When our daughter Florence was born, we were shocked that a tiny, seven-pound beauty could turn our household (and our entire lives) upside down. Why was it so difficult to deal with one human being, when we often took care of a department full of ill patients? How could someone so cute induce a state of perpetual anxiety, forcing us to question every single action we took? It was disconcerting to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old woman is evaluated for fatigue, anorexia, polyuria, and nocturia of several weeks' duration. She had otherwise felt well until the onset of her current symptoms. Medical history is significant for autoimmune pancreatitis diagnosed 1 year ago, treated with a prednisone taper that was completed 8 months ago with resolution ...

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What is holding you back from pursuing a career in medicine? What keeps you from going in 100 percent? Have doubts crept into your life and destroyed your premed dream? Is there someone whispering in your ear that you are not good enough or this is the wrong career option for you? There are many misconceptions about doctors and often times these are perpetuated by individuals who have never walked in a ...

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Every few months when things are slow, someone publishes an article about the imaginary dangers associated with doctors wearing scrubs in public. A recent version is from The Atlantic. An associate editor saw some people in scrubs having lunch in a restaurant and was, of course, horrified. She questioned the magazine’s medical editor, Dr. James Hamblin, whose response was remarkably reasoned (until the end). He pointed out that it ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. A couple of months ago I received a Facebook invitation to “like” a page. That was not unusual, and usually the pages are on silly or obscure topics, but this page was different. The name of the page was New Kidney for Stu. Stuart ...

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burnout2 Illustration by Jorge Muniz, PA-C. We enter medicine with our hearts and souls on fire ready to serve humanity. By the time we complete medical training many of us have anxiety, PTSD, depression -- even suicidal thoughts. Why? Medicine is stressful. Many of us work 100-hour weeks surrounded by suffering and death. We may deliver a stillborn, try to save a teenager with a ...

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When I started medical school, I was most excited to start learning again. Having spent the last couple years as a teacher in a classroom, I sorely missed the experience of being the student. Reflecting on my college days, I missed the intellectual conversations generated in our seminars, hours poring over literature under dimly lit alcoves of the library; even the far-too-frequent all-nighters spent hashing through complex biochemical pathways with ...

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In the 2014 Forbes article “How A Nobel Economist Ruined The Residency Matching System For Newly Minted MD’s,” Amy Ho argues the way we place new medical school graduates into residency positions needs to be reassessed. She calculated the cost of applying to residency to be greater than $7,500 when taking into account loans and interest. If you have not participated in the U.S. medical educational industrial complex, ...

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As a pediatric resident, I have the joy of building relationships with families and watch their children grow while providing them with anticipatory guidance at every visit. From newborn visits to toddler visits to teenager visits, they come, and we all grow together. (They grow chronologically and as a family, I grow in my experience and knowledge.) The questions come in such a wide, but expected, variety: “When can I introduce ...

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I recently wrote an email to two Muslim colleagues apologizing for our nation’s political tenor. I shared with them my embarrassment over suggestions that our government bar Muslims from immigrating and monitor those who live here, my concern that a presidential candidate’s support congeals rather than erodes when he brays that “Islam hates us” and suggests that mosques be closed, and my dismay that so few ...

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“The road to success isn’t productivity, it’s differentiation.” – Tony Crabbe That statement is invaluably true -- especially for direct primary care (DPC) professionals. Your patients aren’t coming to you because you’re the same as everybody else. In fact, they’ve chosen you for the exact opposite reason. You’re gloriously different. The other guys force patients into the mold they’ve created: restrained by long waits, life-sucking insurance battles, and reduction to nothing more than a chart to be ...

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They were both named Mike. Both were superstar physicians and educators at MedStar Health. Both had a wife named Pam, a son, and a daughter. And both died untimely deaths within a year of 50 at the mid-point of their ascending careers, 18 months after being diagnosed with cancer. I don’t believe they knew each other, but having worked with each of them, they will be forever linked in my ...

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They said, "Do everything." She knew something was wrong. And by the time she was 85 she had forgotten the names of her children, the town she raised them in, even the name of her deceased husband. In her 70s she was diagnosed with Alzheimer's. Still coherent, she talked to her physician about becoming a DNR: do not resuscitate. She did not want to live on a machine that would breathe ...

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CMS announced that they will remove questions related to pain from the hospital consumer assessment of health care providers and systems (HCAHPS), commonly known as patient satisfaction survey.  This means that hospitals would continue to use the questions to survey patients about their inpatient pain management experience, but these questions would not affect the level of payment hospitals receive. This is a big victory for patients and the house of medicine. Here ...

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There’s no doubt physicians entering practice today leave their residency programs with a tremendous amount of medical education and training; what seems like a lifetime’s worth of knowledge crammed into just a few, intense years of instruction. Unfortunately, all the time residents spend on rotations, lecture, journal club, and myriad other obligations leaves little opportunity for getting oriented to the more mundane, yet absolutely critical components of practice. As a result, ...

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Did you know that the majority of medical schools only interview about 15 to 20 percent of the applicants that submit an application to that school? Albert Einstein College of Medicine, for instance, had 8,138 people apply for entrance. 1,324 were interviewed. That's only 16.27 percent of the applicants. If you have an interview, that means that the medical school likes you well enough to give you one of their coveted ...

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Recent events seem to be signaling an increasing sentiment toward hitting the metaphorical “pause button” on immigration or perhaps even adopting more anti-immigrant postures in the US and in many other places around the world. The Supreme Court of the United States (SCOTUS) issued its deadlocked non-decision in United States v. Texas, No. 15-674 which will prevent Deferred Action for Parents of Americans and Lawful Permanent Residents or DAPA from ...

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If you want to understand what ails the U.S. health care system, look no farther than the dialysis industry. A recent New York Times article, "UnitedHealthcare Sues Dialysis Chain Over Billing," provides a pre-made case study. In brief, a chain of dialysis clinics, American Renal Associates, pushed poor people out of government coverage and into private insurance with UnitedHealthcare so that the clinics could bill $4,000 per treatment rather than $200. A ...

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Ms. C was one of my first patients with schizophrenia. I saw her on the inpatient unit of a psychiatric hospital where I was training as a psychiatry resident. Ms. C suffered terribly from what we call the negative symptoms of schizophrenia; she sat mute for much of the day in her bed, staring out of the window. She would occasionally respond to a question with a one-word response, but ...

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Once upon a time long, long ago there lived a man who could see things that other people simply could not see. He was not born with this skill but cultivated it slowly and continuously with years of focused attention. He worked as a physician in a large hospital and would sometimes have students go with him to see patients. As far as the students were concerned, he could really see ...

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