I admitted an elderly woman to the hospital recently.  The previous week, she had presented to the emergency department (ED) with chest pain and shortness of breath.  For some unknown reason, a urinalysis was obtained and was found to be abnormal.  The patient left the hospital with a prescription for cephalexin, in addition to unexplained chest pain and shortness of breath.  The patient presented to the hospital this time with, ...

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“Listen to your patient; he is telling you the diagnosis.” This quote from famous physician William Osler is as true today as it was 100 years ago. And yet the latest version of President Trump’s executive order on Medicare threatens what patients overwhelmingly want: a physician involved in their care. Section 5-C of the President’s order focuses on payment parity and supervision of mid-level providers. Changes to either issue would create unintended ...

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Stress is one of the epidemics of modern-day living—especially work-related stress. At a basic fundamental level, it’s just simply a chemical reaction. Your adrenaline and cortisol levels shoot up in response to a stressful stimulus, the primitive “fight-or-flight” response kicks in, and your brain and emotions go into overdrive. The problem with this acute response, is that it tends to lead to illogical thinking and an inability to really find solutions. Research also confirms that having chronically elevated stress hormones is very detrimental for your long-term health and ...

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It’s been liberating and eye-opening and sometimes a pain to have all three of my kids in grade school. The benefits of one drop off and not paying for daycare do outweigh the downside of figuring out what to do with the kids when they have days off. Usually, I plan my schedule accordingly, but I still have to fit in the requisite number of shifts for my ...

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The physician burnout crisis and a national provider shortage have fueled a growing trend in health technology focused on better utilizing physicians and reducing administrative burdens. I became a surgeon because I wanted to help people, not because I had a strong desire to push paper. The high volume of administrative tasks increasingly consumes a physician's time that could be better spent with patients. For example, primary care physicians
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She was new to this ICU. She was young, smart, funny, and considered one of the “cool” nurses. Before we could really get to know her, she exposed her wonderful, fantastic, perfect life all over social media. Their perfect two-story brick house, their two little, perfect angel daughters — the perfect life in the perfect town. But what was most important was her perfect, handsome husband. He was bound to be a self-employed ...

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If my hypertensive patient develops orthostatism and falls and breaks her hip, I fully expect the orthopedic surgeon on call to treat her. I may kick myself that this happened, but I’m not qualified to treat a broken hip. If my anticoagulated patient hits his head and suffers a subdural hematoma, I expect the local neurosurgeon to graciously treat him even though it was my decision and not his to start ...

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The recent pardon of a convicted child rapist by the ex-Kentucky Governor has sparked a lot of controversies. The basis of the pardon was- “the victim’s hymen was noted to be physically intact.” Evolving studies have continuously shown that the hymen is not a reliable or accurate means to conclude sexual assault. But if physical damage is the only criterion used to assess ...

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It's the winter of 1993. A cold, snowy day. Windy. A blizzard. The phone rings. I'm not on call for my patients today — except for one. Daisy has been in my care since the early 1970s, and given the risk that she may suffer a serious downturn, I've instructed her nursing home to call me whenever necessary. This is that call. Daisy, my dear lady, the old artist, is dying. Throughout her ...

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Mr. Fine is in for the eleventh time in less than a week. I work as a social worker in a hospital emergency psych unit. Mr. Fine is suicidal again. It is kind of late in the evening when I see him, although it is my first time, I am the only social worker on tonight. This is the usual situation, one social worker per shift. The psychiatrist takes me aside, quietly ...

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As a doctor, there is an experience that all can relate to. It concerns that particular patient who comes in with not just one concern, but a litany of them. They require more than the prescribed 15 minutes of visit time, and we sit and listen, try our best to console and guide. Yet, for some patients, it never seems ...

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I read the recent article on KevinMD: “I’m sorry: Why I lost my love for medicine” with great sadness. My heart goes out to the author; many of their concerns echoed deeply within me. I am sorry that we, as physicians, haven’t effectively succeeded in solving the myriad of problems facing health care today. And the author is right: Health care as a system, in the ...

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As I was finishing up with my doctor’s appointment for the required immunizations I needed for medical school, my doctor asked if he could give me some advice for my upcoming journey. Being the clueless pre-medical student I was at the time, I said, “Please do.”  He said something along the lines of “They’re going to try to rewire your way of thinking, but stay true to who you are.” ...

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1. Increase retirement investments. As young professionals who will eventually retire or cut back on work at some point, we need to start investing in our future. While many of us may already have started setting aside money for retirement, others of us may not have begun that process. In 2020, let’s strive to do even more. Let’s commit to increasing our retirement savings, even if it’s by a small ...

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"What do you want to be when you grow up?" It's a question I frequently hear from physicians on my clinical rotations. Phrased somewhat tongue-in-cheek, the wording allows me to answer either in jest or in earnest. "An astronaut," I sometimes say, hoping for laughs and no follow-up. Other times, I try out different responses like Halloween costumes: a critical care specialist, an emergency physician, a surgeon. If I want the questioner's ...

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I’m a pediatric hospitalist, and I know that most days in the hospital are routine. But every once in a while, a patient pierces through your armor, and touches your heart in totally unexpected ways. Willow did that to me. Willow was five days old and had been admitted because her breathing was not quite right. I first met her in her hospital room, with her dad hovering over her bassinet, ...

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Eighteen months out of residency and into outpatient psychiatry private practice, for the first time since before medical school, I'm coming home actually feeling a surplus of energy to put into my life outside of clinical practice. Sure, I did my best to maintain my interests and relationships during my training, but doing so felt like trying to wring blood from a stone. A slight sense of boredom in the evening, ...

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The World Health Organization has designated 2020 as the Year of the Nurse and Midwife in honor of Florence Nightingale’s 200th birthday. We owe a lot to Florence Nightingale, but what about Harriet Tubman or Mary Seacole? Nursing – and society – has been changing since the days of these nursing pioneers. It’s way past time to catch up to their timeless insights and fearless activism. We owe to all these ...

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School has gotten back into full swing, and thus we begin another cycle. Will this cycle be better than the last? Every year we find ourselves in this same spot. Summer’s over, big vacations are in the bag, back to school shopping is complete, and we start recovering from our summer spending. We often haven’t yet recovered from the summer splurges before it’s time to start Christmas shopping. Then we begin ...

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It is a busy time of year. I made my rounds to collect my skis after tuning, to pick up items for our Christmas guests, to get my haircut, and to claim my new eyeglasses.  I drove to my golf course and took a half-hour walk on snow-covered paths with my dog.  Dropped him at the groomers, then made stops for last-minute food shopping.  While my wife took on the masses at a megastore, ...

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