KevinMD.com

June 6, 2016Jun 6, 2016

I still remember her clearly. She was a wonderfully vibrant 68-year-old woman from Haiti. She was always impeccably dressed, loved to talk, and had an incredibly infectious laugh. Whenever I walked in to the clinic to see her, her eyes…

“Nice to see you, Doc!” she would say. I …

Physician

We let our professionalism suffer when faced with a difficult patient

Briana Buckner, MD

June 6, 2016Jun 6, 2016

“Be careful. He’s violent.” That was the way sign out began for Mr. T. The intern continued, “He has been in the hospital forever because he was kicked out of his nursing home. Good luck. And, oh yeah … he’s blind.” Puzzled, I looked at my list of patients and, not sure whether I should write “violent” by this patient’s name, I decided instead to write “blind.” I paused. The …

Physician

Medical homes weren’t supposed to be this way. What went wrong?

Hans Duvefelt, MD

June 5, 2016Jun 5, 2016

We have a problem in our clinic. Between our EMR implementation a few years ago and our PCMH recognition shortly after that, our office visit documentation has become bloated and our cycle time has almost doubled. There are no brief…

We have a problem in our clinic.

Between our EMR implementation a few years ago and our PCMH recognition shortly after that, our office visit documentation has become bloated and our cycle time has almost doubled.

There are no brief visits anymore, since every visit entails screening for multiple psychosocial conditions and consideration of various immunization and health maintenance reminders.

Nobody sees over thirty patients a day anymore; we’re lucky to exceed twenty.

That …

Real physician voices, twice a week

Free, and one click to unsubscribe.

Physician

Blame the politicians and bureaucrats for our opioid abuse crisis

Richard Young, MD

June 5, 2016Jun 5, 2016

Prescription opioid abuse is on the political radar. “Painkillers” are a recognized cause of thousands of deaths a year. But what to do about it? A FDA panel recently recommended mandatory training for physicians who prescribe opioids. Congress passed a…

Prescription opioid abuse is on the political radar. “Painkillers” are a recognized cause of thousands of deaths a year. But what to do about it?

A FDA panel recently recommended mandatory training for physicians who prescribe opioids. Congress passed a bill calling for more education, presumably physicians as a prime target. We’ve actually been down this road before, but possibly not how you think.

The politicians and pundits used to …

Physician

5 things we can learn from the NHS doctor strike

Suneel Dhand, MD

June 5, 2016Jun 5, 2016

The United Kingdom’s National Health Service has been facing something of a crisis over the last several months. For those of you unfamiliar with what’s been happening (the issue hasn’t really gained any media traction here in the U.S.), a majority of the country’s 55,000 junior doctors have been holding regular strikes. In the U.K., the way in which doctors train is very different from the U.S., with often over …

Physician

Why young physicians should consider locum tenens

Val Jones, MD

June 5, 2016Jun 5, 2016

When doctors complete their residency training, they are under a lot of pressure to land their first “real job” quickly. Student loan deferments end shortly after training, and whopping debt faces many of them. But choosing a job that is a good long-term fit can be difficult, and gaining a broader exposure to the wide variety of options is key to success. That’s why “try before you buy” can be …

Physician

The opioid crisis: Does empathy make physicians more vulnerable?

Jay Baruch, MD

June 4, 2016Jun 4, 2016

It was Saturday evening, and Audrey G lay awkwardly on an emergency department stretcher in search of a comfortable position. She suffered from chronic hip pain, the unfortunate and unexpected effect of pelvic surgery. But her real chief complaint involved her drug-abusing husband, who that morning stole her recently filled bottle of oxycodone, an opioid pain medicine. Her story included the surgeon who doubted her pain and a year of …

Physician

It’s time for academic medicine to embrace direct primary care

James Breen, MD

June 4, 2016Jun 4, 2016

As a mid-career faculty physician in a family medicine residency program, I have taken a keen interest in the big picture of what is happening to the way our graduates and colleagues practice in the real world. I’ve watched our residents as they prepare to graduate, deliberating among the most prevalent practice options presented to them in our region, usually as an employed doctor in a large multi-specialty practice, or …

Physician

Compassionate care is at it’s best when selflessly focused on helping others

Jeffrey McWilliams, MD

June 4, 2016Jun 4, 2016

I’ve noticed, as I get older life seems to travel full circle no matter your path or destination. I find myself trying to teach my son Grant things that my father attempted to teach me not so long ago. “Don’t…

“Don’t do that, you’ll fall and hurt yourself, or try it this way, and the process will be much easier.”

There is that brief moment of acknowledgment often followed by scraped knees or …

Conditions and Diseases

MKSAP: 32-year-old man with a rash on his face and midchest

mksap

June 4, 2016Jun 4, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of…

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

A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well.

Medical history is significant for a recent diagnosis …

Physician

An open letter to Macklemore about the opioid epidemic

Eric Beam, MD

June 3, 2016Jun 3, 2016

Dear Macklemore, Recently, you -- the white-rapping, thrift-shopping, LGBT-activist-ing, Grammy-winning 2013 phenom -- teamed up with President Obama to deliver a message to the country about the current opioid epidemic. Now let me preface this by saying, I like you,…

Dear Macklemore,

Recently, you — the white-rapping, thrift-shopping, LGBT-activist-ing, Grammy-winning 2013 phenom — teamed up with President Obama to deliver a message to the country about the current opioid epidemic. Now let me preface this by saying, I like you, Macklemore. I like the mixture of equal parts political, earnest and downright goofy that you bring to your music. I like that you seem genuinely …

Physician

I’m a better doctor than any computer

Keith Pochick, MD

June 3, 2016Jun 3, 2016

"I love you," she said as I was leaving the room. Although I was stunned for a second or two, I wasn't really surprised. She and I had gotten along famously from the beginning of our 15 minutes together. She…

“I love you,” she said as I was leaving the room.

Although I was stunned for a second or two, I wasn’t really surprised. She and I had gotten along famously from the beginning of our 15 minutes together. She didn’t “love me” in the way a patient with borderline personality disorder “loves” her enabling prescriber. She loved me because I was there, I was experienced, I was kind, and I …

Read more…

I’m a better doctor than any computer

Health Policy

Health insurance must be driven by physicians. Here’s why.

Tony Barnes, PhD, MBA

June 3, 2016Jun 3, 2016

I am a scientist and a medical economist. I have been privileged to work beside doctors in both their caregiving role and their research role for 20 years. I have seen their challenges and tried to build products and services…

When I left graduate school in 1988, it was the beginning of the movement from fee …

Conditions and Diseases

Would you choose heaven over hospital?

Christy Duan

June 3, 2016Jun 3, 2016

In the dark lecture room, I watched the neurologist's shadow flicker across the only source of light -- a projection of the New York City subway map. He pointed at Times Square station. If the subway system were a brainstem,…

In the dark lecture room, I watched the neurologist’s shadow flicker across the only source of light — a projection of the New York City subway map. He pointed at Times Square station. If the subway system were a brainstem, then Times Square would be the pons, transporting vital signals like breathing, speaking, and swallowing.

He likened the station’s abrupt destruction to a stroke producing locked-in syndrome. Writer Jean-Dominique Bauby describes …

Read more…

Would you choose heaven over hospital?

Physician

One Englishman named John knows more about science than all Americans

Lois Leveen, PhD

June 2, 2016Jun 2, 2016

If that headline sounds like it can't possibly be true, that's because it isn't. But British comedian John Oliver did recently give Americans a great lesson in bad "science," during a segment of his show, Last Week Tonight. Oliver often…

If that headline sounds like it can’t possibly be true, that’s because it isn’t. But British comedian John Oliver did recently give Americans a great lesson in bad “science,” during a segment of his show, Last Week Tonight.

Oliver often uses humor to take on serious social issues. And what could be more serious than the news that smelling farts might prevent cancer?

Lots of things, actually, as it turns out that …

Medical Education

The swastika-donning patient who refused his lactulose

Mark Edelstein

June 2, 2016Jun 2, 2016

As a third-year medical student rotating on the internal medicine service at the VA Hospital, I took care of an elderly patient who was suffering from decompensated alcoholic cirrhosis. His condition was complicated by hepatorenal syndrome, multiple electrolyte imbalances, and…

It was most complicated however by various ethical challenges and by the social and familial factors surrounding this patient’s course of treatment during his one-month stay on our service …

Physician

A child’s father knew when to let go. The health care team didn’t.

Niran S. Al-Agba, MD

June 2, 2016Jun 2, 2016

Physicians are accustomed to seeing patients at the end of their lives. It is difficult to let families know they may lose their loved one. Clinicians are often accepting of patients DNR orders before family members are ready. This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention. It taught me an unforgettable lesson.

During the first ICU …

Physician Finance

When looking for a physician job, salary is the least important factor

Cory Fawcett, MD

June 2, 2016Jun 2, 2016

What is your dream job? It’s the one you would do every day even if no one paid you. When you find it, you never really go to work each day, you go and play. If that is the kind…

What is your dream job? It’s the one you would do every day even if no one paid you. When you find it, you never really go to work each day, you go and play. If that is the kind of joy received from working, then burnout will likely be a long way out of reach. Are there any jobs like that out there for doctors? Yes, there are. But …

Physician

When it comes to your health care, buyer beware

Michael P. Jones, MD

June 1, 2016Jun 1, 2016

A good friend of mine recently found herself between jobs, with a gap in her health insurance and a recurrence of her kidney stones. What she needed were fluids and pain relief, fast. I’m a gastroenterologist, and hoping to minimize the financial impact, I went with her to our local ER and had a conversation with the attending physician. Maybe we could pass on the CT scan and extraneous lab …

Medical Education

Medical trainees cannot live on grit alone

Miriam A. Knoll, MD

June 1, 2016Jun 1, 2016

A recent AMA Wire article highlighted the resident depression endemic and identified some strategies for improvement. The upshot: Too many trainees are unhappy with their jobs. The most important tool used to gauge trainees’ satisfaction with their training programs is…

A recent AMA Wire article highlighted the resident depression endemic and identified some strategies for improvement. The upshot: Too many trainees are unhappy with their jobs.

The most important tool used to gauge trainees’ satisfaction with their training programs is the ACGME survey. Since the ACGME is the organization that formally accredits …

Real physician voices, twice a week

The Podcast

Latest episodes

The Podcast

Latest episodes