KevinMD.com

July 24, 2016Jul 24, 2016

A letter to my nephew, who is just starting residency. There will be days ahead when patients will bring you their most prized and flawed possessions -- their broken bodies, their flagging spirits, their waning hope. They will wonder: "Can…

A letter to my nephew, who is just starting residency.

There will be days ahead when patients will bring you their most prized and flawed possessions — their broken bodies, their flagging spirits, their waning hope. They will wonder: “Can I get back to my loved ones, my life, my dreams? Will you help me? Do you care?”

You will not have all the answers, though you will have read a forest …

Read more…

Sage advice to new medical residents

Medical Education

A medical student delays reporting his needlestick. Here’s what he learned.

Anonymous

July 24, 2016Jul 24, 2016

A few months ago, I was on my general surgery rotation on the colorectal service as a medical student. It was in the late afternoon that we started a case of a robotic rectopexy to repair a rectal prolapse. Our…

As we undocked the da Vinci machine, the resident and I began to suture closed the multiple …

Medications

How OxyContin taught doctors to trust pills over patients

Anna Reisman, MD

July 24, 2016Jul 24, 2016

Treating pain is a notoriously tricky business. But it’s even harder if the medications on which we rely are inappropriately marketed. Last month, a Los Angeles Times investigation of Purdue Pharma asserted that for years, the company falsely elevated the efficacy of its twice-daily OxyContin, a powerful opioid pain reliever. The Times’ review of evidence — including three decades of court cases, investigations, patient and …

Real physician voices, twice a week

Free, and one click to unsubscribe.

Physician

A reminder that there are no guarantees with cancer

Don S. Dizon, MD

July 23, 2016Jul 23, 2016

Most times, I feel excited to be an oncologist. Oncology research is accelerating and every week brings more news, whether it be a deeper understanding of tumor genomics, a broader understanding of cancer genetics and risk, and, it seems, more ways to provide precision therapy. Studies are coming out showing gains in survival in many different cancers, and …

Medical Education

Medical school: A crash course to critically appraise information

Nathaniel Fleming

July 23, 2016Jul 23, 2016

The question, asked to me by a new first-year medical student, seemed simple enough: “There are a lot of different types of reflex hammers out there -- which one should I buy?” As with so many things in medicine, however,…

The question, asked to me by a new first-year medical student, seemed simple enough: “There are a lot of different types of reflex hammers out there — which one should I buy?” As with so many things in medicine, however, I knew that my answer wouldn’t be so straightforward.

As I prepared to answer, I flashed back to one of my first days in medical school, when one of my clinical …

Physician

What we can learn from old school physicians

Suneel Dhand, MD

July 23, 2016Jul 23, 2016

The term “old school” in many facets of life has negative connotations. We live in a modern, technologically advanced and fast-paced world -- and there’s no room for certain people who appear to hold us back. Last year I wrote…

The term “old school” in many facets of life has negative connotations. We live in a modern, technologically advanced and fast-paced world — and there’s no room for certain people who appear to hold us back.

Last year I wrote an article about an experience I had with an “old school” physician. That experience really caused me to reflect on the situation the medical profession finds itself in, …

Conditions and Diseases

MKSAP: 66-year-old man with polyuria and polydipsia

mksap

July 23, 2016Jul 23, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While…

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

A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A repeat random …

Physician

Today happens once. And we are guaranteed nothing.

Michael P. Jones, MD

July 22, 2016Jul 22, 2016

As I sat next to her bed in the intensive care unit, I wondered if she knew that today was her last day when she woke up this morning. I didn’t think she knew that it was her last day…

As I sat next to her bed in the intensive care unit, I wondered if she knew that today was her last day when she woke up this morning. I didn’t think she knew that it was her last day now. I was sure that she knew that something was wrong but did she know that she’d be dead in a few hours?

One of the most profound things about being a …

Physician

This is why hospice work is so fulfilling

Laura Patel, MD

July 22, 2016Jul 22, 2016

I make my way down the aisle of the plane, squeezing past my fellow passengers and plop down in my assigned seat. Sitting next to me is a middle-aged woman with a kind smile. As the plane takes off, she…

I silently debate, do I adopt my travel persona or answer truthfully? Answering honestly will result in one of two things; either we …

Physician

How maternity leave cost this physician

Alicia Welder, MD

July 22, 2016Jul 22, 2016

When I had my first baby, I was a busy resident trying to complete my residency on time. I didn’t want to extend my residency even if it meant sacrificing time with my newborn. In order to get my 8-week leave, I banked days whenever I could. There was one period I worked 45 days straight (well, not straight, I did get the mandatory 24 hours off between once a week) so …

Read more…

How maternity leave cost this physician

Physician

Primary care physicians should advocate for fewer restrictions on women’s choices

Joshua St. Louis, MD, MPH and Dana Desmond, MD

July 22, 2016Jul 22, 2016

Our patient was a 15-year-old girl who came to the emergency room of our hospital saying she wanted to commit suicide after being raped several weeks ago at a classmate's party. In the emergency room, a urine pregnancy test was…

Our patient was a 15-year-old girl who came to the emergency room of our hospital saying she wanted to commit suicide after being raped several weeks ago at a classmate’s party. In the emergency room, a urine pregnancy test was positive. On admission to the hospital, she was very clear that her thoughts of killing herself came from her rape and current pregnancy. She was clear that she wished to …

Physician

The day a young patient took charge and grew up

Hans Duvefelt, MD

July 21, 2016Jul 21, 2016

Dustin Ouellete grew up a bit the other day. I had known Dustin as an infant, and his mother before that. Several years ago, the Ouellete family moved away to the big city, but last summer they came back. Dustin…

Dustin Ouellete grew up a bit the other day.

I had known Dustin as an infant, and his mother before that. Several years ago, the Ouellete family moved away to the big city, but last summer they came back.

Dustin came in a few times with his father, and his main concern was migraines. Dustin’s father, a quiet man who seldom smiles, was concerned that the headaches were keeping his son from …

Physician

I will go on treating patients, because that is what I know

Greg Smith, MD

July 21, 2016Jul 21, 2016

You’ve all heard it. Those ads about that wonderful product that will change your life. The new kind of mattress that will finally give you a good night’s sleep every night. The new electric car. The superfood. They go on about them for thirty seconds or a minute, you are enthralled, and you dream of going right out and purchasing. Ah, marketing, how powerful you are. How much we want …

Physician

The art of taking an excellent medical history

Robert Centor, MD

July 21, 2016Jul 21, 2016

The art of eliciting the medical history requires medical knowledge, cultural knowledge, and many “people skills.” History taking is not science, but rather, art, because it requires interpretation and clarification. Patients with the same symptoms express them differently. A major…

A few examples might clarify these concepts.

The patient tells you that they have chest …

Medications

The demise of FluMist is a victory for science

Roy Benaroch, MD

July 21, 2016Jul 21, 2016

Recently, the CDC announced that its Advisory Committee on Immunization Practices (ACIP) voted to stop recommending the nasal spray flu vaccine, FluMist, for anyone. Bottom line: it doesn’t work. Though their recommendation against the use of FluMist still has to be approved by the CDC director to make it “official,” it’s pretty much a done deal. The AAP’s president has already endorsed the announcement, too.

Bye, Flumist. We’ll …

Conditions and Diseases

After cancer treatment, sexual health challenges are often shielded from partners

Anne Katz, RN, PhD

July 20, 2016Jul 20, 2016

The phone rang in my office one morning last week. Woman: “I received a notice of an appointment with you, and it says to bring my partner or spouse with me. This problem has nothing to do with him.” (The…

The phone rang in my office one morning last week.

Woman: “I received a notice of an appointment with you, and it says to bring my partner or spouse with me. This problem has nothing to do with him.”

(The opening statement could just as easily be from a man, and often is.)

I quickly looked up her notes in the electronic medical record …

Physician

I have seen both worlds, and the naturopathic one is terrifying

Britt Marie Hermes, ND

July 20, 2016Jul 20, 2016

I find it amusing to be accused of being an unsuccessful practitioner of naturopathic medicine. I graduated with high grades from Bastyr University. I landed a highly competitive naturopathic residency. Had I remained in practice, I would currently be eligible to take the naturopathic pediatrics “board-certification” exam offered by the Pediatric Association of Naturopathic Physicians.

I was making decent money at my practices in Seattle and Tucson. By all accounts, I was …

Health Policy

Don’t rant about MACRA. Propose solutions instead.

Bob Doherty

July 20, 2016Jul 20, 2016

Recently, ACP offered practical solutions to physicians’ concerns about Medicare’s proposal to implement the new payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). The College’s detailed recommendations, summarized here in a press statement that is linked…

The College’s detailed recommendations, summarized here in a press statement that is linked to the comment letter itself, would replace CMS’s proposed and unnecessarily complex quality scoring system with a much simpler and understandable approach as developed by the College.

We challenge CMS to completely …

Health Policy

How MACRA will decimate the private practice physician

Niran S. Al-Agba, MD

July 20, 2016Jul 20, 2016

Small, independent private practices are closing, increasing numbers of physicians are retiring, and fewer medical school graduates are choosing primary care. The old-fashioned practice my father and I have built is a dying entity. Parents say coming to see us for an appointment feels more like a visit with a friend than a medical encounter. I am fighting for the survival of primary care practices. MACRA proposed reimbursement will decimate …

Medical Education

A moment of sorrow transformed into bliss

D. Micah Milgraum

July 19, 2016Jul 19, 2016

It's a typical chaotic day on the hospital's hematology and oncology floor. I'm sitting in a side room with one of my fellow medical students, doing paperwork and making follow-up calls for our medical team. That's when the music starts.…

It’s a typical chaotic day on the hospital’s hematology and oncology floor. I’m sitting in a side room with one of my fellow medical students, doing paperwork and making follow-up calls for our medical team.

That’s when the music starts. The sounds of two guitars, a tambourine, and a few maracas drift down the hallway. I can’t make out how many people are singing, but the happy voices and the song’s …

Real physician voices, twice a week

The Podcast

Latest episodes

The Podcast

Latest episodes