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Medical students need guides to help them navigate the hospital

Anonymous

July 19, 2016Jul 19, 2016

Hi there, Allow me to introduce myself. I’m you. I’m you 20 years ago, or 45 years ago if you were in the Class of ’72. I’m you one month ago if you were in the Class of 2016. I…

Hi there,

Allow me to introduce myself.

I’m you.

I’m you 20 years ago, or 45 years ago if you were in the Class of ’72. I’m you one month ago if you were in the Class of 2016. I spilled coffee down my shirt, my hair is kind of a mess, and there are dark circles under my eyes from long hours spent studying.

Sound familiar?

Great. Then you’re in the right place. The …

The word “provider” should be politically incorrect

Sumit Som, MD

July 19, 2016Jul 19, 2016

It turns out that when Shakespeare asked, "What's in a name?" he didn't have medical providers in mind. In the last decade, the nondescript and confusing term "provider" has crept into the American medical lexicon thanks to the Centers for…

It turns out that when Shakespeare asked, “What’s in a name?” he didn’t have medical providers in mind. In the last decade, the nondescript and confusing term “provider” has crept into the American medical lexicon thanks to the Centers for Medicare & Medicaid Services (CMS) which defined a provider as a Medicare participant that is contractually obligated to provide health care to Medicare beneficiaries. This was beginning of clubbing all …

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5 questions to ask before applying to medical school

Dr. Daniel

July 18, 2016Jul 18, 2016

This is the question that every premed student must answer. It is the automatic query that follows after you have informed someone of your future goal to become a doctor. It is also the question many med school interviewers will…

“Why do you want to be a doctor?”

Everyone who poses this question has their own intention behind it. Your follow-up …

We were promised death panels

We were promised death panels

Physician on FIRE, MD

July 18, 2016Jul 18, 2016

The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there's free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma…

The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there’s free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma or a particularly nasty infection. We’re prepared to handle them.

“Where is the patient?” I inquired.

“On the way down from ICU. The surgeon’s on his way in,” I was told.

Hmm … …

Read more…

The cost of taking the USMLE exams is staggering

Matthew F. Covington, MD

July 18, 2016Jul 18, 2016

Based on recent data, medical students pay approximately $136 million dollars each year in registration fees for the U.S. Medical Licensing Examination (USMLE) Step 1, Step 2 CK, Step 2 CS and Step 3 exams. Current registration fees to take…

Current registration fees to take the four USMLE exams are $3,320 per U.S. medical student and $4,125 per international medical graduate (IMG). Estimated annual registration fees for the USMLE exams …

The Joint Commission deserves some blame for the opioid crisis. Here’s why.

Skeptical Scalpel, MD

July 18, 2016Jul 18, 2016

Recently, the Joint Commission issued a statement written by its executive VP for healthcare quality evaluation Dr. David W. Baker, explaining why it was not to blame for the opioid epidemic. If you haven’t already read it, you should. Here…

“In the environment of today’s prescription opioid epidemic, everyone is looking for someone to blame. Often, The Joint Commission’s pain standards take …

Saving billions of dollars in health care: The story of Avastin and Lucentis

Peter Ubel, MD

July 17, 2016Jul 17, 2016

I sometimes worry that my wife Paula won’t be able to see me grow old. Not that I expect to outlive her. She is four years my junior and has the blood pressure of a 17-year-old track star. It’s her eyesight I’m worried about, because she is at risk for a form of blindness called macular degeneration. Paula is the youngest in a long line of redheads, several of whom …

Health Policy

More guns or fewer? The problems with evidence-based gun research

Paul Marantz, MD, MPH

July 17, 2016Jul 17, 2016

In the wake of the Orlando shootings, the usual battle lines are drawn in the usual, predictable way. Urban liberals and many Democrats call for more regulations and enforcement to limit access to firearms (especially assault weapons); hunters and conservatives…

Antibiotics: Maybe it’s time to just say no

Roy Benaroch, MD

July 17, 2016Jul 17, 2016

We’ve heard it before: Antibiotics just don’t work for viral infections. Docs know this, and I think most patients know this, but it’s an addiction we’ve had a hard time shaking. Docs overprescribe because it’s fast, it’s easy, and it…

We’ve heard it before: Antibiotics just don’t work for viral infections. Docs know this, and I think most patients know this, but it’s an addiction we’ve had a hard time shaking.

Docs overprescribe because it’s fast, it’s easy, and it (might) increase patient satisfaction and return visits. That’s led to a cycle of reinforcing expectations from patients — who, after all, keep feeling better after the antibiotics. Of course, they do. …

Let’s end the stereotypes of medical specialties

Hamsika Chandrasekar

July 17, 2016Jul 17, 2016

“I could never go into that specialty. They’re so passive aggressive.” “Those residents are so catty.” “Oh, them? They don’t even know their patient’s names.” “Those residents are such bros.” And so on. I guarantee you that if you’re in…

“I could never go into that specialty. They’re so passive aggressive.”

“Those residents are so catty.”

“Oh, them? They don’t even know their patient’s names.”

“Those residents are such bros.”

And so on.

I guarantee you that if you’re in medicine — or even if you’re not — it would take you no more than two guesses to figure out which specialty each of the above statements is describing. At some point during third year, …

The pharma-fed doctor and the foundation-fed journalist

Michel Accad, MD

July 16, 2016Jul 16, 2016

In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the…

I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the …

Health Policy

Why nurses deserve a place in primary care

Anonymous

July 16, 2016Jul 16, 2016

I’m feeling pretty good about myself today. My patient, recently admitted to home health care, was just not herself, low O2 sats, irregular heart rate with pain on inspiration and feeling a little clammy. While her recent surgery was a neck fusion, it still didn’t completely eliminate the possibility of a pulmonary embolism. Instead of spending 15 to 30 torturous minutes in her primary doctor’s voice mail hell, I made …

Prescribing opioids is a dilemma for every doctor

Alison Block, MD

July 16, 2016Jul 16, 2016

Once a month, she waits patiently in my exam room, despite the fact that I’m almost always running an hour late in my hectic community health center practice. She is 86 and suffers from mild dementia, diabetes, arthritis and an arrhythmia for which she takes warfarin, a powerful blood thinner. At every visit, she comes to me with some sort of homemade gift — a scarf, a tin of cookies, …

Conditions and Diseases

MKSAP: 28-year-old man exposed to pulmonary tuberculosis

mksap

July 16, 2016Jul 16, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated after being informed his roommate at a homeless shelter was diagnosed with pulmonary tuberculosis. He reports no fever, cough,…

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

A 28-year-old man is evaluated after being informed his roommate at a homeless shelter was diagnosed with pulmonary tuberculosis. He reports no fever, cough, night sweats, or weight loss. Medical history is significant for injection drug use, most recently 2 weeks ago, although he reports no known infectious complications in the past. Medical history is …

Health Technology

What J. J. Abrams can teach us about the future of health care

Robert Wong, MD

July 15, 2016Jul 15, 2016

As the practice of medicine becomes increasingly digital, our patients are beginning to manage their health from more convenient points of care. And as telemedicine improves, instantaneous access to health care providers from the comfort of your home or office is now possible. A recent survey of patients in my practice showed that over three-fourths of them have already used or expressed interest in using telemedicine in lieu of a …

Conditions and Diseases

Blood pressure in the elderly: How low is too low?

Steven Reznick, MD

July 15, 2016Jul 15, 2016

A recent publication in a fine peer-reviewed medical journal of the SPRINT study proved that lowering our blood pressure to the old target of 120/80 or less led to fewer heart attacks, strokes, and kidney failure. There was no question on what to do with younger people but to lower their blood pressure more aggressively to these levels. Debates arose in the medical community about the ability to lower it …

Patients are deceived by the slick presentation of statistics

Michael Kirsch, MD

July 15, 2016Jul 15, 2016

“There are three kinds of lies: lies, damned lies, and statistics.” There is much truth in this quotation of uncertain provenance. We see this phenomenon regularly in the medical profession. We see it in medical journals when statistics are presented…

“There are three kinds of lies: lies, damned lies, and statistics.”

There is much truth in this quotation of uncertain provenance. We see this phenomenon regularly in the medical profession. We see it in medical journals when statistics are presented in a manner that exaggerates the benefit of a treatment or a diagnostic test. Massaging numbers is raised to an art form by the pharmaceutical companies who will engage in numerical …

There are limits to what a careful physician can do

James C. Salwitz, MD

July 15, 2016Jul 15, 2016

Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, …