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When it comes to consumer choice, more is not always better
Mark Letterman’s rheumatoid arthritis had been progressing unrelentingly despite popping dozens of pills each week — eight methotrexate pills on Mondays alone. Letterman felt like he was 63 going on 93. If rheumatoid arthritis progresses unchecked, it is as debilitating of a disease as can be imagined. Don’t think garden variety arthritis that only interferes with activities like, um, gardening. Think: finger and wrist joints so inflamed it feels like your hands have suffered a heat stroke from the inside out. Imagine: the joints of your toes so damaged you have to purchase shoes at a medical supply store...
Source: Kevin, M.D. - Medical Weblog - October 18, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/peter-ubel" rel="tag" > Peter Ubel, MD < /a > Tags: Policy Public Health & Rheumatology Washington Watch Source Type: blogs

We are all spiders making our webs
I recently went hiking in a beautiful national park outside of Columbia, SC. This park was in a swampy area and contained all sorts of wildlife (called “critters” down here) and plant life (called “trees and those other things” down here). When I was young, my dad would take us kids on hikes through the Adirondack Park in New York, and so being on hikes in nature hits my soul in a very deep spot. It’s emotional, it’s physical, it’s a treat to my senses, and it’s a spiritual experience for me. I was pondering what it was that moved me so much while hiking. I am the sort of guy...
Source: Kevin, M.D. - Medical Weblog - October 18, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/rob-lamberts" rel="tag" > Rob Lamberts, MD < /a > Tags: Physician Practice Management Source Type: blogs

As a leader, you can be liked or respected. But rarely both.
I want to talk about the word everyone seems to use: drama.  This word is used in many facets, to describe conflict, negative interactions with others, disagreements, or obstruction to a new idea. No one likes drama. Yet some people seem to instigate it, and others seem to have to deal with it on a rotating basis. We all wish we could ignore it, avoid it, and leave it for people who have time and energy for it. Unfortunately, that is not reality. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 18, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/sasha-k-shillcutt" rel="tag" > Sasha K. Shillcutt, MD < /a > Tags: Physician Public Health & Policy Source Type: blogs

Why are you seeing the gastroenterologist?
Gastroenterologists, as specialists, are called upon by other doctors to address digestive issues in their patients. For example, our daily office schedule is filled with patients sent by primary care physicians who want our advice or our technical testing skills to evaluate individuals with abdominal pain, bowel issues, heartburn, rectal bleeding and various other symptoms. The same process occurs when we are called to see hospital patients. If a hospital admitting physician, who is usually a hospitalist, wants an opinion or a test that is beyond his knowledge level, then we are called in to assist. The highest quality re...
Source: Kevin, M.D. - Medical Weblog - October 18, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/michael-kirsch" rel="tag" > Michael Kirsch, MD < /a > Tags: Physician Gastroenterology Primary Care Source Type: blogs

How can we make a best guess with incomplete information?
I have spent three days at the Society to Improve Diagnosis in Medicine. Whenever I come to this meeting, I have insights from listening to talks and many conversations with leaders in the field. When one considers diagnostic errors, one must consider two important factors: physician factors and system factors. We have a major system factor that can cause problems. Most hospitals in the U.S. require a diagnosis for admission. I believe this rule increases diagnostic errors. Currently, I am developing a talk based on the lessons we can learn from fictional detectives. One example that I will likely use came from a relativel...
Source: Kevin, M.D. - Medical Weblog - October 18, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/robert-centor" rel="tag" > Robert Centor, MD < /a > Tags: Physician Hospital-Based Medicine Primary Care Source Type: blogs

The high cost of hospitalists
Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with no reported increase in the readmission rate. Of course, these studies were all conducted within the environment of a screwed up payment system. I think most family physicians w...
Source: Kevin, M.D. - Medical Weblog - October 18, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/richard-young" rel="tag" > Richard Young, MD < /a > Tags: Physician Hospital-Based Medicine Hospitalist Public Health & Policy Source Type: blogs

Death is certain. How you choose to die isn ’t.
“It is not for me to judge another man’s life. I must judge, I must choose, I must spurn, purely for myself. For myself, alone.” -Hermann Hesse, “Siddhartha” What does it mean to die with dignity? As a neurosurgeon who faces life and death decisions routinely, I ponder this question often. When a terminally ill person decides to choose death over suffering, we perhaps recognize the ensuing act as a dignified death. But is there any less dignity in living out one’s life destiny to the bitter end, no matter the suffering, using what precious time is left to better the world one leaves behi...
Source: Kevin, M.D. - Medical Weblog - October 17, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mark-mclaughlin" rel="tag" > Mark  McLaughlin, MD < /a > Tags: Physician Hospital-Based Medicine Oncology/Hematology Surgery Source Type: blogs

Could being vulnerable lead to better health?
Long ago, I represented a doctor who was … difficult. He was a phenomenal surgeon, world famous in his field, but he was not warm and fuzzy — not even close. Cold and hard were more his speed. We spent two weeks together, on trial in city hall. It takes about two years from the time a case is filed to the time the case goes to court. During that time, all I got was cold and hard. If the research is right, and people sue their doctors for bad communication rather than bad medicine, this doctor was showing me why that might be true. But then we went to trial, and he began to crack. Leonard Cohen once said, &ldqu...
Source: Kevin, M.D. - Medical Weblog - October 17, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/heather-hansen" rel="tag" > Heather Hansen < /a > Tags: Physician Malpractice Surgery Source Type: blogs

People, not computers, make health care work
Every morning around 5 a.m., the overnight intern updates me on what happened to the patients on my service. In a hospital where disease knows no hour, the nights can often be just as busy as the days. “Just letting you know, his wound seemed a little wet to me. Maybe it’s starting to get infected.” “Good to know. We may have to change the dressing more frequently.” “And this patient had constant diarrhea overnight. Pretty much every hour.” “Oh, really? Let’s try changing the diet and see if it helps.” Continue reading ... Your patients are rating you online: How...
Source: Kevin, M.D. - Medical Weblog - October 17, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/jason-j-han" rel="tag" > Jason J. Han, MD < /a > Tags: Physician Hospital-Based Medicine Primary Care Source Type: blogs

Being the doctor he set out to be
“Jag ska bli doktor,” a four-year-old boy announced to his family sixty years ago. Somehow, everything he did after that moment seemed to move him in that direction, even when, on the surface, his path through life seemed to be meandering. As a student, he was just as interested in literature and philosophy as he was in scientific subjects. He even failed his first quiz in organic chemistry just after receiving the Berzelius scholarship for achievements in inorganic chemistry. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out...
Source: Kevin, M.D. - Medical Weblog - October 17, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Primary Care Source Type: blogs

Doctors are dangerously tired, and health care leaders aren ’t taking action
Do you want your surgeon to work back-to-back overnight 12-hour shifts and then perform brain surgery on you the next morning? There’s currently no regulation prohibiting this kind of dangerous scheduling in medicine. Physicians are human. Like truck drivers or airline pilots, their fatigue can lead to dangerous consequences for those around them. A recent study showed that even mild sleep deprivation causes the same levels of impairment as alcohol intoxication. Truckers and pilots have to comply with regulations forcing them to rest, however, and physicians do not. Medicine has not only had a long history of avoidin...
Source: Kevin, M.D. - Medical Weblog - October 17, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/suvas-vajracharya" rel="tag" > Suvas Vajracharya, PhD < /a > Tags: Physician Hospital-Based Medicine Residency Source Type: blogs

The hurricane in Puerto Rico is leading a shortage in saline bags
“Doc, you mind switching that to an oral preparation?” our clinical pharmacist inquired during multi-disciplinary rounds as intravenous infusion devices beeped annoyingly in the background.  Taking care of ICU patients can be extraordinarily complicated, so doing it as part of a team helps make sure that all bases are covered. Like many hospitals, ours uses a multidisciplinary model which makes rounds on all patients in the ICU.  An ICU nurse, clinical pharmacist, dietitian,  social worker, pastoral care, respiratory therapist, each provides important insight and perspective that guides patient c...
Source: Kevin, M.D. - Medical Weblog - October 17, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/deep-ramachandran" rel="tag" > Deep Ramachandran, MD < /a > Tags: Physician Critical Care Source Type: blogs

All cancer care needs to consider the whole patient
An excerpt from Cancer What You Need to Know. Treating cancer means taking care of the whole patient — the physical, the emotional, and the spiritual. This starts at diagnosis and carries through treatment and beyond. Unfortunately, for some patients, cancer does find ways to spread that can cause physical pain, emotional strain, and difficulties in dealing with end-of-life issues. Palliative care and hospice providers are experts in helping people deal with these difficult times. These providers are an important part of the cancer care team. Continue reading ... Your patients are rating you online: How to resp...
Source: Kevin, M.D. - Medical Weblog - October 16, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/stephen-rosenberg" rel="tag" > Stephen Rosenberg, MD < /a > Tags: Conditions Oncology/Hematology Palliative Care Source Type: blogs

A letter to my sister (and all other first-year medical students)
Congratulations! At this point, you are almost halfway done with your first year of medical school. Either you have finally figured out what’s going on, or if you’re like me, you are still trying to figure it out. Relax, take a few deep breaths. Medical school is unlike anything you have ever done. The volume of information, constant testing, and overwhelming need to keep up with your peers is an enormous pressure. By now you have probably heard, “just get through this module,” “the hardest part was getting in,” “survive anatomy.” If only it were actually that simple. I find ...
Source: Kevin, M.D. - Medical Weblog - October 16, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/misha-armstrong" rel="tag" > Misha Armstrong < /a > Tags: Education Medical school Source Type: blogs

How not to argue with your kids about marijuana
An excerpt from A Parent’s Guide to Teen Addiction: Professional Advice on Signs, Symptoms, What to Say, and How to Help (Skyhorse Publishing; October 2017). Marijuana, the illegal drug most commonly used by teenagers, is widely accepted as harmless, but is it? Its effects range from the trivial—silliness, bloodshot eyes, etc.—all the way to catastrophic—paranoia, depression, and more. Many teenagers and parents don’t realize that although not as potent, it’s a hallucinogen similar to LSD and Ecstasy. Marijuana and the other hallucinogens can cause serious problems for teenagers who use ...
Source: Kevin, M.D. - Medical Weblog - October 16, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/laurence-m-westreich" rel="tag" > Laurence M. Westreich, MD < /a > Tags: Physician Pediatrics Psychiatry Source Type: blogs

The medical student who had a genuine human profile
“I lift things up and put them down.” This quote is from a commercial for Planet Fitness I have seen in the past. It portrays a bulky body builder on a tour of the gym premises. There is no real communication with the tour guide since he keeps saying that he lifts things up and puts them down, irrespective of what the tour guide actually says. He looks like a robot, focused on one thing that he sure excels at. Like a well-oiled machine, he doesn’t fail. He is the perfect bodybuilder. Medicine requires discipline, excellence, and commitment. There is no doubt about that. Continue reading ... Your patients...
Source: Kevin, M.D. - Medical Weblog - October 16, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/drizzlemd" rel="tag" > DrizzleMD < /a > Tags: Education Medical school Residency Source Type: blogs

Why HSAs are not the answer to our health care system problems
I was talking to a physician in my hospital several years ago, and he expressed his frustration that the annual well-child exams for his four kids were expensive. Puzzled, I stated that I found it odd that a doctor’s own health insurance plan had poor coverage for routine care, and he replied that his group jointly decided on a plan with considerable upfront out-of-pocket costs. Why would doctors buy bad health insurance for themselves? This was before I understood the concept of the health savings account (HSA). An HSA works in the following manner. First, you sign up for a high-deductible health plan (HDHP) which r...
Source: Kevin, M.D. - Medical Weblog - October 16, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/cory-michael" rel="tag" > Cory Michael, MD < /a > Tags: Policy Public Health & Washington Watch Source Type: blogs

Reduce parallel play to provide decent health care for all
I have been doing health care research and advocacy for over 20 years. I’ve seen a lot of passion, anger, and rhetoric around the issues. The health care crisis is simple in that everyone needs health care. The question is what to do about it and who should pay for it. It’s not an easy answer. For starters, we have turned into a culture of entitlement. This includes health care. It might be a “right,” but someone has to pay for it. And we want to pretend that it’s someone else’s responsibility. Recently, I was reading comments following an article on an online news outlet. I was struck b...
Source: Kevin, M.D. - Medical Weblog - October 16, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/peggy-a-rothbaum" rel="tag" > Peggy A. Rothbaum, PhD < /a > Tags: Policy Psychiatry Public Health & Washington Watch Source Type: blogs

The most far-reaching effects of our failed leadership
We were once a nation noted for its achievements. We are now a nation that gets nothing done, unable to make even the slightest movement forward despite multiple national crises — a desperately broken health care system, a horrifying opioid epidemic, sickening gun-related mass murders, the threat of nuclear war, and massive storms resulting from man-made climate change. In the face of such monumental challenges, when bold action is needed, we see none. It is a profound failure of leadership, a stinging indictment of modern American politics and American political leaders. Everyone in America could have decent, afford...
Source: Kevin, M.D. - Medical Weblog - October 15, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/matthew-hahn" rel="tag" > Matthew Hahn, MD < /a > Tags: Policy Public Health & Washington Watch Source Type: blogs

This psychiatrist does most of her work outside of the traditional system
Every now and then, when some people learn what kind of work I do, they say, “You’re doing God’s work. Thank you.” They mean well, so I accept the compliment, though I also tack on, “I also like what I do. It’s meaningful work for me.” So many of the people I see, whether in my current job or in my past jobs working in other underserved communities, have a lot going on that psychiatry and medicine cannot formally address. One example is housing. It is often an effective intervention for the distress of people who don’t have a place to live, though housing is not something phy...
Source: Kevin, M.D. - Medical Weblog - October 15, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/maria-yang" rel="tag" > Maria Yang, MD < /a > Tags: Physician Psychiatry Public Health & Policy Source Type: blogs

Emergency medicine can be exhausting. Here ’s what this doctor does to unwind.
So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of 12 hours duration. I have two to go. I’m working out of town. Not locums, as I’m employed and working in the same place; it’s just a couple hours away, so I stay here. A few observations: It’s hard to turn around from nights to days in 48 hours. I f...
Source: Kevin, M.D. - Medical Weblog - October 15, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/edwin-leap" rel="tag" > Edwin Leap, MD < /a > Tags: Physician Emergency Medicine Hospital-Based Medicine Source Type: blogs

An ode to great clinician-educators
When asked to describe my career, I consider myself primarily a clinician educator.  Recently I have reflected on the influences that allowed me to have a successful career doing what I love.  This post is not meant to mention all those influencers, but just some that I recall often.  As I have thought about this post, I quickly realized that all the “heroes” that I recall focused on clinical education.  Students and residents show great respect and love for the great clinician educators, while too often these same clinician educators get less respect from medical school administration. When...
Source: Kevin, M.D. - Medical Weblog - October 15, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/robert-centor" rel="tag" > Robert Centor, MD < /a > Tags: Education Gastroenterology Hospital-Based Medicine Nephrology Source Type: blogs

Why veterans deserve special recognition
November brings fall weather, raking leaves and one of my favorite holidays.  No, not Thanksgiving, it is Veteran’s Day.  Veteran’s Day is a day reserved to celebrate members of the U.S. armed forces for their service.  Thank you, veterans.  Veterans are found in all segments of our society.  Some are retired, some have started second careers, and some are struggling with health issues as a result of their service.  They comprise both consumers and workforce in health care often with specialization. Military veterans have training and personas very different from civilians.  T...
Source: Kevin, M.D. - Medical Weblog - October 14, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/jarret-patton" rel="tag" > Jarret Patton, MD < /a > Tags: Physician Hospital-Based Medicine Primary Care Source Type: blogs

Alternative medicine for cancer: Greater scrutiny is needed
As the calendar turns to early October, I’m reminded that this is the 6th anniversary of Steve Jobs’ death. At the time of his death, I was a medical student and my wife had just completed six months of chemotherapy. I was surprised to learn that Jobs had died from complications of cancer and shocked to discover that he had initially refused conventional cancer treatment in favor of alternative medicines. At first, I found it difficult to understand how someone with the intellectual and financial resources of Steve Jobs could make such a decision — but I was quickly reminded of the massive amounts of misi...
Source: Kevin, M.D. - Medical Weblog - October 14, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/skyler-johnson" rel="tag" > Skyler Johnson, MD < /a > Tags: Physician Endocrinology Oncology/Hematology Source Type: blogs

If health care is a right, so should having legal insurance
The main justification for single payer seems to be that access to affordable quality health care is a right. Nowhere in our constitution does it say that anyone has a “right” to individual services or property. Housing, food, health care, even cell phones have become “rights.” What our constitution does say is that each citizen does have the right to equal protection under the law, equal access to the courts and equal opportunity to achieve justice. Yet, we have a legal system where justice is dependent on the talents of attorneys, and they are largely still in the private sector. Think about this ...
Source: Kevin, M.D. - Medical Weblog - October 14, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/thomas-d-guastavino" rel="tag" > Thomas D. Guastavino, MD < /a > Tags: Policy Public Health & Washington Watch Source Type: blogs

MKSAP: 49-year-old man with a family history of type 2 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister, and brother) of the disease. History is significant for hypertension, for which he takes losartan and amlodipine in the morning. On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 125/84 mm Hg, pulse rate is 80/min, and respiration rate is 16/min. BMI is 22. There is no S4 gallop. Laboratory studies show a fasting plasma g...
Source: Kevin, M.D. - Medical Weblog - October 14, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Diabetes Endocrinology Source Type: blogs

7 ways we are screwing up AI in health care
The health care AI space is frothy. Billions in venture capital are flowing, nearly every writer on the health care beat has at least an article or two on the topic, and there isn’t a medical conference that doesn’t at least have a panel if not a dedicated day to discuss. The promise and potential is very real. And yet, we seem to be blowing it. The latest example is an investigation in STAT News pointing out the stumbles of IBM Watson followed inevitably by the “Is AI ready for primetime?” debate. Of course, IBM isn’t the only one making things hard for itself. Their marketing budget and appr...
Source: Kevin, M.D. - Medical Weblog - October 13, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/leonard-davolio" rel="tag" > Leonard D'Avolio, PhD < /a > Tags: Tech Oncology/Hematology Primary Care Source Type: blogs

Always ask your patient this one thing
8:00 a.m.: Monday mornings are abhorred by almost everyone, but they are gloomier if you work as an intern. For me, this Monday was an anticipated work-free day — hence, it wasn’t too bad. I had spent a long time at breakfast catching up with friends and later grabbed my books and went to the library to catch up on my studies. This happiness was short lived. And in the afternoon, I was called to assist the clinics and a day of no work turned into a workday again. 2:30 p.m.: I grabbed coffee, rushed to the clinics and began my job of taking a detailed history of the patient. The patient was a twenty-year-old gir...
Source: Kevin, M.D. - Medical Weblog - October 13, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/dr-natasha-khalid" rel="tag" > Dr. Natasha Khalid < /a > Tags: Physician Hospital-Based Medicine Pediatrics Source Type: blogs

Being a specialist is a constant climb. But it ’s worth it.
College → medical school → residency → fellowship. The journey to becoming a doctor sometimes feels like climbing a never-ending ladder. The process started for me as an undergraduate when I was seventeen years old and will go on well into my thirties. I am still climbing. Each level of ascension is drastically different in both your skill set and responsibilities to your patients. The variation from one stage to the next is magnified due to the increase in breadth of knowledge and years of practice. Expectations change and more is demanded as you become an expert in your field. Before every rung you climb, ...
Source: Kevin, M.D. - Medical Weblog - October 13, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/hassan-patail" rel="tag" > Hassan Patail, MD < /a > Tags: Education Hospital-Based Medicine Residency Source Type: blogs

A story from a physician ’s journey to burnout
An excerpt from The Flame Broiled Doctor: From Boyhood to Burnout in Medicine. “So what did my bloodwork show, Doctor?” asked Liz. Liz was friendly and polite, but a textbook example of the Worried Well … healthy but neurotic patients I didn’t need to see as often as I did. “Nothing, my dear,” I said. “Thyroid is fine; blood count is fine. Even the X-ray we took of your chest was fine.” Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 13, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/franklin-warsh" rel="tag" > Franklin Warsh, MD, MPH < /a > Tags: Physician Primary Care Psychiatry Source Type: blogs

Let ’s share our stories about gun violence
It’s a peculiar kind of civil war we are waging in America. 30,000 of us die each year from gun violence, exceeding the number killed annually on all sides in the Syrian civil war. On October 1, we saw more than 58 people slaughtered and hundreds injured in a carefully planned attack. At a concert. In Las Vegas. For no apparent reason. My professional interest in this problem began during my residency in Detroit 30+ years ago. I vividly remember my first day on the Emergency Surgery rotation. Six of us stood around a gurney in the ER, stocked with 2 IV poles, one for each arm, bundles of laboratory tubes with lab sli...
Source: Kevin, M.D. - Medical Weblog - October 13, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/barbara-meyer" rel="tag" > Barbara Meyer, MD, MPH < /a > Tags: Policy Primary Care Public Health & Source Type: blogs

Sharing stories on social media humanizes the medical profession
One way to fight physician burnout is to share our stories and remove the stigma. A KevinMD keynote video excerpt.  I’m currently considering opportunities for 2018: Please visit my physician keynote speaking page to find out more. Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 13, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/kevin-pho" rel="tag" > Kevin Pho, MD < /a > Tags: Kevin's Take Hospital-Based Medicine Primary Care Psychiatry Source Type: blogs

4 ways doctors put themselves last
As physicians, we are conditioned to put ourselves last. This long-standing tendency likely began way before we hit medical school. But certainly, our training reinforces it. Think about it: the personality type that goes into medicine is typically a caretaker. And while medical school reinforces this personality pitfall, It doesn’t end there. Residency brings a whole other dimension of self-neglect. We think, “If I can just get out of residency things will return to “normal.” However, once you’re out in practice, we find new ways to de-prioritize ourselves. We make up reasons why others are m...
Source: Kevin, M.D. - Medical Weblog - October 12, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/maiysha-clairborne" rel="tag" > Maiysha Clairborne, MD < /a > Tags: Physician Practice Management Primary Care Source Type: blogs

How do you fight racism in medicine?
I bleed blue and gold. No, I am not talking about Michigan, West Virginia or Notre Dame. I am definitely not talking about UCLA Bruins (by the way, UCLA fans, a bruin is a brown bear). That’s right — I am a die-hard Cal Bears fan. Thanks to Cal football, and particularly to legendary Marshawn Lynch, my college days were filled with excitement. (I am counting on you, Coach Wilcox.) Marshawn, an Oakland-native running back, is one of the best football players to graduate from Cal, and he happens to play for my team, the Oakland Raiders. Known for his power running style and ability to break tackles, he is one of ...
Source: Kevin, M.D. - Medical Weblog - October 12, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/john-junyoung-lee" rel="tag" > John Junyoung Lee, MD < /a > Tags: Physician Hospital-Based Medicine Practice Management Source Type: blogs

Do the portraits hanging in medical schools hurt women and minorities?
Our powerful subconscious minds are processing information that we don’t even realize we are taking in, so to achieve gender equity we must actively uncover things that are unintentionally promoting stereotypes. For example, we know that if we want to promote a gender equitable environment that putting portraits of men on the walls of the classrooms would not be ideal. Even if there were one or two women in the mix, this type of tokenism contributes to persistent sexism and gender disparities. Indeed, decorating our medical school educational facilities — entrances, classrooms, lectures halls and teaching hospi...
Source: Kevin, M.D. - Medical Weblog - October 12, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/julie-silver" rel="tag" > Julie Silver, MD < /a > Tags: Education Medical school Practice Management Source Type: blogs

3 signs that you ’re ready to leave your job
Medicine is a calling. And almost all of us went into this profession for altruistic reasons. Unfortunately, it’s no secret that the health care landscape has changed dramatically over the last couple of decades, and practicing medicine is undoubtedly getting more difficult for most doctors. Fortunately, I’ve found myself in a better place than most. But after hearing feedback from physicians at various stages of their career, there are a number of reasons why they may be unhappy in their current job. Among these are administrative and bureaucratic headaches, information technology requirements and inadequate s...
Source: Kevin, M.D. - Medical Weblog - October 12, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/ben-levin" rel="tag" > Ben Levin, MD < /a > Tags: Physician Hospital-Based Medicine Practice Management Primary Care Source Type: blogs

3 things women doctors need to succeed
“There was porn in the call room the first night I slept there.” The call room is the room where doctors sleep — if they have minutes to catch some sleep — when they are on call. When you’re the first female doctor to ever be on the service, apparently you might find porn in that room. “I told the partners they could keep the porn if they’d let me paint the walls pink.” Physicians, like lawyers, are mostly men. However, women are breaking the ceiling in both fields, sometimes slowly but always surely. I recently had the honor of giving a keynote to a group of female doctors, ...
Source: Kevin, M.D. - Medical Weblog - October 12, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/heather-hansen" rel="tag" > Heather Hansen < /a > Tags: Physician Hospital-Based Medicine Practice Management Primary Care Source Type: blogs

Here ’s what Dr. Seuss can teach real doctors about burnout
While driving home from a weekend trip, my children were watching The Lorax in the backseat, and I couldn’t help but think how acutely applicable its theme is to the current state of medicine in America. Just as seemingly small changes in the name of “progress” slowly altered the environment in The Lorax, a handful of mostly well-intended modifications have transformed the landscape of medicine into something unrecognizable and unsustainable. We now find ourselves in a place where primary care physician burnout is over 50 percent, and excellent physicians are leaving medicine for careers involving less st...
Source: Kevin, M.D. - Medical Weblog - October 12, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/stacey-searson" rel="tag" > Stacey Searson, MD < /a > Tags: Policy Practice Management Primary Care Public Health & Source Type: blogs

A medical student in therapy
On TV shows, therapists decorate their rooms with leather lounge chairs, throw pillows and organza curtains that let in the light. But Dr. Hassan’s office is in the clinic basement. The fluorescent lighting is sterile. She has a gray metal desk — I think every doctor I’ve shadowed as a medical student has had that same desk. But I’m not here as a student. I’ve been anticipating this appointment for a month. In March, I started to take an online physiology exam for school but instead spent twenty minutes staring motionless at the computer screen. I eventually input the answers and passed the te...
Source: Kevin, M.D. - Medical Weblog - October 11, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/kristen-lee" rel="tag" > Kristen Lee < /a > Tags: Education Medical school Psychiatry Source Type: blogs

The problem with prescribing sleeping pills for older patients
It seems that everyone has advice about sleep these days, and we have become immune to it. “Avoid naps, caffeine and alcohol close to bedtime. Get exercise. Get out of bed if you can’t sleep. Turn off the TV and any electronic devices hours before bedtime. Enjoy a relaxing ritual. Keep to a routine.” Please do all of these, because they actually work! Shifting your bedtime later to achieve sleep consolidation also works. In fact, there is an insomnia-focused cognitive behavioral therapy (CBT-I) that has shown dramatic benefits. Here’s the problem. Many people come to their doctors asking for a sleep...
Source: Kevin, M.D. - Medical Weblog - October 11, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/lea-c-watson" rel="tag" > Lea C. Watson, MD, MPH < /a > Tags: Conditions Geriatrics Primary Care Psychiatry Source Type: blogs

Please make primary care as sexy as Grey ’s Anatomy
Dear Shonda Rhimes, the brilliant mind behind my favorite television show, We need to talk about “Grey’s Anatomy.” I’m a fan. A really, really big fan. The kind of fan who — in the last 48 hours — rewatched all of last season’s episodes to prepare for the season premiere, and who has blocked off every Thursday night this fall to get lost in the drama at Grey Sloan Memorial. We all have our vices, and “Grey’s” is mine. But something occurred to me as I was bingeing on last season. From the lifesaving surgeries to the metastasized cancers, half of the plot lines and...
Source: Kevin, M.D. - Medical Weblog - October 11, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/elizabeth-metraux" rel="tag" > Elizabeth M étraux < /a > Tags: Policy Mainstream media Primary Care Public Health & Source Type: blogs

This is who ’s to blame for the opioid crisis
“Do not get caught” seems to be the real rule of the law in South Florida, where I live. I was trained to limit the use of controlled substances, narcotics, hypnotics and sedatives. Their use can affect consciousness, ability to drive a car and work.  More severe consequences include respiratory depression and overdose from too high of a dosage or mixing too many medications and over the counter items. The Joint Commission, medicine’s good housekeeping seal of approval authority, along with major medical organizations have accused clinicians of undertreating pain. “Pain is the fifth vital sign,...
Source: Kevin, M.D. - Medical Weblog - October 11, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/steven-reznick" rel="tag" > Steven Reznick, MD < /a > Tags: Physician Pain Management Primary Care Source Type: blogs

The exact moment this doctor realized the amazing power of women
I remember the exact moment I realized the amazing power of women; that together, women can accomplish anything they put their minds to. I grew up in a household of women. I had no brothers to compete with, and my parents always encouraged us to learn and develop leadership skills. However, even growing up in an encouraging environment, I still developed an unconscious bias. In school and in college, I often held back when I knew the answers to questions. I did not want to “one-up” people in my class or be labeled as a “know it all.” I also knew there were negative connotations to being labeled as t...
Source: Kevin, M.D. - Medical Weblog - October 11, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/sasha-k-shillcutt" rel="tag" > Sasha K. Shillcutt, MD < /a > Tags: Physician Hospital-Based Medicine Surgery Source Type: blogs

No female physician should have to feel that her gender is a factor limiting her success
A father and a son are in a car accident.  The father dies instantly, and the son is taken to the nearest hospital.  The doctor comes in and exclaims, “I can’t operate on this boy!” “Why not?” the nurse asks. “Because he is my son,” the doctor responds. How is this possible? *** I first saw this riddle in a Washington Post article in October 2016. I was four years out of residency, and for the first time in my career, had started to feel like I wasn’t treated quite the same as the male physicians that made up the majority of my group.  I read the riddle ov...
Source: Kevin, M.D. - Medical Weblog - October 11, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Physician Emergency Medicine Practice Management Source Type: blogs

A teacher ’s calling never ends
“We are what we repeatedly do. Excellence, then, is not an act but a habit.” – Will Durrant, historian For better or worse, all of my high school English teachers were memorable. Each held a precise but non-overlapping image of the perfectly crafted essay; therefore, every September I found myself adopting a brand new writing style. A paper that would have garnered an “A” at the end of one school year routinely received a “C-minus” at the beginning of the next. For the next few months, I would master the new approach only to have it discarded and replaced again the following y...
Source: Kevin, M.D. - Medical Weblog - October 10, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/bruce-campbell" rel="tag" > Bruce Campbell, MD < /a > Tags: Physician Hospital-Based Medicine Palliative Care Source Type: blogs

We must be brave enough to seek change
On the porch. It’s that time of year again, when we escape from the heat of New York City summers, and head to New Hampshire, to the Central Lakes District, where my wife’s family has had a house perched out over the clear waters of Newfound Lake for over 120 years. It’s a small wooden house, with barely enough room for all of us squeezed in, painted bright yellow and orange, with a beautiful porch that allows for perfect viewings of the sunset on the lake beyond the mountains across from us. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social...
Source: Kevin, M.D. - Medical Weblog - October 10, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/fred-n-pelzman" rel="tag" > Fred N. Pelzman, MD < /a > Tags: Policy Primary Care Public Health & Washington Watch Source Type: blogs

A question to ask physicians: How much is tough enough?
“You folks have it easy.” As a resident, it is not uncommon to hear these words on the wards from older physicians. After all, this new generation is spoiled, one could say. At the time when I trained, we had hour limitations and “caps” on the number of cases we could handle as interns on our shifts. Now, that seems to have reversed. Second year was tougher in a sense that there were almost no limitations on workload. I remember pushing through exhaustion quite frequently. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A socia...
Source: Kevin, M.D. - Medical Weblog - October 10, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/drizzlemd" rel="tag" > DrizzleMD < /a > Tags: Education Critical Care Hospital-Based Medicine Medical school Psychiatry Source Type: blogs

What ’s the one word to improve the well-being of clinicians?
Recently, I was asked an intriguing question by an interviewer: “If you had a magic wand and could have one wish for improving the well-being of clinicians and addressing burnout, what would it be?” My response? Respect. Respect for the humanity of everyone who touches the health care system — patients, family members, administrative staff, organizational leaders, clinical staff, clinicians, cleaning staff, parking valets, pharmacists, lab technicians, front desk staff, and the folks who answer the phone and help with appointment scheduling. My answer was not really a fair one. I believe that respect of t...
Source: Kevin, M.D. - Medical Weblog - October 10, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/diane-w-shannon" rel="tag" > Diane W. Shannon, MD, MPH < /a > Tags: Physician Practice Management Primary Care Psychiatry Source Type: blogs

After Las Vegas: What is the change that needs to occur?
Las Vegas: 59 dead, 500+ injured. I worry about our medical colleagues who will suffer tremendously while treating the injured; they will be wracked with guilt for the patients they could not help and false back to the horror of that night and the ensuing days and weeks caring for the living. We must find ways to support each other help them cope as well as looking for sensible solutions. My son was 18 months old when the Columbine shootings took place. The school and nearby park were where we spent many hours playing. I was shocked, and grief-stricken. I had friends whose children were trapped at the school, and others wh...
Source: Kevin, M.D. - Medical Weblog - October 10, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/rita-agarwal" rel="tag" > Rita Agarwal, MD < /a > Tags: Physician Emergency Medicine Public Health & Policy Source Type: blogs

A missed diagnosis haunts this physician
Eighty percent of diagnoses can be made based on the history and physical.  Take the subjective and objective; throw in some medical history, family history, social history and you can figure out your assessment and plan. Doctors are the detectives of the body and the more facts, the easier it is to solve the mystery. This is the fictional note that I wrote in my head concerning a fellow physician friend when she approached me in confidence a few weeks ago. Subjective Depressed mood, anxiety, insomnia, anhedonia, weight loss present, abdominal pain. Symptoms per patient have been present for one week.  May have b...
Source: Kevin, M.D. - Medical Weblog - October 10, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Conditions Psychiatry Source Type: blogs