From the notes I read, it seems that other medical specialties limit “social history” to whether or not someone uses tobacco, drinks alcohol, or uses drugs. “Social history” is meant to get a sense of the context in which people live. Where do they live? Who do they live with? How did they come to live there? Where did they grow up? What sort of work do they do? How much ...

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In the wake of the recent flood of allegations of sexual harassment against so many men in so many different positions of power, the refrain has begun, “The rules have changed.” Frivolous concerns about office holiday parties threaten to trivialize the remarkable transformation of women finally being believed, and men finally beginning to be held accountable for their actions. The rules have not changed. What has changed is that, at long ...

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“Wow, cool case,” was the response from the residents in continuity clinic on Monday morning as I told them about a patient I had seen over the weekend at our main campus urgent care. Ironically, or maybe more tellingly, I thought the same thing; “that was a cool case.” The “cool case” was a senior in high school who was eagerly looking forward to her college career but woke up with ...

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Sometimes there are no words. Not even a eulogy. Then one courageous family writes this obituary. (This obituary was written by Rachel Dawson, his wife, with the blessing of his parents.) In it, they share how their son lost his battle with severe depression. How he adored his children. How he sacrificed fun, free time, and relaxation to receive his medical ...

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Many of the everyday coalface problems we face in health care are simply due to suboptimal communication. It could be the patient or family member who doesn’t know what’s going on in the hospital, the nurse who is confused about orders, or the doctor who doesn’t understand the reasoning behind the seemingly terrible administrative directive they are receiving. Take it from me, as someone who has seen health care at close ...

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It’s been 21 years since Drs. Robert Wachter and Lee Goldman, in an article in the New England Journal of Medicine, first described a new delivery model called “hospitalists” – clinicians whose primary professional focus is the care of hospitalized patients. Since that time the healthcare system has seen rapid growth of hospitalist programs across a variety of specialties. In the OB world, I have had the opportunity to ...

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Practicing medicine with all of its responsibilities often reminds me of a black hole. It seems each time something new is added it gets pushed into the vast vortex of the black hole, hidden from those around you and jumbled with everything you are expected to do. People around you see the world as you present it. They rarely get a glimpse through the pinhole to the expansiveness that is beyond ...

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As the national opioid crisis takes center stage, I want to make a case for the authority of the family physician in managing and treating this problem. I am a family physician and have been treating patients with opioid dependence and addiction for 12 years. These patients comprise about half of my practice. The other half is representative of a typical primary care practice. I have patients who have been treated ...

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Too much data, big and small. Every morning when I log onto our electronic health record, one group of messages are from patients with their self-recorded health information data that they've sent to me for review. Here's my home blood pressure over the past 24 hours. Here are my fingerstick glucose readings over the past 24 hours. Here's my weight over the past 24 hours. Here is my depression score over the ...

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When you tell anyone in health care that “sedation” to the point of coma is given in dentists’ and oral surgeons’ offices every day, without a separate anesthesia professional present to give the medications and monitor the patient, the response often is disbelief. “But they can’t do that,” I’ve been told more than once. Yes, they can. Physicians are not allowed to do a procedure and provide sedation or general anesthesia at the ...

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