship

Anne Katz, RN, PhD

August 28, 2016Aug 28, 2016

I am sensitive to language and the way we use it in health care; as the editor of the Oncology Nursing Society’s premier research journal, the Oncology Nursing Forum, and as a sexuality counselor, words are my business and the…

The conversation typically goes like this:

Me: “Hello, can I speak with Mr./Ms. X …

Medical Education

Medical student: “I was less stressed in Afghanistan.”

Pamela Wible, MD

August 27, 2016Aug 27, 2016

Dear Pamela, Let me start off by telling you that I am a warrior, a protector, and a healer. I am an Army veteran. I’ve worked as an EMT, completed a bachelor's degree and two years of medical school, plus…

Dear Pamela,

Let me start off by telling you that I am a warrior, a protector, and a healer. I am an Army veteran. I’ve worked as an EMT, completed a bachelor’s degree and two years of medical school, plus I’m raising a family. I’ve achieved amazing things, but I have never been defeated like I’ve been over these past few years.

Honestly, I was less stressed in Afghanistan. Medical school is …

Physician

The true essence of what it means to be a companion

Amanda Sommerfeldt, MD

August 27, 2016Aug 27, 2016

The world can be a lonely place. Despite technology designed to bring us closer, it seems we've become more isolated. We view profiles rather than embrace complete individuals. We spend hours crafting a persona, a smooth and unblemished public face.…

The world can be a lonely place. Despite technology designed to bring us closer, it seems we’ve become more isolated. We view profiles rather than embrace complete individuals. We spend hours crafting a persona, a smooth and unblemished public face. Raw, unattractive emotions: grief, insecurity, jealousy. We mask those from others and even hide them from our deepest selves. Ultimately, rather than becoming more connected, I suspect we are cast …

Conditions and Diseases

MKSAP: 57-year-old man with substernal chest pain

mksap

August 27, 2016Aug 27, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus,…

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

A 57-year-old man is admitted to the hospital for evaluation of substernal chest pain. His medical history is significant for type 2 diabetes mellitus, coronary artery disease, hypertension, and hyperlipidemia. He manages his diabetes as an outpatient with diet, exercise, and metformin. His other medications are aspirin, metoprolol, atorvastatin, and sublingual nitroglycerin as …

Health Policy

Invest in primary care and you get what you pay for

Niran S. Al-Agba, MD

August 26, 2016Aug 26, 2016

In 1978, the Institute of Medicine published A Manpower Policy for Primary Health Care: Report of a Study where they defined primary care as “integrated, accessible services by clinicians accountable for addressing a majority of heath care needs, developing a…

The four main features of “good” primary care based on this definition are: 1. First-contact access for new medical …

Physician

Politics in the exam room? Here’s what this doctor does.

Steve Schlozman, MD

August 26, 2016Aug 26, 2016

When I was 17 years old, I insisted that my father, a pulmonologist, join Physicians for Social Responsibility. I had just read about the organization in my history class, and I was feeling increasingly hopeless that I would live to…

My father refused to even have the discussion.

I’ll get to why he refused in a minute, but first, a bit of …

Conditions and Diseases

7 pediatrician tips for back-to-school success

Chad Hayes, MD

August 26, 2016Aug 26, 2016

The new school year is just around the corner (or maybe it’s already started where you live). Either way, here are a few quick tips to make sure you start the year off right: 1. Sleep is key: Poor or…

The new school year is just around the corner (or maybe it’s already started where you live). Either way, here are a few quick tips to make sure you start the year off right:

1. Sleep is key: Poor or insufficient sleep can have significant effects on school performance. Many of us (myself included) let our children stay up later during the summer months. But as school starts back, it’s important …

Medical Education

You failed your surgical boards. What’s next?

Skeptical Scalpel, MD

August 26, 2016Aug 26, 2016

"I graduated this July and took the QE (written general surgery boards) on July 19th. I got my results today, and I failed. Not only did I fail but my score placed me in the 5th percentile. Needless to say,…

“I graduated this July and took the QE (written general surgery boards) on July 19th. I got my results today, and I failed. Not only did I fail but my score placed me in the 5th percentile. Needless to say, I’m disappointed. You hear stories about CE (oral exam) failure but never about QE failure. I never blew the ABSITE out of the water (50, 29, …

Health Policy

Government-run health care isn’t going away

Bob Doherty

August 25, 2016Aug 25, 2016

We all want this sometimes, don’t we? We want the things in our daily lives that bug us the most, like long lines at the DMV, to just go away. But how often does that really happen? As the senior…

We all want this sometimes, don’t we? We want the things in our daily lives that bug us the most, like long lines at the DMV, to just go away. But how often does that really happen?

As the senior staff person for ACP’s governmental affairs team in Washington, DC, I often hear from exasperated physicians who want ACP to just make things they don’t like go away, whether it’s MACRA …

Physician

The bureaucratic hassles physicians face are extraordinary

Peter Ubel, MD

August 25, 2016Aug 25, 2016

Left to our own devices, most of us physicians try our best to provide high-quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many of us get so caught up in our busy clinic schedules we occasionally forget to, say, order mammograms for women overdue for such tests, or we don’t get around to weaning …

Physician

Donald Trump’s medical letter has so many things wrong with it

Jennifer Gunter, MD

August 25, 2016Aug 25, 2016

Donald Trump is talking about Hillary Clinton’s health as are two doctors who have never evaluated Clinton. This attention on Clinton has renewed some interest in the letter Donald Trump released last year from his personal physician. Many outlets have…

Many outlets have picked it apart, but I want to tell you as a doctor exactly how bad it is. I would never write …

Physician

Why we should remember our moments of vulnerability

Michelle Zhang, MD

August 24, 2016Aug 24, 2016

During my first rotation of intern year, we took care of a woman who walked into the hospital with a kidney stone and never walked out. 52 years old, diabetic but otherwise healthy, she had been vacationing in Vermont with her son and extended family when she became sick with high fevers. When her symptoms didn’t improve, her son rushed her to our emergency room where an imaging scan revealed …

Physician

A physician tells a health insurance CEO what she really thinks

Cathleen London, MD

August 24, 2016Aug 24, 2016

I graduated medical school in 1995. I believe in a single-payer health system. I am about championing for my patients. I left a salaried position in academic medicine to go an underserved area of rural Maine and start a practice.…

Dear Mr. CEO,

My name is Cathleen Greenberg London. I am a family medicine physician who …

Real physician voices, twice a week

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