Dear Dr. Wible, I want to fill you in on what really goes on behind the scenes at my medical school and maybe you can help inform other students about what happens here before they make a huge mistake. If students slip through the cracks of a U.S. medical school, then international med schools in the Caribbean may be the next choice. Some have better residency match rates than others so ...

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It won't work. Obamacare works for the poorest that have affordable health insurance because all of the program's subsidies tilt in their favor. Obamacare doesn't work well for the working and middle class who get much less support -- particularly those who earn more than 400 percent of the federal poverty level, who constitute 40 percent of the population and don't get any help. Because so many don't do well under the law, ...

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Among surgeons, it’s pretty common knowledge that residents and other providers may perform non-critical parts of a patient’s procedure. This not only helps residents and other trainees gain valuable surgical experience, it also gives patients better and faster access to high-demand surgical expertise. The question is this: How well are surgeons explaining these facts to their patients? Recent guideline updates by the American College of Surgeons (ACS) underscore the need ...

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Eight months into a healthy pregnancy, my belly suddenly hung lower. I noticed that the baby’s movements slowed, decreased in frequency, and seemed sluggish compared to just a few days before. Concerned that something might be wrong, I called my obstetrician’s office and described what I’d noticed. The nurse I spoke with gave rote and reassuring advice: “Babies often get crowded near the end of pregnancy,” she said briskly. “Drink some ...

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As physicians ready themselves for the future of medicine under onerous MACRA regulations, it seems appropriate to glance into the future and visualize the medical utopia anticipated by so many.  Value-based care, determined by statistical analysis, is going to replace fee for service. Six months ago, I received my first set of statistics from a state Medicaid plan and was told my ER utilization numbers were on the higher end compared ...

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It would never have gone down this way ten years ago when length of stay was all the buzz. The CT scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a quick observation stay. Bing, bang, boom. One, two, three. Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner ...

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“Management is about coping with complexity. Leadership is about coping with change.” - John Kotter Even before the results of the recent presidential election were in, few necessities were as present in our daily lives as the need to cope with constant change. This is true across all facets of personal and professional experience in America, but perhaps nowhere more than in health care. Over the next generation, we need to cope ...

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I use an ongoing spreadsheet to keep track of and to report my demographics and stats for each telepsychiatry consult shift I do. I’ve done thousands of consults in over two dozen South Carolina emergency departments over the last half-dozen years. We have now gone over thirty thousand consults as a group. It never ceases to amaze me, as I fire up my computer, log on to my systems and bring ...

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Medicine, what a noble profession.  As the keepers of human health and longevity, we are entrusted with a huge but solemn responsibility.  It’s an ancient artwork, passed through the generations from pre-antiquity, hand in hand from physician to physician.  The Hippocratic oath ensuring that we first “do no harm” and commit ourselves to the honorable calling.  We often hear “see one, teach one, do one” and so propagates the training ...

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Part of a series. Those of you who have read some of my past posts are aware that I wrote mostly about various aspects of primary care and our dysfunctional healthcare delivery system overall. About 18 months ago I wrote a post for KevinMD on moving to a retirement community. More recently I became focused on the primary care needs of older individuals and from there got ...

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Since the study of science is the most common route taken to a career in medicine, there’s a tendency among doctors to neglect, if not outright scoff at the arts and humanities. That’s a shame, and not only because an appreciation of history or philosophy might make you a better doctor. I’m in complete agreement with that notion, but as an opinion, it can’t be definitively proven. Instead, I think it’s ...

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asco-logo One of the questions that I face (and which I am certain many of us do) concerns the use of alternative therapies. Iron chelation therapy, high-dose vitamin C infusions, Chinese herbs — interest in these therapies and others like them are driven by word-of-mouth (“a friend of a friend”), claims on websites and patients curiosity. Cancer is ...

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Monday night, at Lincoln Center waiting for Beethoven’s Ninth to begin. Masses of glass spatially dividing David Geffen Hall from the Metropolitan Opera, are still allowing for the majestic Viennese crystal chandeliers next door to provide the necessary visual interruption between the two symphonic masterpieces, Beethoven’s Eight and Ninth. For me, the excitement about this particular event is deeply personal: Ode to Joy became part of my classmates’, my friends’ collective ...

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Rationing of health care services according to an individual’s ability to pay — or, as the case may be, the inability to do so — is becoming more prevalent in the United States, both in the public and private insurance spheres. Commercial payers, for example, increasingly require doctors to follow a complex and time-consuming authorization process. Recent surveys show that 75 percent of doctors complain about this often unnecessary step. Insurance ...

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One of the popular critiques of the American health care system is that it is high-volume, low-quality, and that this is a direct result of the traditional fee-for-service approach to paying doctors for medical care. In the past, doctors and hospitals have been paid much the same way that we pay for other goods and services. When they provide a service, such as an appointment or a procedure, they are ...

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The onset of the new millennium has brought about a shift in not only the technological aspect of our industry, but also the mindset of physicians who are entering the field. Gone are the days of "work 40 years at the same practice, retire and live the good life."  Physicians are finding more creative ways to be doctors including entering non-clinical careers, being entrepreneurs on the side, and moving into ...

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"I've got to use the right tool," I thought to myself as I attempted to pound a nail into the wall with the bottom of my coffee cup. Kneeling on the exam room table, I was attempting to hang a picture on the wall before the clinic day began. I have all sorts of useful tools in my clinic: scalpels, special scissors and a multitude of precision instruments for surgical ...

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In the past few weeks, we have lost two female physician colleagues tragically to suicide, a pediatrician and psychiatrist.  In the general population, males take their lives at four times the rate of females.  However, for physicians specifically, the suicide rate is evenly distributed between genders; making our occupation the one with the highest relative risk for women to die by suicide.  This is ...

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A couple years ago, I reached the seven-year mark after my initial board certification with the American Board of Anesthesiology (ABA). At the time, it was a significant milestone. I was eligible to take the all-important Maintenance of Certification in Anesthesia (MOCA) exam. Diplomates of the ABA -- that’ right, I’m considered a diplomate -- in other words, a board-certified anesthesiologist. Diplomates were encouraged and incentivized to take the $2,100 exam ...

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It’s rare for medical students nowadays to go through training without knowing someone who uses prescription stimulants to study. The ever-popular Adderall and Concerta seem to be omnipresent on college campuses and medical schools, while prescriptions for these medications are suspiciously less common. In environments where success and self-worth are often based on academic achievement, the temptation to succumb to using these pills is high. The temptation is even higher as ...

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