KevinMD.com

May 3, 2016May 3, 2016

Talking to health care professionals about the importance of loving your patients and colleagues -- as I often do -- might raise eyebrows. How can we be expected to love our patients during a 15-minute clinic visit? How can love…

Talking to health care professionals about the importance of loving your patients and colleagues — as I often do — might raise eyebrows.

How can we be expected to love our patients during a 15-minute clinic visit? How can love form among hospital teams coming together for a surgical procedure but then moving on to other work? Perhaps most importantly, how will this love make any difference in our patients’ lives …

Medications

Don’t forget the power of over the counter remedies

Edwin Leap, MD

May 3, 2016May 3, 2016

I recently had an enormous kidney stone. Well OK, it seemed enormous to me. But in terms of kidney stones, it was reasonably large; 9 mm, in fact. Large enough that I had to have lithotripsy (the use of sound waves to break up the stone) performed by my friend and most excellent urologist, Dr. Robert McAlpine in Seneca, SC.

As uncomfortable as the whole experience was (and it wasn’t my …

Physician

The family member in the corner may be paying more attention than you think

Karen S. Sibert, MD

May 3, 2016May 3, 2016

Nothing brings out the mama lioness in me more than seeing one of my cubs not being treated as well as I think it should be. Recently I had the unusual experience of accompanying my oldest daughter into an unfamiliar…

Nothing brings out the mama lioness in me more than seeing one of my cubs not being treated as well as I think it should be.

Recently I had the unusual experience of accompanying my oldest daughter into an unfamiliar hospital for a minor surgical procedure. Now, this daughter isn’t exactly a cub; she’s a full-fledged adult, with a master’s degree in health care administration, a husband, and two small boys of …

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Physician

A pediatrician writes to the politicians about the state of medicine

Sharon S. Jellinek, MD

May 3, 2016May 3, 2016

This is the first letter I’ve ever written to a political figure, and I pray that someone on your staff will bring this letter to your attention. I have been a physician for close to 30 years. I am a second-generation pediatrician struggling to keep an independent solo practice alive. Not one politician has addressed what I feel is the major threat to health care: the physician-patient relationship. Without this, …

Physician

When patients cry, please don’t do this

Peter Ubel, MD

May 2, 2016May 2, 2016

Just three weeks earlier, she had noticed something strange about one of her breasts. An irregular shape. Her daughter brought her to the doctor, and soon the patient, I’ll call her Amanda, was diagnosed with breast cancer, stage “to be determined.” In fact, she was now in an oncologist’s office, learning what tests she would receive to determine the extent of her tumor. And sitting between her and the …

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When patients cry, please don’t do this

Physician

Patients are suffering while physicians are suffering

Robert Centor, MD

May 2, 2016May 2, 2016

Ran into a radiology colleague today. He will retire soon, and was happy to discuss the stress on radiology. I have observed more interpretation errors (or at least I think I have) over the past five years. We now strongly…

My friend opined that volume expectations have become unsustainable. We order too many imaging studies. When you ask physicians to ramp …

Medical Education

Residents should pay it forward to medical students

Hamsika Chandrasekar

May 2, 2016May 2, 2016

Dear future self, Remember that day on surgery you stepped into the OR for the first time? How you had no idea you were supposed to pull your own gloves for the scrub nurse from the supplies cabinet, or that…

Dear future self,

Remember that day on surgery you stepped into the OR for the first time? How you had no idea you were supposed to pull your own gloves for the scrub nurse from the supplies cabinet, or that you needed to stand an arm’s length away from the equipment table to avoid breaking sterility? Remember how scared you felt? How clumsy you were when you scrubbed in, in a …

Physician

Quality is another word for absolute control

James C. Salwitz, MD

May 2, 2016May 2, 2016

Like an anthem, a holy grail, the word appears in every journal, every proposal, and every health strategic plan. “Quality.” We say, read and hear it so often we are developing quality fatigue. Like iterative hackneyed phrases such as “out-of-the-box”,…

Like an anthem, a holy grail, the word appears in every journal, every proposal, and every health strategic plan.

“Quality.”

We say, read and hear it so often we are developing quality fatigue. Like iterative hackneyed phrases such as “out-of-the-box”, “deep-dive” and perhaps even “personalized medicine,” quality has begun to feel like water torture and risks being deprived of flavor or meaning. However, do not so fooled or bludgeoned that you lose …

Physician

Why we should welcome questions from our patients

Rob Lamberts, MD

May 1, 2016May 1, 2016

I was talking with a few friends not long ago. Our conversation somehow got to the issue of authority, and what exactly respect for authority looks like. One of them, trying to make a point, turned to me and asked: “So you surely deal with people who don’t listen to what you have to say. What do you do when your patients don’t take the medications you prescribe?”

I think he …

Physician

A geriatric patient with questions her doctor never heard before

H. Lee Kagan, MD

May 1, 2016May 1, 2016

My longtime patient Brenda let the top of her exam gown drop to her waist, stepped down off the exam table and turned to look at herself in the mirror. As I watched, she cupped her seventy-eight-year-old breasts in her palms and unceremoniously hoisted them up to where they’d probably resided when she was in her twenties.

“I’m thinking about having my boobs done,” she said. “My girlfriend had hers done, …

Physician

Midlife crisis may be a myth, but midlife purpose is real

Manoj Jain, MD, MPH

May 1, 2016May 1, 2016

When he turned 45, Mitch Alsup bought a red Corvette. Mitch is a quick-talking guy with dirty blonde hair and a short, trim physique. He has a ready smile and is willing to share his story. “As a kid, I…

When he turned 45, Mitch Alsup bought a red Corvette.

Mitch is a quick-talking guy with dirty blonde hair and a short, trim physique. He has a ready smile and is willing to share his story.

“As a kid, I use to go down to the Chevrolet dealership and sit in a Corvette,” he recalls. “I wanted one when I turned 18, but I came from a poor family. I had to …

Physician

Conquering guilt as a trauma surgeon mother

Jamie Coleman, MD

April 30, 2016Apr 30, 2016

Guilt was not a huge part of my vocabulary until I became a mom. I never felt much guilt about how I spent my time. Didn’t feel guilty about sleeping in, or working out, or having a girls’ night out.…

And then I became a mom. You know, that moment when you get shoved into the most beautiful world; a place more beautiful than you could …

Medical Education

Why a study of medical resident hours was unethical

Ruth Macklin, PhD

April 30, 2016Apr 30, 2016

In a recent post, I wrote about the iCOMPARE research study that is comparing the effects of increasing medical residents’ consecutive duty hours with observing the currently prescribed limits on their shifts. According to the study protocol, the primary hypothesis of the research addresses the safety of patients: that mortality under the increased residents’ duty hours will not significantly exceed patient mortality under the current mandated standard for medical residents on …

Conditions and Diseases

The issues behind sex-selective abortion aren’t as clear as you think

Jennifer Gunter, MD

April 30, 2016Apr 30, 2016

Dr. Brian Goldman, in his blog for CBC radio, wrote about the new article in the Canadian Medical Association Journal (CMAJ) on the sex ratio after induced abortion in Ontario, (i.e., sex selective abortion). The article in the CMAJ confirms…

The article in the CMAJ confirms what is no surprise to me as an OB/GYN, that the ratio of male to female births for a third child born to women who emigrated to …

Conditions and Diseases

MKSAP: 50-year-old man with increasing urinary frequency and urgency

mksap

April 30, 2016Apr 30, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated for a 1-year history of increasing urinary frequency and urgency and occasional urge incontinence. He has no symptoms of…

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

A 50-year-old man is evaluated for a 1-year history of increasing urinary frequency and urgency and occasional urge incontinence. He has no symptoms of urinary hesitancy or incomplete emptying. The patient has primary progressive multiple sclerosis. Medications are dalfampridine and vitamin D.

On physical evaluation, temperature is 36.8 °C (98.2 °F), blood pressure is 120/55 mm …

Medical Education

The absurd cost of becoming a doctor

Ahmad Yousaf, MD

April 29, 2016Apr 29, 2016

I start this article with a disclaimer: I am not here to comment on the decreasing salaries of physicians or the knowledge that I will never get paid the way the prior generation of doctors got paid. It is hard for me (and the American public) to feel bad for anybody making more than $200,000 a year when the median household income is in the mid-$40,000 range.

What this article is …

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The absurd cost of becoming a doctor

Physician

How can we take care of patients we have never seen?

Michael Kirsch, MD

April 29, 2016Apr 29, 2016

Of course, patients are entitled to medical care around the clock. You would not expect to show up at 2 a.m. at an emergency room to find a "closed" sign. If you are having chest pain on a weekend, and…

Of course, patients are entitled to medical care around the clock. You would not expect to show up at 2 a.m. at an emergency room to find a “closed” sign. If you are having chest pain on a weekend, and you call your doctor’s office, you should expect a prompt response from a living and breathing medical doctor. Patients are aware that when they call the doctor at night, that …

Physician

“You can’t create an addict in the ER.” Yes, you can.

Edwin Leap, MD

April 29, 2016Apr 29, 2016

I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an…

I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in …

Physician

When pregnancy is the cost of getting medical care

Joseph Bergsten, MD

April 29, 2016Apr 29, 2016

When was the last time you used heroin? In the past have you injected heroin or any other drugs? Are you currently using drugs besides opiates like methamphetamines, cocaine, benzodiazepines or alcohol? After two years of family medicine residency, I…

After two years of family medicine residency, I ask these questions like they are questions that everyone asks in a casual conversation with a patient. Although these types of interviews are customary for me, I recognize that it takes …

Conditions and Diseases

Oncologists teach and comfort. Patients need both.

Don S. Dizon, MD

April 28, 2016Apr 28, 2016

I was at a meeting in 2014, called the REV Forum; its objective was to rethink cancer care delivery by gathering patients, advocates, thought leaders, and entrepreneurs. Even now I am struck by some of the things I learned that…

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