In the long weeks since Valentine’s Day 2018, when those 17 students were killed in a mass shooting at Marjory Stoneman Douglas High School, justified outrage has flowed from all corners of society. In New York, high school students have marched through Manhattan streets. On Capitol Hill, others have protested for tighter gun legislation. Recently, at Stanford University, our medical community held a community health panel, titled “Gun Violence and ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 47-year-old man is evaluated during a follow-up examination. He is obese and has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. He reports that he has always has been overweight, and over the years, his weight has gradually increased to 123 kg (271 lb). During the past ...

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Strong letters of recommendation are essential for supporting your residency application and matching well. This article details how to ensure you get great letters of recommendation. Knowing what constitutes a great letter of recommendation is crucial to obtaining outstanding letters. A strong letter of recommendation clearly conveys knowledge of the medical student, how that student performed and qualities that predict excellent performance in residency. Strong letters of recommendation include the following:

On a Sunday afternoon, I arrived at the hospital for my psychiatry ER shift. As medical students, we keep an eye on the track board for new patients to see. Two names turned bright red, and I chose to follow Jackie Swanson. Her initial ER evaluation read “Patient is a 30-year-old female here for SI, HI, and AVH in context of recent sexual assault and cocaine use.” She was brought ...

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“The patient in room 17 needs an IV line! Hey, have you ever put in an IV before?!” Everybody looked at me at once. I tried my best to maintain a confident outer appearance. But I’ll admit, I was caught off guard. I thought back to my attempted IV insertions throughout my anesthesia rotation earlier in the year. I struggled with getting the IV line smoothly into the vein. I followed ...

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I recently went to an infectious disease educational session sponsored by the Massachusetts Medical Society and the New England Journal of Medicine called "Epidemics Gone Viral." The focus was preparedness for the next epidemic, which may come from anywhere. John Brownstein talked about how its arrival will be monitored and reported using Twitter and artificial intelligence. With the meeting going viral with excitement as Bill Gates got ...

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I log onto KevinMD every day to get my much-needed dose of physician commiseration. At least once a day, one of us writes an article about burnout. It typically leaves me feeling quite validated. I particularly enjoy reading the comments section, as many of you make me laugh with your physician reality-based humor. I am more burned out than I ever hoped to be. I work in primary care, have a ...

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In 2013 I began searching for ways I could change my career to reduce my workload, but not give up medicine altogether. During that time I took a cruise and looked at various jobs I could do on a cruise ship. One of the jobs I was qualified for, I thought, was to be a Cruise Ship Doctor. After talking with the ship’s doctor to find out what it was like ...

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The Affordable Care Act (ACA), widely known as “Obamacare,” has survived several repeal attempts by Congress. Storm clouds, however, are still on the horizon. The ACA’s individual mandate obligates every American to be covered by comprehensive health insurance. This requirement has been the most unpopular feature of the law. That’s because healthy people, especially those who are self-employed or between jobs, have found the ACA premiums too expensive. They are not alone. Health ...

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Six months ago, I had severe right flank pain. In the ER, I had an ultrasound showing a possible kidney stone. I deferred a CT scan and went home with medication. I fit the textbook picture: I had abnormal imaging, and I was given a treatment and discharged. I was advised to return if the pain worsened or failed to resolve. I briefly improved, but then the pain returned much ...

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“Why don’t you just get a shotgun and blow his brains out next time? Better yet, next time stay the hell away from my patient!” I was frozen, and the ICU attending wasn’t even talking to me. My co-intern had barely started her presentation when she met damnation. Mind you — there was a senior resident, a pulmonary fellow, and a team of nurses caring for the patient also. Yet the ...

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Angela Harris has been here in the hospital for six hours, awaiting the results of her CT scan. I won't take responsibility for all of that wait time: complicated CT scans and labs do take a significant amount of time to perform. But she didn't need to wait the last hour. She was waiting on me — her emergency physician — because I needed to confirm her cancer diagnosis with radiology, ...

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The tragic case of Alfie Evans has roiled Great Britain and the world. Alfie was a two-year-old child in the United Kingdom with an unknown degenerative brain disease who eventually deteriorated to the point that he required life support. His brain had become mostly liquid, and he could not see, speak, or hear. Alder Hey Hospital decided his condition was terminal and irreversible and wanted to stop ...

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I have spent a good part of my career investing time and energy towards side hustles.  I generally categorize them into two distinct types of ventures.  The lazy side hustle involves starting a business or consulting in a field tangential to ones main hustle.  For example, an accountant who works normally as an auditor may do a few tax returns on the side during tax season.  I call his ...

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“Those emergency room residents are f**king retarded!” This was the comment that rang through the workroom.  I had only been on this hospital service for three days, and I was having a discussion about a patient with my attending when the on-call resident had burst into the workroom and sat down next to me. He was fuming. “Why the f*** would they think I need to be consulted for this? Only ...

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One of the things that can help a physician live a balanced life is finding ways to thrive in the workplace. This is currently a work in progress for me, but I am excited to share what I have learned so far. For some context, I was previously practicing as a nephrologist; and I transitioned to being a hospitalist on an as-needed basis to create flexibility in my schedule. This ...

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Why do we say “curiosity killed the cat?” Isn’t curiosity what drives people to ask insightful questions? To keep an open mind? And to continue learning at age 6 or 60, alike? Curiosity is what sets apart people who are fixed in their opinions and beliefs and those who adjust in light of new information. Recently, I read an article in The New Yorker that suggested that Donald Trump doesn’t read books ...

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In the days after Hurricane Maria made landfall on Puerto Rico, four Yale physicians began an ambitious effort to send thousands of pounds of medical supplies to the storm-ravaged island. Despite having had no prior experience with disaster response, these doctors worked with contacts in Puerto Rico to generate a detailed needs-assessment, determining exactly which medical supplies were needed on the island. Using social media, traditional media, and professional connections, ...

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Speeding through town, I had just dropped off a kid at football practice. I raced back to the church to drop off another kid, then drove quickly to a soccer practice for a third. At about 7:00, I start to lose my cool. I'm used to my husband being late. But tonight I was frustrated. I sat in the parking lot with two babies, strapped in their seatbelts, fidgeting and ...

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Say we met ten years ago. And you asked me: Would health care delivery be more complicated in the future? I would've said, "No, it would be simpler!" Pointing you to technology trends, I would’ve told you that health care transactions will indeed become more automated, much simpler. Repeatable administrative tasks would be tech-enabled and algorithm-driven. My company started life in billing claims for doctors. Back then I was quite sure billing would ...

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