A doctor wants to leave medicine to sell Tupperware A letter received by Pamela Wible, MD. Dear Pamela: I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is ...

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Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER doc, I need [insert name of specialty here].” And ...

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Three days after finishing my residency, I became the medical director of the community health center where I had taken my first job.  It forever changed, and probably saved, my career. The risk of burnout hit me early. While I loved patient care, I also found the stress, the lack of control of my time, and the inefficiencies of my clinic’s system hard to accept and to manage. I knew I ...

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It's a strange thing to be driving about in your car in the middle of the day.  For one who has spent the majority of his professional life sheltered in dark offices and aseptic hospitals, the summer sun and fresh breeze is quite lovely.  One almost begins to approach humanness.  Normal.  This must have been what it felt like before immersion into the tribe of medicine. Sometimes I have trouble remembering ...

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Why are we shortening medical degrees? The four-year medical degree has been the mainstay of U.S. medical schools for more than a century, following the publication of the Flexner report in 1910. Prior to this, there was little standardization about what a medical degree could or should look like. Medical school education was subsequently standardized to two years of academic study, followed by two years of clinical learning. Since the report, ...

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I am a young hospitalist who is 16 months into my role at an urban academic medical center. Unlike many of my more-senior colleagues who found their way to hospital medicine by circumstance, luck, or as a second-career path, I have been planning my career in hospital medicine since the beginning of my residency training. The things that drew me to hospital medicine as a trainee -- its emphasis on problem-solving, ...

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Dr. Peterson, the radiation oncologist, gets right to the point. "The medical center's tumor board has concluded that your cancer is inoperable, incurable and untreatable," he says flatly. "Any chemotherapy or radiation treatments would be palliative in nature." He begins explaining the reasons behind the board's verdict, but everything he's saying washes out. My mind stopped working as soon as I heard the words "incurable" and "palliative." I am sliding into shock. Dr. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 76-year-old woman is evaluated for a 1-day history of headache, left eye pain, nausea and vomiting, seeing halos around lights, and decreased visual acuity of the left eye. She has type 2 diabetes mellitus, hypertension, and atrial fibrillation. Medications are metformin, digoxin, metoprolol, hydrochlorothiazide, and warfarin. On physical examination, temperature is 36.8 ...

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What is value in cancer care? It depends. Value. A simple word with lots of meanings, all of which depend on the context of the moment. Value in health care -- especially in cancer care -- is certainly no exception. What is undeniable is that we are seeing an increasing clamor about value in cancer treatment. And one person's value is clearly another person's concern. At the crux ...

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Everyone wants to be sure their physician is competent and appropriately trained. The way this is done is through credentialing. A new applicant for privileges to practice at a hospital or other health care facility fills out an application and submits a curriculum vitae that details when and where a physician trained and the certifications obtained, such as specialty boards, and a work history (if any). Copies of key documents -- medical degrees, ...

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I find myself in a unique position. I recently retired as an orthopedic surgeon and my wife and I moved out of my practice area. At the same time, my wife was diagnosed and started treatment for breast cancer. So I got opportunity to interact with the health care system both as a provider and as a family member of a patient receiving long term care first from providers I ...

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Establishing a digital presence is rapidly becoming a necessity for health care professionals, medical practices, and institutions. Yet something that often gets obscured in the discussion is the fact that at its heart, digital media is about people. As such, it’s about relationships, and it’s about communication, and increasingly, your digital footprint means educating, engaging, and growing your audience. When you do this in a way that authentically reflects you and your ...

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I stared down at the tired, deteriorating woman sprawled across a bariatric bed before me. A breathing tube was in her throat while multiple catheters pierced her arms and neck, pouring powerful medications directly into her veins. Among several functions, these infusions would maintain her blood pressure high enough to keep her organs alive. This was my initial, visual impression of a patient I was responsible for during my first ...

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This year's flu vaccine, as you likely know, is taking a drubbing. The contention is that CDC flubbed, and didn't get quite the right flu strains in the mix. That is apparently true, although more the "fault" of the influenza virus and its natively wily ways, than of the CDC. Either way, the drubbing is disproportionate to any flubbing. The drubbing occurs in the context of a strong, new ...

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Top stories in health and medicine, December 19, 2014From MedPage Today:

  1. High-Dose Flu Vaccine Better for Frail Elderly. For frail older people living in long-term care, a high-dose inactivated influenza vaccine is a better option than the standard drug.
  2. Look into SGLT2 Fracture Risk, Researchers Urge. Look deeper into the potential relationship between SGLT2 inhibitors and bone fractures.

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We all have prejudices. We have racial prejudices. Religious prejudices. Gender prejudices. Occupational prejudices. Age prejudices. Weight prejudices. Height prejudices. We prejudge based on hair style. Language. Accent. Clothing. Shoes. Attractiveness. Tattoos. Names. Jewelry. Family. Hobbies. Cars. Schools. Type of home. Music. Where a person lives. What type of work a person does. What a person reads. Talents. Disabilities. Physique. Medical history. Injuries. Opinions or assessments by others. No one is ...

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It took me until 2010 to buy an iPhone and in just a few years, I’ve become so dependent on it, without fail, I will always make a U-turn to make sure it’s with me -- my smartphone is essentially a new limb for me. I know I’m not alone. Most did not predict the rocket speed adoption and transformative power of modern smartphones when the iPhone launched in 2007. But, in ...

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Last year, hospitals and health systems underwent 98 consolidations, a 51 percent increase from 2010.  Many of these mergers and acquisitions arose in response to declining government reimbursement and the Affordable Care Act.  Smaller hospitals are having increasing difficulties maintaining a margin and many face high debt burdens, bankruptcy or even closure. But is consolidation the clear-cut answer? Here are 4 reasons bigger actually may not be better for all hospitals: 1. Disparate ...

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Dont quit medicine. Here are 5 reasons why. There’s been a lot of talk recently about low morale and disgruntlement among doctors. A recent article on focused on a list of reasons when doctors know it’s time to quit. I found the article a bit sad and unfortunate, but I’m sure the feelings behind it were sincere. Another excellent article in the Wall Street Journal last week extensively discussed the ...

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Dont dread internship: 5 truths from a first year intern I admittedly spent a good portion of the fourth year of medical school dreading internship. A year where I was expected to suddenly be a doctor and to have all the answers. A year where I would work long hours and carry several pagers at one time. I come to you in blog form to inform you of some of the ...

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