Who named our bones? And what were they thinking?
All of our 200+ bones have names, which facilitates describing them when we cannot actually hold them or point directly at them. It might be easier to remember the names if they were familiar ones like Robert, Sally, and Kevin, but no such luck. Latin was the original language of science, so the bones received Latin names. Some of those were derived from Greek. All were purely descriptive and widely understood, providing that you spoke Latin. For example, the shoulder blade is mostly flat and triangular. An anatomist picked one up, pondered a bit, and decided it resembled the blade on a shovel or spade. He named it sc...
Source: Kevin, M.D. - Medical Weblog - July 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/roy-a-meals" rel="tag" > Roy A. Meals, MD < /a > Tags: Conditions Orthopedics Source Type: blogs

MKSAP: 70-year-old man with heartburn
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 70-year-old man is evaluated in follow-up for heartburn of 7 years’ duration. He has frequent nocturnal reflux but has not had odynophagia or dysphagia, and his weight has been stable. He was recently started on once-daily omeprazole with good control of his symptoms. He has a 30-pack-year history of cigarette smoking and continues to smoke. On physical examination, vital signs are normal; BMI is 29. The remainder of the physical examination is normal. He is concerned about his long-term heartbur...
Source: Kevin, M.D. - Medical Weblog - July 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology Source Type: blogs

Not all depression is alike. Here are the differences.
Adapted from Understanding Antidepressants. In his often-quoted beginning of Anna Karenina, Tolstoy wrote, “All happy families are alike; each unhappy family is unhappy in its own way.”  If we stretch this notion a little — going from families to individuals, and from unhappiness to depression — we come up with an interesting question, which is the subject of this blog: Are persons with depression all alike, or is each depressed in his/her own way?  In one sense, the answer seems to be that the difficult experience of depression is unique to each person, affected by age, past experiences, ...
Source: Kevin, M.D. - Medical Weblog - July 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/wallace-b-mendelson" rel="tag" > Wallace B. Mendelson, MD < /a > Tags: Conditions Psychiatry Source Type: blogs

Tips to manage chronic pain on summer vacation
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. It’s officially that time of year. Summer is in full-swing, and all of America is getting ready to take a much-needed holiday. However, some Americans, particularly those who suffer from chronic pain, often dread getting away. They are afraid their chronic pain might prevent them from having a good and restful vacation. They ask, “Will the long flight wreak havoc on my back?” Some of my patients even forgo trying to get away on holiday due to these fears. Other patients fear going away on a vacation because th...
Source: Kevin, M.D. - Medical Weblog - July 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/john-dombrowski" rel="tag" > John Dombrowski, MD < /a > Tags: Conditions Pain Management Primary Care Source Type: blogs

Burnout in the male physician
When I first started writing and speaking about physician burnout, I focused most of my efforts on the female physician — after all, most of my work stems from personal anecdotes, and I am of course a female physician.  I could probably give a talk about women physicians and burnout in my sleep at this point. Rightfully so, though, as my work spread to wider audiences, more and more men started responding with comments such as, “What makes you think only moms don’t want to miss their kids’ soccer games?,” “Do you think I want to spend 80 hours a week in the hospital?,” or &ldq...
Source: Kevin, M.D. - Medical Weblog - July 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/nisha-mehta" rel="tag" > Nisha Mehta, MD < /a > Tags: Physician Practice Management Source Type: blogs

When someone claims something is healthy, be skeptical
I stood in line at the grocery store waiting to pay for my items. The woman behind me, who would be categorized as obese, was eyeing some of the snacks so conveniently placed in the checkout aisle. She grabbed a meal bar and analyzed it for a few seconds, then said aloud to me: “You ever had one of these? They’re pretty good. And they’re gluten-free, that’s how you know they’re healthy.” Healthy. What a word. A trillion different opinions, guidelines, historical changes, and bits of data crammed into seven letters. A word we toss around like a hot potato, assigning to it whiche...
Source: Kevin, M.D. - Medical Weblog - July 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jamie-katuna" rel="tag" > Jamie Katuna < /a > Tags: Conditions Obesity Primary Care Source Type: blogs

How a physician found success and fulfillment living outside the box
An excerpt from the Docs Outside the Box podcast, episode 2: How a physician found success and fulfillment living outside the box Dr. Nii: I have an exciting guest that I want to showcase for you. Her name is Dr. Melanie Watkins. She’s a psychiatrist who’s practicing in California. I’ve been following Melanie for quite some time on Twitter. She’s been known to have very poignant Twitter messages — whether they are motivational in aspects or encompass the whole aspect of mental health. As anybody who’s following her can see, she’s got her hand in many different things. Truly, s...
Source: Kevin, M.D. - Medical Weblog - July 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/nii-daako-darko" rel="tag" > Nii-Daako Darko, MD, MBA < /a > Tags: Physician Practice Management Source Type: blogs

Medical training is over. What ’s the next chapter?
Today is a strange day. I treated myself to a slice of nondescript doughy hospital pizza for lunch today. If this was an actual pizza place, and I had a choice, I would never order this pizza. But today, the pizza tasted fantastic. In fact, it tasted like the best pizza I’ve ever had. Why you ask? Because this would likely be the last time I’d ever eat this hospital pizza. I enjoyed it and every memory associated with it. 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 - July 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/manu-prativadi" rel="tag" > Manu Prativadi, MD < /a > Tags: Education Medical school Radiology Source Type: blogs

A physician ’s mistakes as a rookie MD
July is upon us again: that New Year celebrated only by those in the medical field. A time when medical students begin as doctors, interns become residents, residents become fellows and, basically, everyone in every position is one year less experienced at it than the person who held that position the day before. This July marks the end of my first year of pediatric hematology/oncology fellowship. Finally, after college, grad school, med school, residency, chief residency, fellowship number one, and now the beginning of fellowship number two, it is the end of my last first year of training. A time for gratefulness, sentime...
Source: Kevin, M.D. - Medical Weblog - July 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/rebecca-e-macdonell-yilmaz" rel="tag" > Rebecca E. MacDonell-Yilmaz, MD, MPH < /a > Tags: Physician Hospital-Based Medicine Source Type: blogs

Medical students: Welcome to the wards
Dear third-year medical students, Welcome to the wards. I remember this stage — basking in the glory of completing pre-clinicals, in the excitement of finally switching heavy textbooks for living, breathing people, in the realization that medical education now lies in the hands of those I wanted to heal. I would be sleeping less, but living more, because this was my purpose. Remember this moment because this will be the most difficult year yet. Your humanity, empathy, and purpose will be challenged. You’ll experience exhaustion like never before. You’ll be broken down, time and time again. But still, find...
Source: Kevin, M.D. - Medical Weblog - July 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/zainab-mabizari" rel="tag" > Zainab Mabizari < /a > Tags: Education Hospital-Based Medicine Medical school Source Type: blogs

Make a commitment to ask patients about firearms
Author’s note: My personal reflection about the Sutherland Springs mass shooting was written before the horrific events at Stoneman Douglas High School and Santa Fe High School. The chorus of voices has only increased in amplitude regarding the calls to responsible action on firearm safety. While a larger debate continues in Washington, DC, I ask myself again: What can I do now as a medical provider to make a difference? The answer remains the same: Ask patients about firearm access and safety. Pledge today to hold yourself accountable, and encourage your colleagues to do the same regardless of political or ideologic...
Source: Kevin, M.D. - Medical Weblog - July 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/john-hunninghake" rel="tag" > John Hunninghake < /a > Tags: Policy Public Health & Washington Watch Source Type: blogs

A physician ’s attempt to seek psychiatric help
Physicians all around us are dying from suicide. For me, some deceased colleagues I knew more closely, others were faces that you would pass on the wards. Even two physicians that I knew peripherally died just this past week. The issue of physician suicide is in the news now, and facts are available. At least a whole medical school class worth of physicians dies by suicide each year. The suicide rate for female physicians is 2.27x greater than the general female population. I am one of many physicians struggling with depression and suicidal thoughts and ideation. For me, this new low is complicated by the fact that I was b...
Source: Kevin, M.D. - Medical Weblog - July 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Physician Psychiatry Source Type: blogs

The case against physician side hustles is weak
As many of you know, I am a big fan of side hustles.  I see them as a financial independence superpower that not only leads to increased revenue and diversification, but also joy and passion.  I am not, however, unaware of the fact that many feel they are a waste of time.  The case against side hustles is real.  There are many reasons why an individual may decide not to step into this busy street full of entrepreneurial traffic.  And I cannot blame them.  Starting a new business venture when already bogged down by kids, family and a full-time W-2 can be difficult. Yet, I th...
Source: Kevin, M.D. - Medical Weblog - July 19, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/docg" rel="tag" > DocG, MD < /a > Tags: Finance Practice Management Source Type: blogs

Physician Speaking by KevinMD: Fall 2018 schedule and 2019 proposals
I sincerely appreciate all your support for my boutique speakers bureau, Physician Speaking by KevinMD. These speakers are both practicing physicians and award-winning speakers that shine on stage. This Fall, we will highlight the following events: 2018 Ohio Dermatological Association Annual Meeting, Columbus OH Richmond Academy of Medicine, Annual Meeting, Richmond VA Maricopa County Medical Society, Annual Meeting, Phoenix AZ Kaiser Permanente San Francisco, private event, San Francisco CA MGMA18, Featured Speaker, Boston MA Pri-Med Midwest, Keynote, Rosemont IL College of American Pathologists, CAP18, Keynote, Chicago ...
Source: Kevin, M.D. - Medical Weblog - July 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/kevin-pho" rel="tag" > Kevin Pho, MD < /a > Tags: KevinMD Practice Management Source Type: blogs

How do you come back after losing a battle?
During my pediatric surgery training, I could easily point out which was the hardest day for the three fellows that were under training on that specific year. It was late evening when I received a call that one of our patients had coded. I was at home, and the drive usually took me exactly seven minutes. Due to social reasons, this patient was in the hospital with us for months (at least that is what my memory recalls) prior to the long-awaited operation that would change his life for better, making it impossible not be extremely emotionally attached to that little boy. He underwent prolonged CPR, followed by open chest ca...
Source: Kevin, M.D. - Medical Weblog - July 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/andrea-bischoff" rel="tag" > Andrea Bischoff, MD < /a > Tags: Physician Pediatrics Surgery Source Type: blogs

Managing your freedom after residency
The first time I was asked to provide a bio — in this case, it was to appear on my residency’s website — I wasn’t sure what to include. It was supposed to be short, not really an autobiography or memoir and it was supposed to make our program look approachable, impressive and balanced. I gave a quick summary of my background, my education, my interests, why I picked the program and ended with a brief listing of my hobbies and interests: “… she loves spending time with family and pursuing hobbies, including photography, travel, gardening, cooking, being outdoors and reading the newspaper...
Source: Kevin, M.D. - Medical Weblog - July 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/allison-edwards" rel="tag" > Allison Edwards, MD < /a > Tags: Physician Practice Management Primary Care Source Type: blogs

Physician suicide: Putting words into action
“The parts of me that used to think I was different or smarter or whatever, almost made me die. ” — David Foster Wallace in an interview by David Lipsky Recent physician-suicides and all those before were committed by people; people caught in an organization rigged against them  —  one that breeds new and exacerbates existing, mental health issues. Physicians are people. Doctors are people. They happen to be people who care, which makes them super humans, not superhuman. They submitted their trust to a system that leveraged their good nature against them and exchanged it for the bottom line....
Source: Kevin, M.D. - Medical Weblog - July 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/joshua-goldman" rel="tag" > Joshua Goldman, MD < /a > Tags: Physician Psychiatry Source Type: blogs

Both physicians and CEOs need time to think
I’ve always likened the job of a primary care physician to that of a chief executive officer of a small business. Family doctors manage the “business” of delivering and coordinating care for more than a thousand patients at an average cost, in the United States, of $8,500 per year: an $8 to $12 million business. Because the actions or inactions of the PCP impact the need for, and cost of, specialist and hospital care “downstream” from the primary care office, I think of this as “our” business. Because of this, I subscribe to the Harvard Business Review. I figure doctors must have s...
Source: Kevin, M.D. - Medical Weblog - July 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Practice Management Primary Care Source Type: blogs

Learn from the prior generation that left little for their own retirement
One of my best friends recently sent me an article from the Wall Street Journal discussing the generation that is about to enter into retirement.  The article highlighted how this generation will have an unacceptably high proportion of people who are unable to retire.  Following a generation that had guaranteed pensions, this left them with the reassurance that they would someday have one, too.  Left ill-prepared for retirement, this generation is likely to work until the day they die or to face the consequences of poverty and dying poor in America. In order to avoid repeating history, we must...
Source: Kevin, M.D. - Medical Weblog - July 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/the-physician-philosopher" rel="tag" > The Physician Philosopher, MD < /a > Tags: Finance Practice Management Source Type: blogs

When attendings come to work rounds
This article suggests not: “What Happens When the Attending Comes to Work Rounds?” 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 - July 18, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/robert-centor" rel="tag" > Robert Centor, MD < /a > Tags: Education Hospital-Based Medicine Source Type: blogs

Why are we treating outpatients like inpatients?
Repercussions. Every action that is taken, especially when it comes to healthcare, has ripple effects, which often end up being more far more significant than we anticipate, turning that ripple into a tidal wave. Every time somebody besides actual health care providers steps into the mix and tell those of us taking care of patients that there is “something else that we have to do,” we often see it open up a proverbial can of worms that in many cases we didn’t want opened. Whenever government regulators, hospital administrators, the makers of electronic health records, or bureaucrats from insurance compani...
Source: Kevin, M.D. - Medical Weblog - July 17, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/fred-n-pelzman" rel="tag" > Fred N. Pelzman, MD < /a > Tags: Physician Hospital-Based Medicine Practice Management Primary Care Source Type: blogs

Why physicians need disclosure coaching
In March 2018, The Collaborative for Healing and Renewal in Medicine (CHARM) published an article titled “Charter on Physician Well-being” in JAMA. The piece describes guiding principles and lists recommendations for promoting well-being among physicians. The charter successfully pulls together, in a 2-page document, a comprehensive approach to preventing burnout and fostering well-being among physicians. One recommendation especially caught my attention. “Anticipate and Respond to Inherent Emotional Challenges of Physician Work.” A tenet of addressing physician burnout is that some amount of s...
Source: Kevin, M.D. - Medical Weblog - July 17, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/diane-w-shannon" rel="tag" > Diane W. Shannon, MD, MPH < /a > Tags: Physician Practice Management Source Type: blogs

Are abuse-deterrent opioids the solution to the opioid crisis?
As a primary care doctor who cares for many patients with opioid-use disorder, I am invested in timely and effective strategies to curb our nation’s opioid epidemic. Because so many instances of opioid addiction and overdoses begin with or involve commonly prescribed opioids, we need multiple strategies that address the significant harms associated with prescription opioids. I am skeptical of one strategy, however: The President’s Commission and the Food and Drug Administration are promoting development of abuse-deterrent prescription opioids as the solution to our opioid problem. These technologies t...
Source: Kevin, M.D. - Medical Weblog - July 17, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/tiffany-lu" rel="tag" > Tiffany Lu, MD < /a > Tags: Meds Medications Pain Management Source Type: blogs

The social determinants of a physician ’s path
Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to their rural roots? The story of Prashant, a physician raised in rural Bihar, India, is instructive. When I first met Prashant, he was a second-year medical student in Patna Medical College and Hospital. Patna is the capital of Bihar, and Bihar is one of the poorest states in India. Prasha...
Source: Kevin, M.D. - Medical Weblog - July 17, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/dr-saurabh-jha" rel="tag" > Dr. Saurabh Jha < /a > Tags: Physician Hospital-Based Medicine Primary Care Public Health & Policy Source Type: blogs

The satisfaction of Suboxone treatment
My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound. Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my medication-assisted treatment (MAT) patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma, and various infectious diseases. Years ago, working in a mental health clinic, we had strict rules to defer everything to each patient’s primary care provider that wasn’t strictly related to Subo...
Source: Kevin, M.D. - Medical Weblog - July 17, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Pain Management Primary Care Psychiatry Source Type: blogs

A health insurer ’s true motives
A patient came to see me with lower abdominal pain.  Was she interested in my medical opinion?  Not really.  She was advised to see me by her gynecologist who had advised that the patient undergo a hysterectomy.  Was this physician seeking my medical advice?  Not really.   Was this patient coming to see me as her day was boring and she was bored and needed an activity?  Not really. After the visit with me, was the patient planning to return for further discussion of her medical status?  Not really. So, what was going on here.  What had occurred that day was the result of an...
Source: Kevin, M.D. - Medical Weblog - July 17, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/michael-kirsch" rel="tag" > Michael Kirsch, MD < /a > Tags: Physician Gastroenterology OB/GYN Source Type: blogs

Guidelines, multiple specialists, and the science versus the art of medicine
My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader. Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a chemotherapy agent called Cytoxan. Six days later it was clear that dialysis was required at least until the patient’s kidneys responded to the therapy and began ...
Source: Kevin, M.D. - Medical Weblog - July 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/steven-reznick" rel="tag" > Steven Reznick, MD < /a > Tags: Physician Cardiology Hospital-Based Medicine Source Type: blogs

Social workers are medicine ’s unsung heroes
You can tell a lot about a job and the people doing it by asking them to describe their best day at work. For Ali, a 28-year-old pediatric cancer social worker, that day occurred one year ago. A 17-year-old cancer patient who had been given two months to live made a bucket list. On her list were graduating from high school and getting accepted into college. So Ali and her colleagues arranged a graduation ceremony in the hospital, at which they read off a list of the colleges to which she had been accepted. Ali and other social workers savor such opportunities to make a difference. They got to know the patient and her famil...
Source: Kevin, M.D. - Medical Weblog - July 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/richard-gunderman" rel="tag" > Richard Gunderman, MD, PhD < /a > Tags: Policy Public Health & Source Type: blogs

Reading the body language of your patients
When a patient is unwell and seeking help, a vast number of emotions could be going through their mind. Their whole life could have been turned upside down, they may have been fearing this moment for a while, and stressing over the implications of their illness. To physicians, it may sometimes feel like just another name on our list or almost become a routine mechanical interaction, but for the patient — it’s their life on the line. Therefore, when any patient sees us, a huge number of them (if not the majority) are going to be a bit nervous. It’s important physicians recognize this. Doing so wi...
Source: Kevin, M.D. - Medical Weblog - July 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/suneel-dhand" rel="tag" > Suneel Dhand, MD < /a > Tags: Physician Hospital-Based Medicine Primary Care Source Type: blogs

A medical student ’s side hustles
I got together this past weekend with a few of my medical school classmates and ahhh, the memories. Being in the trenches together, just like in residency, tends to create a bond that remains throughout time. We picked up right where we left off and talked about the good ol’ times, how life used to be, and how it is so different now, especially because we now all had families. That evening after getting together, I began to reminisce about those years. It’s crazy to think how much life can change in 13 years. But I realized one thing hadn’t changed – I still love side hustles. Everyone knows th...
Source: Kevin, M.D. - Medical Weblog - July 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/passive-income-md" rel="tag" > Passive Income, MD < /a > Tags: Finance Practice Management Source Type: blogs

Belts or no belts on school buses?
The tragedy on a New Jersey highway in May involving a school bus and a dump truck horrified the nation while also raising familiar questions about school bus safety. The impact ripped the body of the bus off its chassis, killing two people and injuring most of the 45 passengers on board. By one witness’s account, “A lot of people were screaming, and they were, like, hanging by their seat belts.” The sobering image of terrified children suspended by seat belts begs an important question – might the number of fatalities have been higher if New Jersey did not mandate seat belts on school buses? Curren...
Source: Kevin, M.D. - Medical Weblog - July 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/aida-cerundolo" rel="tag" > Aida Cerundolo, MD < /a > Tags: Policy Emergency Medicine Public Health & Source Type: blogs

How to thrive during your residency
Even though my own internship was a decade ago, I vividly remember the transition from student to resident. Residency was monumental in my path to becoming a physician. There were obvious changes: People now called me “doctor,” my misshapen short white coat was upgraded to a more comforting full length one, and I was often the first one paged to respond to patient problems. Coupled with the positive aspects though, I also faced some challenges. I struggled with depression, my relationship with my girlfriend was strained, and I felt overwhelmed as I contemplated switching specialties after my second year (from o...
Source: Kevin, M.D. - Medical Weblog - July 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/varun-verma" rel="tag" > Varun Verma, MD < /a > Tags: Physician Hospital-Based Medicine Residency Source Type: blogs

Why is trauma activation so expensive?
An 8-month-old baby fell 3 feet and hit his head on a carpeted floor in a San Francisco hotel room. He was crying and the parents, who were from South Korea, called an ambulance. By the time the child arrived at the hospital he was obviously fine. After a bottle, a nap, and a few hours in the hospital, he was discharged. The hospital sent a bill two years later, which included a charge of $15,666 for a trauma activation. A trauma activation involves paging a number of hospital staff to go to the emergency department as quickly as possible. Those paged may include an attending surgeon, two or three surgical residents, an an...
Source: Kevin, M.D. - Medical Weblog - July 15, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/skeptical-scalpel" rel="tag" > Skeptical Scalpel, MD < /a > Tags: Policy Emergency Medicine Source Type: blogs

The can and can ’t of cannabis
As of now, twenty-nine states have legalized medical marijuana use and eight have legalized recreational use. The debate rages on about legalization, but the actual effects of cannabis get much less attention. A huge issue is that cannabis can be both helpful and harmful for a wide range of symptoms and conditions, and currently, the research is incomplete. But the barriers to actually study this substance are resource-intensive and restrictive. One of the biggest barriers for researchers who apply for federal funding is regulation. Cannabis is categorized as a Schedule I drug by the Drug Enforcement Agency (DEA). A substa...
Source: Kevin, M.D. - Medical Weblog - July 15, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/eunice-zhang" rel="tag" > Eunice Zhang, MD < /a > Tags: Policy Public Health & Source Type: blogs

Getting beyond the numbers in your medical school interview
Everyone knows that the process of applying and getting accepted into medical school is highly competitive. Last year, 51,680 people applied for seats in U.S. medical schools. Collectively, they submitted 816,153 applications — a whopping 16 applications per person on average. Only 21,338 applicants matriculated to a U.S. school last fall, or 41 percent of applicants. So how do the admissions committees evaluating all these applicants make their decisions? We know that the MCAT is one of their most important tools in identifying students with high aptitude, with GPA used also to validate past academic performance. Fo...
Source: Kevin, M.D. - Medical Weblog - July 15, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/tiffany-ciolek" rel="tag" > Tiffany Ciolek, MBA < /a > Tags: Education Hospital-Based Medicine Medical school Source Type: blogs

Why do so few doctors treat people with opioid addictions?
Dear Doctor, Please help me understand why so few of you have chosen to treat people with opioid addictions. I’ve been following the topic of opioid addiction for years. It is one of the most common themes for First Opinion submissions. Authors routinely point to the importance of medication-assisted therapy, the standard of care for individuals with opioid addiction (a term that those in the know tell me I should replace with opioid use disorder). That means treatment with methadone, buprenorphine, naltrexone, or combinations of these — medications you could prescribe if you wanted to. The surge...
Source: Kevin, M.D. - Medical Weblog - July 15, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/patrick-skerrett" rel="tag" > Patrick Skerrett < /a > Tags: Conditions Medications Primary Care Public Health & Policy Source Type: blogs

How employers and plan sponsors can save the U.S. workforce from opioids
Opioid use has reached epidemic proportions over the past decade, becoming one of America’s highest-priority public health issues. With opioid abuse spiraling out of control, lawmakers, regulators, and health professionals are scrambling to better understand key drivers of this issue and develop an effective action plan. Although the devastating impact of opioids on families and communities is well known, less focus has been given to how it affects the workplace and the role that employers and health care plan sponsors can play in combating it. Opioids’ impact on America’s workforce Opioid use is surging ...
Source: Kevin, M.D. - Medical Weblog - July 14, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-bartley-bryt" rel="tag" > A. Bartley Bryt, MD, MPH < /a > Tags: Policy Pain Management Public Health & Source Type: blogs

Female physicians: You ’re lucky to be here
Never touch your hair. It cannot be down, and it cannot look fancy. Optional styles include bun, ponytail, or braid. I might as well shave it off! I hear you thinking it – we’ve all thought it – but it’s wrong. The only thing worse than looking like a woman that’s too hot is looking like you’re not a woman at all. Woman? Sorry, I meant girl. Never touch your phone. Male doctors who touch their phones are using them as information gathering and analyzing devices. They are on the cutting edge of technology and medicine. They are basically Steve Jobs in a white coat. Not you. Girl doctors w...
Source: Kevin, M.D. - Medical Weblog - July 14, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/allie-gips" rel="tag" > Allie Gips, MD < /a > Tags: Physician Emergency Medicine Source Type: blogs

Patients are more than lab results
I loved my endocrinology block in medical school. It was one of my favorite units. One hormone acts on another gland, which either induces a positive feedback releasing its successor hormone or a negative feedback blocking its predecessor. It was step-by-step. It was straightforward. I loved the material so much that I reached out to an endocrinologist to shadow her. I wanted to see the power of what we were learning applied to patient care. I’d always known that patient care was what truly motivated me. And the night before I was set to shadow, I had somehow found it in me to learn everything about the thyroid, the ...
Source: Kevin, M.D. - Medical Weblog - July 14, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/johnathan-yao" rel="tag" > Johnathan Yao < /a > Tags: Conditions Diabetes Endocrinology Source Type: blogs

MKSAP: 24-year-old woman with atopic dermatitis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman with longstanding atopic dermatitis is evaluated for an acute worsening of her disease in the past week. She has had increased pruritus and now has multiple painful areas within the involved skin. She has been applying petrolatum jelly and triamcinolone ointment and washing with gentle cleansers without improvement. She is otherwise well and takes no medications. On physical examination, vital signs are normal. She has eczematous plaques with scattered pustules in the involved areas. ...
Source: Kevin, M.D. - Medical Weblog - July 14, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Dermatology Infectious Disease Source Type: blogs

What is the pediatrician ’s role in marijuana use?
I recently listened to DDx, a new podcast from Figure1. In their third episode, a 37-year-old man presents to the emergency department in the middle of the night with persistent vomiting and retching. He is highly vocal and agitated. Upon questioning, he reveals that he experiences these episodes frequently and previous investigations have all been inconclusive. His skin is noted to be flushed and his father explains that he has spent most of the day taking a hot shower. At this point, Dr. John Richards realizes the key piece of information other physicians may have overlooked. “Do you smoke marijuana?” he asks...
Source: Kevin, M.D. - Medical Weblog - July 13, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/cherilyn-cecchini" rel="tag" > Cherilyn Cecchini, MD < /a > Tags: Conditions Pediatrics Source Type: blogs

Doctors are conditioned to deny
13 years ago a colleague of mine did a labiaplasty on my 18-year-old daughter for medical reasons. What was supposed to be routine has become a nightmare for her.  Not only did he remove all of her labia minora, but he also denervated her clitoris. When he saw her post-op, he told her she was fine, maybe a little “atrophied.”  Because of this obfuscation, years went by before she really understood how damaged she was. By then, the statute of limitations had lapsed and she had no recourse. Still seeking closure on this disaster, my daughter recently went to one of his peers who confirmed the exten...
Source: Kevin, M.D. - Medical Weblog - July 13, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Conditions Malpractice OB/GYN Source Type: blogs

Pronouns matter: How we can do better in LGBTQ patient care
In the wake of Pride Month, I have been reflecting on how our health care system impacts the lives of individuals with identities across the gender spectrum. Sometimes, when sending a prescription to a pharmacy for any given patient, we will get a phone call that the date of birth on file with insurance does not match the date of birth we have on file. Typically, this is a clerical error that is easy to fix. What is more jarring is when a patient we know identifies as female is on file with their insurance company as being male. That one letter on a chart — M instead of F — is a stark reminder of the many daily...
Source: Kevin, M.D. - Medical Weblog - July 13, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/carlene-macmillan" rel="tag" > Carlene MacMillan, MD < /a > Tags: Physician Primary Care Source Type: blogs

Restoring the trust in the medical profession
A guest column by the American College of Physicians, exclusive to KevinMD.com. Trust is the belief that another person or entity will act in your best interest, and it serves as the foundation upon which the doctor-patient relationship and our health care system are built. But we have a significant trust paradox in American medicine. As individual physicians, we do very well in holding the public’s trust and confidence; but the medical profession as a whole, not so much. When asked, over two-thirds of U.S. citizens rate the honesty and ethical standards of physicians as “very high” or “high,”...
Source: Kevin, M.D. - Medical Weblog - July 13, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/philip-a-masters" rel="tag" > Philip A. Masters, MD < /a > Tags: Policy American College of Physicians Public Health & Source Type: blogs

6 pieces of advice for graduating medical students and residents
My (sometimes solicited, but often unsolicited) advice for graduating medical students, residents, and fellows: June is one of my favorite times of the year.  One, because it’s summer, but also because it’s graduation season.  I love seeing and hearing about everyone’s accomplishments, and seeing years of hard work come to fruition – although if I’m being honest, it’s bittersweet, because it’s also a reminder of how I’m getting older. This year, I’ve been more aware of it than most, because I’ve received a lot of messages from medical students waiting to...
Source: Kevin, M.D. - Medical Weblog - July 13, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/nisha-mehta" rel="tag" > Nisha Mehta, MD < /a > Tags: Physician Practice Management Source Type: blogs

It ’s time for academic attendings to teach personal finance
A recent post by the White Coat Investor got me pretty fired up.  Dr. Dahle spoke about three of the main financial enemies that face physicians. The third one that he mentioned had something to do with medical culture.  The gist of it was that talking money in academic medical centers is considered taboo.  While I think WCI is right, it really made me angry.  As an academic attending physician, it made me feel like we are utterly failing our students and residents. Why and how can we make the change? Let’s dig in. Why should you care? If you are in academics, my presumption is that you ...
Source: Kevin, M.D. - Medical Weblog - July 13, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/the-physician-philosopher" rel="tag" > The Physician Philosopher, MD < /a > Tags: Finance Practice Management Source Type: blogs

Here ’s why we need socioeconomic diversity
Parents cheer, students rejoice, and teachers relax — it’s graduation season, one of my favorite times of the year. A few weeks ago, the Class of 2018 at Harvard Medical School (HMS) marched across campus to complete their final hoorah as medical students. I observed in awe and noticed something spectacular: most graduates who delivered a speech represented minority groups. This sighting was not happenstance. Energy is allocated to bolstering racial diversity in medicine because diverse cohorts help students learn cultural humility. Minority doctors are also more likely to work in underserved areas. An addition...
Source: Kevin, M.D. - Medical Weblog - July 12, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/david-velasquez" rel="tag" > David Velasquez < /a > Tags: Policy Public Health & Source Type: blogs

Every patient has a rich history behind their current state of health
As I was reviewing his chart, I noticed under social history that “freelance artist/painter” was listed as his occupation. I’ve never met a patient of such talent and honestly, I was excited to meet him. When I arrived at the ER, I was introduced to an unassuming elderly man. He wore a pair of worn out jeans and a burnt orange T-shirt. Tufts of white hair emanated from under his baseball cap. He ran out of home oxygen a day ago and was brought by ambulance for COPD exacerbation. After being on high-flow oxygen for some time, he transitioned to a nasal cannula dialed to three liters. “Hi Mr. Birch, m...
Source: Kevin, M.D. - Medical Weblog - July 12, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/ton-la-jr" rel="tag" > Ton La, Jr. < /a > Tags: Education Hospital-Based Medicine Pulmonology Source Type: blogs

Third year of medical school is like learning to ride a bike
I could see the excitement on my six-year-old daughter’s face as we pulled into the parking lot and unloaded her new bike from the car. She had been anxiously awaiting this moment for several weeks — she was going to learn to ride a bicycle. She watched with increasing interest as I unscrewed the training wheels, tightened her handlebars and handed her the bike. She got on her new bike and with me holding onto the back of the seat and started to pedal. “Let go, Daddy,” I heard her say. She was ready to be “big,” and “big girls” don’t need help riding their bike.“T...
Source: Kevin, M.D. - Medical Weblog - July 12, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/samuel-singer" rel="tag" > Samuel Singer < /a > Tags: Education Medical school Pediatrics Source Type: blogs

8 steps to have those difficult conversations
An excerpt from No-Drama Leadership: How Enlightened Leaders Transform Culture in the Workplace. Although the ability to initiate difficult conversations is part of good leadership, I’ve never met a leader who enjoys it. Whether your conversation is about body odor, rude behavior, dress code, personal conduct or performance issues, difficult conversations are something that most of us avoid. In reality, the primary reason we avoid difficult conversations is that many of us lack the skills we need to handle such situations. As a health care leader, your intention must be about improving performance for the betterment ...
Source: Kevin, M.D. - Medical Weblog - July 12, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/marlene-chism" rel="tag" > Marlene Chism < /a > Tags: Physician Practice Management Source Type: blogs