It hasn’t always been this way. For years, I worked at the typical high-achiever pace, like many striving to become a doctor. Upon entering medical school, I set challenging expectations of myself — graduate at the top of my class, study a relentless number of hours, score at least one standard deviation above the mean for boards (two would be better). It was an exciting time fueled by the desire for ...

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Did you know, one in four people over 65 have abnormal memory impairment? This is the finding from screening with an objective test.  In half of those who test abnormal, there were common conditions - such as depression and medication interactions – which can be addressed and even reverse the memory problem.  But for the other half, the memory problem is a sign of mild cognitive impairment, which can be ...

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In the emergency department, we see them all the time.  The person with a medical problem too serious to ignore, but not quite bad enough to require admission.  The patient referred to the specialist who comes back to the ER. "I couldn’t afford the cash upfront."  The new cancer in the uninsured.  The pneumonia without a doctor.  The homeless not eligible for Medicaid. The senior barely able to stand, but whose ...

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I did not want a baby.  As a 26-year-old third-year medical student who had quite recently ended a far from ideal relationship -- of this, I was certain. On vacation, in New York City, walking in Soho carelessly, I laughed with my friend Noelle over the fragility of condoms. “Trust me,” I said. “They break.” How many months in my sexually active life did I apprehensively count and recount the number of ...

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Next in a series. In my previous post, I explained the basics of my Healthcare Incentives Framework, which enumerates the jobs we want a health care system to do for us and links them to the parties in the health care system that have the greatest incentive to fulfill those jobs. If you haven’t read that post, I recommend you read it first. For those ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old woman undergoes follow-up consultation regarding a pre-employment physical examination. She reports feeling well, with no recent illness. Medical history is notable for gastroesophageal reflux disease. Her only medication is omeprazole. She is black. On physical examination, vital signs and other examination findings are normal. A peripheral blood smear shows ...

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A lot of media attention, including television, print, and online sources, is focused on various plans to revolutionize the delivery of health care in America.  Critics point to medical errors, waste of resources, and lack of access among the numerous factors requiring the replacement of our health care system.  To many politicians and think tank experts, the combination of government support programs (including Medicare, Medicaid, and Social Security disability) plus ...

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As a young college student or post-grad, you may have accumulated credit card debt. I certainly did. However, somewhere in the process of “adulting,” you may have realized that having lots of debt isn’t a good thing. You may have even heard investment gurus like Dave Ramsey preach that all debt is bad and insist that people do any and everything to rid themselves of the terrible “D-word” as fast ...

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asco-logo As an oncologist, I have seen the devastating impact of being told one has cancer. The reaction I most often see among my patients is fear that they’ve been given a death sentence, an urgent need for a plan, and hope that they will survive. I often want patients to know I too sense their ...

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Though I owe a debt of gratitude to all of my internal medicine attendings, none of them can claim credit for getting me through the gulag of residency. That distinction, instead, belongs to Zubin Damania, alias ZdoggMD, an internist and purveyor of viral YouTube music videos.

I first became aware of Damania’s videos when a med school friend sent me a link to his online archives, resulting in one ...

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Storytelling is as old as humanity. In telling our stories, we share, learn, and ideally pass along wisdom. As Isak Dinesen once wrote, "To be a person is to have a story to tell." This story starts with PW's cancer diagnosis in 2009. Nodal marginal zone lymphoma: not curable, hopefully manageable. For some, cancer invites a retreat within. For others, it can be a call to action. For me, it was a ...

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With the epidemic in health care of overwork, stress, and burnout, psychological safety is a crucial factor in achieving the highest levels of quality of care and quality of work environment. While simple in concept, psychological safety is also quite fragile and needs careful attention on a day-to-day and conversation-to-conversation basis to assure it. Psychological safety means that people feel safe to speak up about concerns, new ideas, negative feelings, and ...

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We primary care physicians hate data. Taken on their own, numbers are benign, but when we hear the word "data," physicians are reminded of a litany of related issues that make our lives far more difficult: checkboxes. Regulatory compliance. Prior authorizations. Unnecessarily complicated payment schemes. By virtue of our training and the principles that guided the decade we spent obtaining our degrees, we are empiricists by nature. It's sad to think ...

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asco-logo The couple that entered my office on a warm fall day seemed out of sorts. She looked nervous, and he looked irritated. Before he sat down I heard why he felt that way: “I don’t even know why we’re here.“ I explained briefly what my role is but this did not seem to clear up anything. “I just want her to be ...

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You know that one patient? The one who calls the nurses every five minutes and keeps hoarding the jello cups down the hall? She has a thousand problems but doesn’t bother to take care of herself. She keeps coming back complaining about her issues and wasting our time by asking the same question again and again without listening to what we say. And don’t get me started on how awful ...

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It is easy to feel the gravity that accompanies the act of caring for those whose souls are still stuck to the surface of the earth. Their nerves still feel. Their skin still bleeds. Their eyes blink, and their hearts beat. Their chests rise and fall and rest for a moment before this rhythm repeats. They cry when poked and, sometimes, ask if they are going to live or die, ...

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I woke up to him, pacing the bedroom. Within an hour, I was pacing the ER at his bedside. Our experience at one of the country's best-ranked hospitals lasted only three days before we were discharged home. What led us there will last a lifetime in our minds. When faced with your own mortality (or that of your husband's), you are forever changed. We are grateful for his continued recovery from myopericarditis. ...

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If you’ve ever been in the hospital for a surgery, you probably had a resident speak to you about the procedure; you were presented a laundry list of risks, the benefits mentioned, asked if everything was understood. And finally, you initial in several spots before signing your name on the dotted line. You looked at the wall clock and noted that the conversation took a mere six minutes. Is this proper ...

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I am a cardiac anesthesiologist. I meet most patients I care for minutes before I take them to the operating room and render them unconscious. I breathe for them, administer pain medicine and drugs to give them amnesia, and I keep their hearts, lungs, kidneys, and brains working. Pretty important stuff. I want to speak on behalf of physicians. I want all patients to know something: We need you to talk to us. We ...

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Five months ago, "little kids" started visiting my father-in-law, stealing things. The hallucinations and dementia progressed, and we were forced to move him to a memory care unit. Memory care unit is the polite term for a lockup unit for people with dementia. Walking through the locked doors for the first time triggered in me an intense urge to run away. First, you encounter the "dementia parking lot" with the "inmates" parked ...

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