Prevailing wisdom states that more is better — and it is no different when it comes to our expectation of medical treatments. With the help of the internet, patients and their families have come to expect intensive tests, treatments and therapies at every life stage. But sometimes, too much treatment can do more harm than good. This is true in all ages but is especially relevant for older adults living with ...

Read more...

It was my first day of orientation at medical school. In a hallway stood a coat rack overflowing with white garments. I set down my accumulated papers, reached for a hanger and — for the first time ever — shrugged first one arm and then the other into a white coat. It was too large, but I had no other options. The unisex coats ran from XXS to XXL, but the ...

Read more...

Physician Speaking by KevinMD is a boutique speakers bureau founded by Kevin Pho, MD. Today's spotlight physician speaker is Dr. Jordan Grumet. Dr. Grumet is next speaking in February 2019 at a corporate retreat for Esse Health. Jordan Grumet, MD is an internal medicine physician and a hospice medical director.  He has worked in academic as well as private ...

Read more...

As a medical student, you are thrilled to start your residency and to put your four years of studying and clinical rotations to the test. Now the time has come to begin earning a paycheck. This is the beginning of the financial stages of physicians. As an attending who has transitioned into practice, you may be stressed and wondering if you are on track to meet your financial goals. You are ...

Read more...

“I am really uncomfortable and in pain,” said Elaine tearfully as I met her in the preoperative area for the first time. She had a very sad and difficult history, dealing with complications from childbirth nearly two years ago. She had developed a communication between her rectum and vagina, which allowed feces to come out vaginally. Despite multiple surgeries from reputable medical centers in NYC, the problem recurred. And she ...

Read more...

I spent my early and mid-career years working in a pediatric intensive care unit (PICU) at a large academic center. We did almost everything except for a few things esoteric at the time — small bowel transplants, a few kinds of experimental surgery. I’m now in my late career (but have no plans to quit anytime soon!) and work in a smaller PICU. I am frequently confronted with the issue ...

Read more...

Two of my local hospitals just invested 3 to 4 million dollars in preparation for an inspection of the facilities by the Joint Commission. The cost of the inspection runs in the $10 million dollar range after the preparation costs. The inspection is a high-stress situation for the administration because if you fail, or lose your accreditation, the private insurers will void their contract with you and you won’t get ...

Read more...

asco-logo When I was in medical school, I loved pathology. The visual learning and deep understanding of disease were attractive enough that after second year, I took an extra year before clinical rotations to work as a post-sophomore fellow, working as a resident cutting specimens and performing autopsies. I missed patient contact but it served as a great foundation for clinical medicine ...

Read more...

Q. Have you ever thought about doing a post on oversaving? I realize most docs probably have the opposite problem, but I bet there is a subset of the FIRE crowd that this may apply to. Does this ever come up in all the interactions you have? A. It was no surprise to see this question come in as a direct message on the WCI Forum, rather than an email ...

Read more...

You’ve probably seen it on the news – a rare, polio-like illness is causing cases of paralysis in children. Here’s the latest info, based on our best current knowledge from the CDC. Acute flaccid myelitis (AFM) is a sudden illness that causes weakness in one or more extremities – one arm or (less likely) a leg, or any combination of arms and legs. The words in the name express the key ...

Read more...

Disability can be a devastating outcome to a doctor’s career and self-image. Think about it: You busted your butt to learn how to do a Whipple procedure, end up getting into a skiing accident that ends your career right there. No worries, because you purchased the appropriate coverage of own-occupation disability insurance, right? Having disability insurance certainly provides a protective cushion, especially you are the sole breadwinner. This is a no-brainer, ...

Read more...

An excerpt from Leadership Lessons from History: A Study Guide Written for Physicians & Other Healthcare Leaders. In June 1812, Napoleon invaded Russia along with an army of 600,000 men; fewer than 100,000 made it back. During their ignoble military withdraw, in the middle of a terrible winter, thousands of ...

Read more...

I am a critical care physician and spend a good amount of time in the emergency room seeing consults. As an internal medicine resident, we were often in the ER, admitting new patients. In my three years of residency, we spent only two to four weeks working in the emergency room. It was the one time I had an insider’s view of life as an ER physician. And, man, was ...

Read more...

After my surgery rotation, I was in a very bad place. I felt like two months of grueling work hours and relentless studying were wiped away in an instant by a bad test score. That single number somehow mattered more to me than every positive comment I had received from my patients, colleagues, residents, and attendings. I felt like I had put my heart and soul into that rotation, constantly ...

Read more...

Recently, social media and news organizations have been awash in the physician-led backlash to the NRA’s now infamous “stay in your lane” tweet, and consequently, awash in images of the literal blood of seriously wounded or now deceased patients. Gun control is undeniably a cause near and dear to many physicians, who are duty-bound to try desperately, many times in vain, to save the lives of too many innocent Americans ...

Read more...

This article is sponsored by Careers by KevinMD.com. After spending a decade in college and medical school, followed by internships and residency, seeking additional guidance at the beginning of your career may seem excessive. You’ve already taken direction from dozens of leaders; isn’t it time to cut your own path? Yes and no. You’ll make plenty of your ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old woman is evaluated during a routine follow-up visit. Medical history is significant for hypertension and chronic active hepatitis B infection. Her hepatitis B infection has been treated with tenofovir for the past 5 years with suppression of her serum hepatitis B DNA levels. She currently notes mild ...

Read more...

It’s that time of year again when retail outlets start counting down the days to Christmas and deck their stores with holiday cheer. For many people, this time of year feels magical. Yet for others, it is a consumer competition to buy the absolute best gift at the lowest price. While both these groups love the holidays in their own way, there is a third group for which the holidays ...

Read more...

Recently, a physician asked my opinion if a patient needed a colonoscopy. My partner was already on the case and I was covering over the weekend. The facts suggested that a colonoscopy was warranted. The patient had a low blood count and had received blood transfusions. Certainly, a bleeding site in the colon, such as a cancer, might be responsible. We do colonoscopies to address similar circumstances on a regular ...

Read more...

“Admission diagnosis: causa socialis” In my training in Sweden, it was not unusual to admit patients to the hospital for social reasons: an elderly person who could no longer manage at home, a person whose social network fell apart, and so on. “Social reasons,” causa socialis, was a legitimate diagnosis (Swedes used more Latin than Americans, at least back then). And it was used with only mild grumbling. There was a clear ...

Read more...

1525 Pages