Recently a measure was proposed to allow APRNs full practice authority in the VA health care system.  With this measure, the embattled VA hopes to help optimize access to health care for our veterans. A measure to help with the firestorm of problems we witnessed unravel at the Phoenix VA system two years ago. Sounds great, right? Nothing is ever that simple in American medicine. The professional organizations are, once again, ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman is evaluated for a 10-year history of recurrent episodes of acute-onset feelings of fear and anxiety. These episodes initially occurred approximately 4 times per year but for the past 3 months have been occurring once or twice per month, especially when she is under stress. She describes the ...

Read more...

It is no secret that mental health conditions are prevalent, and recent years have seen an increase in the dialogue on their causes and consequences. However, we do ourselves a disservice when discussing mental health outside the context of the broader system in which care is provided, and the insurance constraints that drive shortcomings in health care delivery. SAMHSA estimated that 58 percent of adults have a medical condition ...

Read more...

Dear medical student, resident, or fellow, You will one day forget something. We are currently in a systematic plot to have everyone forget something important. We are quietly unaware it is happening. We are asked to forget how we got here. I want to remind you. I want us all to remember. You undoubtably were more mature than your peers. You undoubtably sacrificed to develop the persona that one day would impress ...

Read more...

Summer is heating up, and so is the election rhetoric. In this year's campaign for the White House, when it comes to verbally attacking each other, neither candidate seems to recognize any limits. Personally, I think this behavior reflects poorly on both candidates. In heath care, it's almost impossible to escape this negativity. The media devours and thrives upon it. In our hospitals, televisions in the doctor's lounge, cafeteria and in ...

Read more...

My eyes open. The blackness of the call room envelopes me. Consciousness sets in with a lingering disorientation. A small green light, is speaking … ringing. “Are you standing up?” The resident on the other end knows her attending too well. She’s right not to risk my falling asleep mid-conversation. A woman has arrived laboring at 24 weeks gestation. Records aren't available, but she reports her fetus has a diaphragmatic hernia. ...

Read more...

Why must we keep repeating history? NCLB significantly increased the federal role in education by holding schools accountable for the academic progress of all students. NCLB held teachers responsible for education of children; MACRA-proposed changes will hold physicians responsible for the medical progress of our patients.  The largest problem with this approach is students and patients go home each day to whatever environment in which they live.  Neither teachers nor physicians ...

Read more...

Dear Dad, I often think about the night you passed away.  I was caring for you while you were dying from metastatic colon cancer.  Every hour I woke up to give you Dilaudid so you wouldn't feel pain and Ativan so you wouldn't be scared.  You had only just been diagnosed eight months before.  Despite aggressive chemo, radiation, abdominal surgeries, and all the hope and prayer in the world, the cancer ...

Read more...

Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent -- in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to ...

Read more...

Now that the dust has settled in the wake of America’s most recent mass shooting, the odds seem high that history will repeat itself, and our legislature will again fail to enact any meaningful reform. Like it or not, we as a country, through our elected representatives, have decided that we value unfettered access to deadly weapons over an individual’s right to feel safe in public spaces. Why this ...

Read more...

The morning my patient Evan tried to end his young life, I woke up early to make banana pancakes. It was a warm spring day, and I pushed up the windows in my kitchen. That same morning, Evan opened his window with a different intent. He had argued with his parents the evening before, not unexpected at 16, yet this was different. Evan is transgender, and his parents were not ...

Read more...

Starting this fall, second-year students will no longer have the stress of grades at our medical school, Washington University in St. Louis (WashU). In extending the pass-fail system from the first year to the second preclinical year, WashU joins the other 18 of the top 20 research medical schools on U.S. News and World Report that grade the entire preclinical curriculum on a pass-fail basis. (The sole holdout is Penn, ...

Read more...

For many people with chronic disease, the toughest thing is convincing themselves they’re not crazy. This is especially true for those with an illness with no clear etiology. For millions of people around the world suffering from multiple sclerosis, lupus, fibromyalgia, chronic abdominal pain, ALS, rheumatoid arthritis, certain types of cancer, chronic fatigue syndrome, and hundreds of other illnesses, just making it through the day is overwhelming. Not only do many of ...

Read more...

With Obamacare and creation of health insurance exchanges, many believed that health insurers would compete for patients much the same way hotels, rental cars companies, and airlines compete for customers. By comparing identical benefits packages from different insurers, patients could select their insurer based on the monthly premium and the extent of the hospital and physician network. In a recent Vox article, Ezra Klein urged insurers do "something like Southwest ...

Read more...

In the medical field, it is said that July, not April, is the cruelest month. It even has a name, the July Effect. In June, hospitals hum and smoothly operate after a year of working out the kinks. In July, they welcome, or dread, the arrival of new recruits: newly minted physicians and medical students, eager to prove themselves, yet raw and untrained. For me, as a senior resident, it ...

Read more...

It’s that time of year where upcoming fourth-year students are frantically preparing applications for their chosen specialties.   Statements like “I LOVE psoriasis,” and “’I’m fascinated by the colon,” are heard from eager, smiling, seemingly-passionate faces when asking preceptors for a "strong letter of recommendation.’" But what about you? You know, the one whose specialty decision-making process feels more like being tossed into an M.C. Escher lithograph than the instant, undeniable attraction ...

Read more...

I sat across from her and in my most official yet trusting psychiatrist’s tone gave the spiel I delivered many times. “Amanda, I’d like to start you on a medication that might help your depression. Like every medication it can cause side effects, however, many people have no side effects or only have minor ones. This drug can cause weight gain, increased risk of diabetes, and increased risk of heart disease.” A ...

Read more...

Recently, physicians in small private practices and rural areas breathed a collective sigh of relief.  There is a possibility the implementation of changes to physician reimbursement (known as MACRA) could be delayed.  Thank you, Mr. Slavitt, for listening.  I am grateful to Orrin Hatch (R-UT) and Ron Wyden (D-OR) for keeping our rural needs in mind.  We have a window of opportunity for rural health care to survive, but we ...

Read more...

I had just taken over three other residents' phones and pagers when 2-year-old “Bryce” jumped off the couch in our oncology unit, landed on his chin, and bit completely through his lower lip. I quickly reviewed his platelet level from that morning, examined him, and began calling plastic surgery and anesthesia for sutures. While I was on one phone, a second one started ringing. I declined the call and tried ...

Read more...

When diagnosed with abdominal mesothelioma, a rare cancer with a blighted future, evolutionary biologist and writer, Stephen Jay Gould, turned his attention to the statistics; specifically, the central tendency of survival with the tumor. The central tendency -- mean (average), median and mode -- project like skyscrapers in a populated city and are the summary statements of a statistical distribution. The “average” is both meaningful and meaningless. The average utility of ...

Read more...

Most Popular