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Getting it right: the challenge and reward of clinical diagnosis
A guest column by the American College of Physicians, exclusive to KevinMD.com. It was actually a great diagnosis that led me to become an internist. I distinctly recall a patient admitted to my service during my third-year internal medicine clerkship inpatient rotation. He was extremely sick and what was wrong with him had eluded multiple other physicians before he ultimately landed in my hospital. Through disciplined, methodical, logical thinking and focused testing, his diagnosis eventually became clear — eosinophilic granulomatosis with polyangiitis (what in those days was known as Churg-Strauss syndrome). I watc...
Source: Kevin, M.D. - Medical Weblog - December 17, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/philip-a-masters" rel="tag" > Philip A. Masters, MD < /a > Tags: Physician American College of Physicians Primary Care Source Type: blogs

Physician asset protection: Is it a good idea to pay down debts?
Being in a high income, high-risk field I often think of asset protection. The lawsuit may not come from medical work, but from an auto accident or someone slipping on my front step. All of these can lead to suits, and as a high-income earner, we all have a target on our back. The last thing I want to do is work hard to save money to then have it taken away by one lawsuit. There are of course many ways to protect your assets, and they should all be put into place. Insurance Malpractice insurance For one, having a good malpractice insurance as a physician is key. Hopefully, your group has paid for your insurance, and it has...
Source: Kevin, M.D. - Medical Weblog - December 17, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/dads-dollars-debts" rel="tag" > Dads Dollars Debts, MD < /a > Tags: Finance Practice Management Source Type: blogs

To this physician, thankfulness is his lifeline
The complaint was constipation. In the exam room, a quiet girl stood in a too big johnny, her eyes staring down at the floor. The 13-year-old was here with her “aunt.” Like over 50,000 children before her, she’d made the fifteen hundred mile plus journey from El Salvador to escape the violence of government and gang fighting, perhaps not knowing Mara Salvatrucha and the other gangs hung out only a few blocks away from the health center. Her heart and lungs sounded fine, and her abdomen was soft with good bowel sounds. An inspection of her backside revealed sheets of condyloma cascading over her perineum a...
Source: Kevin, M.D. - Medical Weblog - December 17, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jeffrey-collins" rel="tag" > Jeffrey Collins, MD < /a > Tags: Physician Emergency Medicine Pediatrics Source Type: blogs

Is this is why women so often settle?
Being 100 percent, authentically you is extremely freeing. It is awesome, brave, and takes courage and strength. It is also completely exhausting at times. Like, I-think-I-have-Influenza tired. The more I age, the more I advance. The more I advance, the more I realize how living my life in the constraints of other’s opinions or wants or desires for me is not an option. This leads me to be lonely at times, and on an unchartered path. 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 - December 16, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/sasha-k-shillcutt" rel="tag" > Sasha K. Shillcutt, MD < /a > Tags: Physician Practice Management Source Type: blogs

#MeToo in medicine. This is one physician ’s story.
The senior psychiatry resident at the University of Washington School of Medicine warned me ahead of time. She laughed as she said, “He’s weird. You’ll get used to him.” When I first met with him, the psychiatrist lazily spun in his chair, his left hand tucked into his pants, his thumb hanging out. After he told me his expectations as my supervisor, he patted my right thigh as he ended the meeting. I spent one day a week training in his clinic. He often put his hand on my shoulder. If he sat near me, he extended his arm to pat my leg. When I sat far from him, he crowed compliments in front of patien...
Source: Kevin, M.D. - Medical Weblog - December 16, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/maria-yang" rel="tag" > Maria Yang, MD < /a > Tags: Physician Psychiatry Source Type: blogs

MKSAP: 48-year-old man with knee pain and swelling
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated for a 2-day history of right anterior knee pain and swelling. The pain began suddenly and has increased in intensity. He currently rates his pain as an 8 on a 10-point scale. He has no knee instability and reports no fever or chills. He has no history of trauma and has never had this problem before. Other than his right knee pain and swelling, he feels well. He is employed as a carpet layer. His only medication is ibuprofen, which provides minimal relief. On physical examin...
Source: Kevin, M.D. - Medical Weblog - December 16, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Orthopedics Rheumatology Source Type: blogs

Is autonomy really better for patients?
It used to be that doctors knew best. We told you what to do, and you obediently complied. The world has changed, and the paternalistic system of yore has given way to the shared decision model where patient autonomy is respected. The old way: “Well, I’ll be setting you up for surgery soon.” The new and improved way: “Let’s discuss all of the reasonable options with their respective advantages and drawbacks. Then, you make the call.” To paraphrase the mantra of a certain news network: Doctors report; you decide! Continue reading ... Your patients are rating you online: How to respond. M...
Source: Kevin, M.D. - Medical Weblog - December 16, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/michael-kirsch" rel="tag" > Michael Kirsch, MD < /a > Tags: Physician Gastroenterology Primary Care Source Type: blogs

The myth of multitasking in primary care
Primary care doctors don’t usually have scheduled blocks of time to read incoming reports, refill prescriptions, answer messages or, what we are told the future will entail, manage their chronic disease populations. Instead, we are generally expected to do all those things “between patients.” This involves doing a little bit of all those things in the invisible space between each fifteen-minute visit, provided we can complete those visits, their documentation and any other work generated in those visits, in less than he fifteen minutes they were slotted for. If we can’t capture (steal, really) enoug...
Source: Kevin, M.D. - Medical Weblog - December 15, 2017 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 Primary Care Source Type: blogs

Psychiatrists should not be involved in presidential politics. Here ’s why.
The media, politicians, celebrities, athletes and other groups have questioned the fitness and mental health of the president, but one group has largely refrained: mental health professionals. This recently changed. One of the latest efforts is a book, a collection of assessments by 27 psychiatrists and mental health providers, called “The Dangerous Case of Donald Trump.” Indeed, the book’s editor publicly renewed her concerns on Nov. 30, 2017 in a letter to The New York Times. As an academic psychiatrist and advocate for those with mental illness, I want to discuss something important that has been missi...
Source: Kevin, M.D. - Medical Weblog - December 15, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/arash-javanbakht" rel="tag" > Arash Javanbakht, MD < /a > Tags: Policy Psychiatry Washington Watch Source Type: blogs

Youth football and concussions: some good news?
Concussions and football have come up before, and the news so far has been discouraging. We want kids to stay active, and football is one of the most popular boys’ sports out there. But we know that some prominent professional athletes have had serious, cumulative brain damage from years of football – sometimes brain damage that has destroyed their lives. What about high school football, or football starting even earlier? Are we encouraging a sport that’s a cause of serious, lifelong disability? A recent publication gives at least some reassurance. From the August 2017 issue of JAMA Neurolo...
Source: Kevin, M.D. - Medical Weblog - December 15, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/roy-benaroch" rel="tag" > Roy Benaroch, MD < /a > Tags: Conditions Neurology Pediatrics Source Type: blogs

Patients made this doctor care about politics
Before I went to medical school, I had little interest in politics. It wasn’t that I didn’t care about my country; I spent seven years serving in the United States Navy and have always taken pride in being an American. I suppose the reason for my political apathy was because things had always gone pretty well for me. I grew up in a conservative, upper-middle-class family with two working parents. I lived in a nice house, attended private school for several years, and went on vacations with my family. My parents worked hard (and still do) for what we had, and I’m confident they made sacrifices that I didn&...
Source: Kevin, M.D. - Medical Weblog - December 15, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/chad-hayes" rel="tag" > Chad Hayes, MD < /a > Tags: Policy Public Health & Washington Watch Source Type: blogs

Did medical school desensitize doctors to debt?
The high-pitched wail of the pneumatic saw cutting through the tibia, and the little bits of tissue the blade flung onto the surgeon’s gown were not enough to get to me the first time I saw a surgery, during my senior year in high school. It was the smell. Sliding down the wall in the corner of the operating room, wondering if lunch would stay put, I began to question my career choice. Certainly, no respectable doctor would almost pass out at the sights and smells of the operating room. No one else in the room was sitting on the floor. Eight years later, by the end of medical school, those horrifying things no longer...
Source: Kevin, M.D. - Medical Weblog - December 15, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/cory-fawcett" rel="tag" > Cory Fawcett, MD < /a > Tags: Finance Medical school Practice Management Source Type: blogs

The first rule of medical school interviews: Don ’t talk about cost
The fall is over, and winter has come, which means I have just wrapped up a busy season of medical school interviews. Most interviews are conducted in a similar fashion with an hour of introduction, speeches by the dean, presentations of facts I already knew from the website, and finally the interviews. Within the first hour, I understand the reason: “We are the best medical school at (fill in the blank).” Though typically nestled between the Dean’s’ speech and interviews is a financial aid officer who briefly lectures on the options available to finance one’s education (as if federal loans di...
Source: Kevin, M.D. - Medical Weblog - December 15, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/nicholas-s-tito" rel="tag" > Nicholas S. Tito < /a > Tags: Finance Medical school Practice Management Source Type: blogs

Going skin deep: Is a tattoo ethically binding?
There’s currently an image in heavy circulation making its way around the internet of a hospital patient’s chest tattooed with the words “Do **not** resuscitate,” accompanied by what is assumed to be the man’s signature. This 70-year-old patient arrived at an emergency department unconscious with elevated blood alcohol levels. He did not have any form of identification on him, and his health care providers did not have an identifiable means by which they could contact the patient’s family. The health care team was unable to reverse the man’s unconscious state and were left wonderin...
Source: Kevin, M.D. - Medical Weblog - December 14, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/cody-mullens" rel="tag" > Cody Mullens < /a > Tags: Education Emergency Medicine Hospital-Based Medicine Source Type: blogs

How do you tell a 24 year old that she is dying?
Physicians are no strangers to death. We are baptized into medicine with cadavers as first-year medical students. We learn to break bad news. We lose patients, some that are expected and some we never see coming. Through it all, we maintain a distance, an emotional reserve that enables us to shoulder these losses but still see the next patient with the full attention they deserve. But every now and then we lose a patient, and that loss stays with us. One thing that we don’t learn in medical school is how to grieve these losses. For me the grief came in my dreams, three consecutive nights dreaming that she was still a...
Source: Kevin, M.D. - Medical Weblog - December 14, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jennifer-caputo-seidler" rel="tag" > Jennifer Caputo-Seidler, MD < /a > Tags: Physician Oncology/Hematology Palliative Care Source Type: blogs

Both markets and the government are needed to fix health care
The most common dividing lines in the national discourse on health care reform simply miss the mark. If one looks beyond the partisan posturing, each side has valid points, but also glaring weaknesses. We may need to work together to get health care right. I was recently invited to a political gathering to discuss health care reform. The room quickly divided along traditional lines. From left of the political spectrum, there were supporters of single payer who argued that our current multi-payer for-profit system is wasteful and that a single government non-profit payer is necessary to reduce waste and control costs. They ...
Source: Kevin, M.D. - Medical Weblog - December 14, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/matthew-hahn" rel="tag" > Matthew Hahn, MD < /a > Tags: Policy Public Health & Washington Watch Source Type: blogs

The patient who was a former bowling champion
My new patient was having trouble breathing and had lost his ability to swallow; despite this, he had been too proud to call either friends or family for help. He had lost thirty pounds and his clothes hung loosely. His belt was far too long. The day I met him, I thought, “This man could walk through a harp.” People had tried. Over the previous months, his worried family members had made several attempts to see him, but he always pushed them away with excuses why they should not visit. One day over his protests, his daughter went to his house. “His voice sounded so different!” she said. When she pus...
Source: Kevin, M.D. - Medical Weblog - December 14, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/bruce-campbell" rel="tag" > Bruce Campbell, MD < /a > Tags: Physician Oncology/Hematology Source Type: blogs

Take advantage of these 2 ways to save money
That’s right folks, I am talking about two types of money saving maneuvers: Save Money #1: spending as little as possible when making purchases through price competitions, coupons and rebates. Save Money #2: putting money you don’t spend into savings and investment accounts for your future. Save money on purchases ‘Tis the season for giving, but ’tis also the season for buying.  Make sure you are doing everything you can to save on those purchases.  This is definitely an easier process when shopping online as a few clicks and keystrokes will let you price compare in an instant, but still...
Source: Kevin, M.D. - Medical Weblog - December 14, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/another-second-opinion" rel="tag" > Another Second Opinion, MD < /a > Tags: Finance Practice Management Source Type: blogs

Do quality metrics really improve patient care?
178 measures. This is what we’re up to — the collected compilation of quality and performance metrics for our ambulatory care network, across all the different divisions. Where did these come from, who decided this is what we should measure, does anyone really have any idea if measuring these things reflects the true quality of the care our patients receive? 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 - December 14, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/fred-n-pelzman" rel="tag" > Fred N. Pelzman, MD < /a > Tags: Policy Practice Management Primary Care Source Type: blogs

Motivating patients to stop smoking and lose weight before surgery
The committee that plans and oversees medical care for the county of Hertfordshire, England announced recently that unless obese patients lose a specified amount of weight and smokers quit smoking for at least eight weeks, they will not be allowed to undergo elective surgery. Patients with a body mass index (BMI) greater than 40 must lose 15 percent of their weight within nine months, and patients with a BMI over 30 must lose at least 10 percent. Free counseling for weight loss and smoking cessation is available to all. Variations of these rules have been in effect in about one-third of England for quite a while. In some a...
Source: Kevin, M.D. - Medical Weblog - December 13, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/skeptical-scalpel" rel="tag" > Skeptical Scalpel, MD < /a > Tags: Physician Surgery Source Type: blogs

Screening: Do you follow guidelines or your gut?
The commentary below is meant to invoke meaningful discourse rather than incite an unpleasant argument. Less than a year ago, I heard Ben Stiller doling out kudos to his heroic doctor who diagnosed him with early-stage prostate cancer by using a simple, widespread screen. What was interesting was that Stiller was actually underage. What I mean is that the star was not of age to be screened, according to current prostate cancer screening guidelines (American Cancer Association’s guidelines). He was in his mid-forties. The guidelines are pretty straightforward. Men over the age of 50 can be screened after an informed c...
Source: Kevin, M.D. - Medical Weblog - December 13, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/dana-corriel" rel="tag" > Dana Corriel, MD < /a > Tags: Conditions Oncology/Hematology Source Type: blogs

What ’s in a woman physician’s last name? A lot.
A recent post about a physician using her maiden name professionally generated major controversy on a physicians’ group. Hundreds of comments later, it became evident that female physicians who chose to use their maiden names are subjected to negative judgment. I am a physician married to a supportive man who understands my choice to keep my last name. I am not unique in my circle. Most of my female physician friends have not changed their names. Moreover, two male physician colleagues took their wives’ last names. I believe a woman has the right to make her own choices. Hence, I was amazed by the controversy a...
Source: Kevin, M.D. - Medical Weblog - December 13, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/veronica-maria-pimentel" rel="tag" > Veronica Maria Pimentel, MD < /a > Tags: Physician Practice Management Source Type: blogs

3 ways tech innovation can fight physician burnout
According to published reports, over 50 percent of doctors are burned out. The reason? They are overwhelmed by payment and quality rules as well as poor information technology. It’s no secret that physicians spend long hours seeing patients. But as financial pressures have mounted within hospitals, doctors are forced to perform more administrative tasks. In fact, administrative tasks account for nearly a quarter of the average doctor’s schedule. That’s all time diverted away from patient care. Many physicians feel a loss of autonomy — a major factor in burnout. The National Academy of Science now se...
Source: Kevin, M.D. - Medical Weblog - December 13, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mark-kelley" rel="tag" > Mark Kelley, MD < /a > Tags: Tech Primary Care Psychiatry Source Type: blogs

Physicians: Understand the the cash flow quadrant
I owe a lot to Robert Kiyosaki. His book, Rich Dad Poor Dad, actually helped start me on my path to financial freedom, and his other writings have all taught me very valuable lessons. While I don’t agree with everything, he says in every book, one thing that really cemented the idea of passive income in my mind was the concept of the “cash flow quadrant.” This concept is so important and fundamental that I believe every doctor needs to read and understand it as much as possible (for more detail, check out his book, the Cash Flow Quadrant). But since none of us have much free time, let me br...
Source: Kevin, M.D. - Medical Weblog - December 13, 2017 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

Social media: The ultimate tool for women in medicine
There is a movement afoot. I can feel it. I can see it. Women in medicine are no longer going to tolerate the subtle and not so subtle discrimination that has stymied their career growth. They are not going to be complacent while their male colleagues are paid higher salaries, offered speaking engagements and research opportunities and promoted at a greater rate. Women in medicine are pulling together in an incredibly organic way — fostered by social media. Their goal is to help each other achieve their professional goals. It has been two years since Heather Logghe, a surgical intern first tweeted #Ilooklikeasurgeon....
Source: Kevin, M.D. - Medical Weblog - December 13, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/meridith-j-englander" rel="tag" > Meridith J. Englander, MD < /a > Tags: Social media Public Health & Policy Radiology Twitter Source Type: blogs

Doctors should start watching more science fiction. Here ’s why.
I often say that electronic health records (EHRs) is like Skynet in the Terminator. I expect to turn around from my screen someday, and Arnold will lift me by my throat saying, “You haff not been doing yuh meaningful use.” We practice in a time when EHR confounds us by freezing, crashing and chaining us continuously to our work, as we spend evenings and weekends on documentation. For reimbursement purposes, we are instructed to include more and more useless details. As we pay more attention to the “iPatient” than to the real patient, we have confused the map for the territory. Is there a Dr. John Co...
Source: Kevin, M.D. - Medical Weblog - December 12, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/seiji-yamada" rel="tag" > Seiji Yamada, MD, MPH < /a > Tags: Tech Health IT Hospital-Based Medicine Practice Management Primary Care Source Type: blogs

Think the world is in chaos? Focus on mental health.
About a year ago, I did away with TV. It was an overwhelming expense with little personal utilization. I thought to myself while struggling with the decision to cut the cable, “What will I be missing?” I may no longer be “Keeping up with the Kardashians,” but I do keep a regular eye on my iPhone news feed. It is an addiction many people share. That itch to grab our phones with every buzz and ding. That phantom sensation you feel as if your phone vibrated in your pocket only to find out there is nothing new waiting for you. Lately, the news feed is plagued with political updates. Then there are the p...
Source: Kevin, M.D. - Medical Weblog - December 12, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/philip-tran" rel="tag" > Philip Tran, MD < /a > Tags: Physician Psychiatry Source Type: blogs

Is there a future for robot-assisted surgery?
Recently, there was a fascinating article in the Wall Street Journal regarding robot-assisted surgery. It reported the results of two articles published in JAMA that demonstrated that robotic-assisted surgery cost more and took longer without achieving superior results to laparoscopic surgery on average. With this, my LinkedIn account lit up. Here are several of the comments that came through: “I’ve come to assume that robotic surgery is better for GYN and colon surgeries simply because of their increased precision and accessibility to small spaces.” “Robots are sexy, the media covers it like it&rsq...
Source: Kevin, M.D. - Medical Weblog - December 12, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/peter-f-nichol" rel="tag" > Peter F. Nichol, MD, PhD < /a > Tags: Tech OB/GYN Surgery Source Type: blogs

This physician is burned out. But not for the reason you think.
I am an Olympian. I am a retired All-American student-athlete.  I am a resident.  I am burned out. Let me be clear: I love medicine and the opportunity to have privileged relationships with patients and their families.  I thrive on the fast-paced environment, growing to-do lists, and the chance to work in a field with endless learning.  I love working in team environments to provide optimal care for patients and their families.  The most rewarding point in residency training has been the transition to a senior resident where I can create positive learning environments for other learners.  Prac...
Source: Kevin, M.D. - Medical Weblog - December 12, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Education Hospital-Based Medicine Psychiatry Source Type: blogs

5 expenses that go down after you retire
In order to safely plan for a successful retirement, it’s imperative to have a general idea of what your spending needs will be when retired. We cannot calculate whether or not our anticipated withdrawal rate would be considered safe (in the range of 3% to 4%) without knowing the size of the annual withdrawal. That number can be difficult to pin down, as there are many variables. It can be informative to budget (we don’t) or track spending (we do), but this year’s spending might not look like last year’s, and could be entirely different than what we will end up spending in retirement. Fortunately, t...
Source: Kevin, M.D. - Medical Weblog - December 12, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/physician-on-fire" rel="tag" > Physician on FIRE, MD < /a > Tags: Finance Practice Management Source Type: blogs

Medical workers: Vaccinate yourselves first
Just under half of health care workers do not get their annual flu vaccine. Some of these workers contract the flu and unknowingly transfer it to their sick hospitalized patients, and in some cases, because of them passing the flu along, those patients die.   We know the most important reason for health care workers to get vaccinated against influenza is that it is the most effective way of preventing influenza among their patients. And yet, unfortunately, many health care workers are putting patients at unnecessary risk. If medical professionals know this, then why aren’t they complying?  As physician...
Source: Kevin, M.D. - Medical Weblog - December 12, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/joseph-r-masci" rel="tag" > Joseph R. Masci, MD < /a > Tags: Conditions Hospital-Based Medicine Infectious Disease Primary Care Source Type: blogs

Insurance and the destruction of our health care system
When interviewing for my book, I asked about insurance, but the topic came up even when I didn’t specifically ask about it. It was never positive in relation to practice. A doctor said, “I expected to be around tough and hard cases. I expected it to be hard. I did not expect to have to think if the insurance company will not pay for it.”Another one said, “This completely changes the role we play as physicians The insurance companies are taking the ability to practice medicine the way we want to away from us.” Another doctor agreed, “It used to be in the days of yore you provide the servi...
Source: Kevin, M.D. - Medical Weblog - December 11, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/peggy-a-rothbaum" rel="tag" > Peggy A. Rothbaum, PhD < /a > Tags: Policy Public Health & Washington Watch Source Type: blogs

The hidden work of primary care
It was nearing the end of my day at the mobile health clinic where I work as a nurse practitioner, providing free, comprehensive primary care to uninsured patients in central Florida. Clinic was officially over, and we were no longer taking patients; I was signing notes and finishing up some teaching points with a PA student when a woman walked up and asked me if she could “talk to me for a minute, just to ask a quick question.” After many years working in community health, I know these types of requests are rarely “quick,” but, understanding our patients’ limited opportunities access to care,...
Source: Kevin, M.D. - Medical Weblog - December 11, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/michelle-nall" rel="tag" > Michelle Nall, MPH, ANP-BC < /a > Tags: Policy Primary Care Source Type: blogs

The demand for preparation: from the playing field to the OR
We often pull comparisons between unexpected resources in any given profession, especially when it comes to adopting tried and true best practices. For example, I always encourage hospital systems and training institutions to look to the hospitality industry for the treatment of patients and guests, among other areas. Last year, as I settled into my seat on a cross-country flight, I witnessed a textbook example of looking outside the box for surgical training inspiration. One aisle over from me, an NFL coach taped pages upon pages of plays across the seat in front of him, studying for an upcoming game. As a practicing head...
Source: Kevin, M.D. - Medical Weblog - December 11, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/scott-magnuson" rel="tag" > Scott Magnuson, MD < /a > Tags: Physician Hospital-Based Medicine Surgery Source Type: blogs

It ’s important to give patients an idea of what to expect
The familiarity that health care professionals develop with complex medical procedures and topics is the result of years upon years of hard work, and over time we become accustomed to the jargon. We use phrases like “lap chole” and “appy” without much thought when talking to each other and (if we have a momentary lapse) with patients. We take the fantastic array of medical specialties, procedures, and knowledge in our world for granted. The extraordinary becomes mundane. For patients, medicine is very different. The situations they encounter are, for the most part, totally novel. They don’t go...
Source: Kevin, M.D. - Medical Weblog - December 11, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/kristin-puhl" rel="tag" > Kristin Puhl < /a > Tags: Education Hospital-Based Medicine Surgery Source Type: blogs

So you want to make a big purchase. How do you save for it?
Most people’s monthly spending is a series of recurring payments, like rent, food, and utilities. There are also some one-time purchases that might require a few months of saving, like a nice vacation or a new suit. And then there are some things that require many months or years of savings. An engagement ring. A wedding. A new car. A down payment on a house. When saving for big purchases, how do you go about saving the money, and how should you invest those savings before you buy? 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 - December 11, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/wall-street-physician" rel="tag" > Wall Street Physician, MD < /a > Tags: Finance Practice Management Source Type: blogs

Many digital health solutions lack evidence: How physicians can help
Technology makes this an exciting time for health care. Not only are technological advances making health care better, they’re also making it more affordable. To get a taste of the potential of where health and technology are going, you only need to look as far the recent Fortune article titled, “Prepare for a Digital Health Revolution,” or to search through the more than 300,000 health apps available today. But is all this excitement just hype? Opinions differ. Last year the CEO of the American Medical Association (AMA), the nation’s largest association of physicians, described many of the current ...
Source: Kevin, M.D. - Medical Weblog - December 11, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/bronwyn-harris" rel="tag" > Bronwyn Harris, MD < /a > Tags: Tech Cardiology Mobile health Pulmonology Source Type: blogs

Digital health ’s big diversity problem
This summer, a controversial memo written by a Google employee was leaked to the public. Within the memo, the author James Damo, details how the biology of men produces “a higher drive in status.” Google quickly condemned the statements and fired Damo, citing their pledge to standup diversity within their company. And similarly, Denise Young Smith, Apple’s vice-president of diversity and inclusion, faced similar criticism for stating “there can be 12 white, blue-eyed blonde men in a room, and they are going to be diverse too because they’re going to bring a different life experience and l...
Source: Kevin, M.D. - Medical Weblog - December 10, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/danielle-j-brooks" rel="tag" > Danielle J. Brooks, JD < /a > Tags: Tech Health IT Public Health & Policy Source Type: blogs

A reaction to ORBITA: Keep on stenting, judiciously
Physicians’ reactions to ORBITA — a blinded, randomized controlled trial (RCT) from Britain with a sham arm comparing percutaneous coronary intervention (PCI) to placebo in patients with stable angina — are as fascinating as the cardiac cycle. There were murmurs, kicks and pulsating jugulars. Though many claimed to be surprised and many unsurprised by the null results of the trial, the responses were predictably predictable. Some basked in playful schadenfreude, and some became defensive and bisferious. No shame in sham The coverage of the trial in the The New York Times was predictably jejune and hyperbo...
Source: Kevin, M.D. - Medical Weblog - December 10, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/dr-saurabh-jha" rel="tag" > Dr. Saurabh Jha < /a > Tags: Conditions Cardiology Source Type: blogs

The residency hunt is no small task: Here ’s some advice for medical students
‘Tis the season. Thanksgiving? Sure. Christmas? That too. But for thousands of fourth-year medical students and foreign medical graduates all over the United States, fall through early winter is a time of job hunting — interviewing for residencies. This is a critical step in our training, where we specialize in the individual fields of medicine that will carry us through our careers. The residency hunt is no small task. Where we match can have a profound impact on our lives, and on the communities where we learn. It’s a steady address for the next three to seven years, if not for an entire career. It...
Source: Kevin, M.D. - Medical Weblog - December 10, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jennifer-adaeze-okwerekwu" rel="tag" > Jennifer Adaeze Okwerekwu, MD < /a > Tags: Education Hospital-Based Medicine Residency Source Type: blogs

The moment I became a passionate doctor
I was nearing the end of my pediatrics rotation as a third-year medical student when the senior resident asked me to admit a patient to the general pediatrics floor. The only information I had as I headed down to the intensive care unit was that she was a ten-year-old girl who had survived an extensive resuscitation at home. By this point in my education, I was certain that I wanted to be a pediatrician. I had recently finished my internal medicine rotation. Fresh in my mind were hospitalized patients who were suffering from their past choices, like drug addiction and alcoholic cirrhosis. I had cared for a man who, as soon...
Source: Kevin, M.D. - Medical Weblog - December 10, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jo-ann-gates" rel="tag" > Jo Ann Gates, MD < /a > Tags: Physician Critical Care Pediatrics Source Type: blogs

Your EHR password could help fight burnout
You sign in, and there it is, your third request for your password just to open your electronic health record (EHR). “Again?” you think to yourself in frustration as your patient waits silently for you to log in and start the visit. It seems physicians are becoming increasingly frustrated with EHRs, and in most surveys, EHRs are noted as a main contributing factor to physician burnout. Two recent studies have shown that many physicians are spending over half of their time interacting with the EHR rather than direct patient care. In fact, the lattery study found physicians from four different specialties in fami...
Source: Kevin, M.D. - Medical Weblog - December 9, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/michael-spertus" rel="tag" > Michael Spertus, MD < /a > Tags: Tech Health IT Practice Management Primary Care Source Type: blogs

Why aren ’t doctors allowed to grieve?
My alarm went off at 4:15 a.m. I lay in bed dreading the day ahead of me. By 4:50 a.m., I arrive at the nursing home where I was doing a geriatric rotation. A stack of charts and a patient complaint list was awaiting me. On the list were the usual suspects: a follow up for lab results, a fall, abdominal pain. And at the bottom was a note on my patient — “deceased, requires discharge note.” Sharing the news with my colleagues, there was a moment of sadness and a shared sentiment of, “Aww. She was sweet,” and just as quickly we went back to pre-rounding. Frustrated, I sat down to write a dischar...
Source: Kevin, M.D. - Medical Weblog - December 9, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/kirsten-lederer" rel="tag" > Kirsten Lederer < /a > Tags: Education Emergency Medicine Geriatrics Source Type: blogs

MKSAP: 22-year-old woman is evaluated for a flare of Crohn disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 22-year-old woman is evaluated for a flare of Crohn disease. A colonoscopy performed 6 months ago showed moderate, patchy, left-sided colitis extending from the descending colon to the splenic flexure. She responded to therapy with prednisone but declined maintenance therapy in advance of conceiving. She is now 12 weeks pregnant and for the past 2 weeks has experienced bloody diarrhea and left-sided abdominal pain. On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 110...
Source: Kevin, M.D. - Medical Weblog - December 9, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology OB/GYN Source Type: blogs

Here ’s how to be a good mom and good doctor
Go to college, go to medical school, start and finish residency and fellowship, get married, settle down and have children … There is a certain expectation of what a “successful life” would look like for a physician mom. Some may even choose to stop work and become a full-time stay-at-home mom. Even when my spouse, who works part-time for most of our marriage, took a year off work to be the stay at home parent — all the information from school came to me. Phone calls confirming class times and schedules, changes, issues relating to the kids. Nevermind that dear husband put his contact number as the...
Source: Kevin, M.D. - Medical Weblog - December 9, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/foreign-bornmd" rel="tag" > Foreign BornMD < /a > Tags: Physician OB/GYN Practice Management Source Type: blogs

A first-time case in a 35-year medical career
A couple of years ago I saw a young man with pain in his lower right abdomen. I sent him for an urgent CT scan with a “wet read” to check for appendicitis. It was afternoon, and things were crazy at the office. I forgot all about the pending CT report. I have learned this about myself: I am efficient because I have the ability to hyperfocus, but that has made me dependent on my support staff to see the big picture of my schedule or pending, unfinished tasks. The next morning there was a fax from Cityside with a lengthy explanation saying he had an epiploic appendagitis, and it went on to explain that this is a ...
Source: Kevin, M.D. - Medical Weblog - December 8, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Conditions Gastroenterology Surgery Source Type: blogs

Surprise! Doctors spend more time with computers than with patients
Medical appointments are getting shorter by the year. Sometimes it feels like doctors have no time to spend with their patients. What’s to blame for these brief clinical interactions? It could be the electronic health record, or EHR. Because of changes in how insurance companies and the government pay for medical care, doctors increasingly need to document their care on the computer, causing many physicians to spend more time with their desktops than with their patients. Two recent studies give us quantitative estimates of the stupendous amount of time physicians spend on computers, rather than in direct contact with...
Source: Kevin, M.D. - Medical Weblog - December 8, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/peter-ubel" rel="tag" > Peter Ubel, MD < /a > Tags: Physician Health IT Practice Management Primary Care Source Type: blogs

An eye-opening rotation at the Indian Health Service
For the month of September, I embarked on the experience of a lifetime, living and working on the largest Native American reservation in the United States. Sprawled across the four corners region of Utah, Arizona, New Mexico and Colorado, the Navajo Reservation in Chinle, Arizona, encompasses an area as large as the entire state of West Virginia. Its population, however, is only about 300,000, making it extremely rural. To leave the reservation from Chinle, where I was living, required over 100 miles of travel in any direction. I would strongly recommend a rotation like this to other medical students, as I experienced...
Source: Kevin, M.D. - Medical Weblog - December 8, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/eric-schmidt" rel="tag" > Eric Schmidt < /a > Tags: Education Primary Care Source Type: blogs

Withdrawal of care in the PICU: What happens if there is disagreement?
Most experienced pediatric intensivists, myself included, have encountered situations in which we, the doctors, believe continuing to support a child is unethical because it is not saving the life but prolonging the dying; whereas the child’s parents believe the opposite — that it is unethical to withdraw life support because all life is sacred, no matter the circumstances. Sometimes these situations arise because poor communication causes families to distrust the doctors. But sometimes both sides understand each other clearly, but still disagree profoundly about the proper thing to do. What happens then? Docto...
Source: Kevin, M.D. - Medical Weblog - December 8, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/christopher-johnson" rel="tag" > Christopher Johnson, MD < /a > Tags: Physician Critical Care Pediatrics Source Type: blogs

Should you pay off medical school debt or invest in the stock market?
I am frequently asked the following question: “Should I pay off my student loans before I put money aside to invest in the stock market?” The person asking this quick and simple question is looking for a yes or no answer. The problem I am faced with is there is not enough information in the question to give a proper answer. Therefore, I say, it depends. It depends on how the debt sits in your overall financial picture. If you are drowning in debt and struggling each month to get by, then the first step must be to restore a workable balance. There are more than financial ramifications to overwhelming debt. Argum...
Source: Kevin, M.D. - Medical Weblog - December 8, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/cory-fawcett" rel="tag" > Cory Fawcett, MD < /a > Tags: Finance Practice Management Source Type: blogs