The business of medicine is unlike any other type of standard “business” in that health insurance and hospitals confound what would appear to be a simple exchange of services for a set price.  You know that the confusion is bad when neither doctors nor the patients fully understand how the insurance system works.  I have seen patients going into surgery for a lap chole being quoted a price that ended ...

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Being a physician is an important role. It's easy to forget the impact that you have on a patient just by being at their bedside. It's huge. Have you ever been a patient? It's an incredibly vulnerable experience. You're not really sure what's happening and what is going to happen next. People are really putting their faith in you to understand their needs and to ease their suffering. It's a powerful thing to ease ...

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Every winter, flu season descends upon the hospital. The most consistent reaction among any of our physicians — trainee and attending alike — who succumb to this nasty virus is one of guilt. Even the thought of "calling out sick" leads to such extreme guilt that many colleagues choose to come to work sick instead. Several trainees have admitted to suffering from flu-like symptoms but pushing themselves to come to the ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for a 6-month history of loose stools, bloating, and a 3.2-kg (7-lb) weight loss. Her medical history is otherwise unremarkable. Her brother has type 1 diabetes mellitus, and her mother has autoimmune thyroid disease. She reports no other symptoms and takes no ...

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Sometimes, old ideas and time-tested treatments remain the best. Newer doesn’t always mean better. Except in the case of one of our oldest antihistamines, tried-and-true Benadryl. It is time for that old drug to be retired, sent off to pasture, and never used again. Goodbye, Benadryl. Fare thee well, adieu, and don’t let the door hit you on the way out. Benadryl (diphenhydramine) was introduced in 1946. The top single that ...

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"I dreamed a dream my life would be ... so different from this hell I'm living." Twenty years ago, I would pull out my Les Miserables piano book and pound out "I Dreamed a Dream" while my fellow medical student/roommate would sing along with me to the line above with gusto. In the scheme of things, we didn't have it so bad. We hadn't been abandoned by our lover-baby daddies. We weren't ...

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In recent times, physician burnout has rightfully surfaced as a social concern for the medical fraternity. Physician burnout is a thing, and lately, I was thinking about it related to nephrology. Many national physician organizations and local hospital systems are developing strategies to reduce work-life stress and improve the engagement of the workforce. In November 2018, I represented the Renal Physician Association at the interim meeting of the American Medical Association ...

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Today my clinic patient lost his wallet, including his cash, government ID, and his credit cards. He drove more than 130 miles to the clinic.  Still, somehow, he sat in front of me in the exam chair as patient as ever through all my history questions. When I asked about his day as I was washing my hands just prior to the exam, he told me his wallet story. I ...

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"Under duress, we do not rise to our expectations. We fall to our level of training." - Bruce Lee (supposedly) When I was looking for My Patient, well before his neighbor grabbed my butt, I remember noticing that most of the slots in the doors of the isolation jail cells were open. These slots are tall enough to pass a softball and wide enough to pass a clipboard. They are about three ...

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Imagine a looming global crisis that threatens the health of countless people, confounding scientists and governments with its sheer magnitude and complexity and growing at a pace that will quickly exceed our ability to reverse course. Sounds a little like climate change, right? The existential threat I'm referring to in this case is microscopic: antibiotic-resistant bacteria and fungi. In a way, antibiotic resistance is the climate change of medicine. It has potentially lethal ...

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Every day, children are cared for in clinics and hospitals. And every day, some of them are unhappy about it; some of them deeply unhappy about it. The contemporary practice of nursing and medical care includes health care providers having to touch their patients. This may include an abdominal exam, listening to their lungs with a stethoscope, or even slightly invasive maneuvers, such as having to put an otoscope into their ...

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“Are you serious! What are you doing to my son! How can you have him tied to the bed like this!” Michael’s* mother was irate and yelling at my resident as I stood at the back of the room. Michael had HIV/AIDS with a CD4 count of 20. Hours before, he had bit his mom on the hand, leaving visible bite marks. As his mom continued to scold my resident, my ...

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It is well known by now that a physician’s demeanor influences the clinical response patients have to any prescribed treatment. We also know that even when nothing is prescribed, a physician’s careful listening, examination, and reassurance about the normalcy of common symptoms and experiences can decrease patients’ suffering in the broadest sense of the word. This has been the bread and butter of counselors for years. People will faithfully attend and ...

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Many doctors make the decision to pursue a career in medicine in their youth.  They have an experience that points them in this direction.  And once the decision is followed by a firm commitment, we seldom change the course.  Medicine here I come! At that age and with such limited life experience, it's impossible to truly grasp the depth of the commitment to this career. Becoming a doctor is not a career decision, ...

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Medical training is lengthening as students increasingly take gap years before and during medical school. Excessively long training times contribute to many problems. Trainees show high rates of burnout, depression, suicidal ideation, and alcohol abuse. Crippling student debt, compounded by the opportunity cost of not earning a salary, make it difficult for under-resourced individuals ...

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Tiramisu, chocolate mousse, red velvet cake, freshly baked cookies, and warm brownies topped with ice cream. These are some of my favorite desserts and the things I start thinking about when I am under intense stress. I often gaze at the bakery section at the grocery store just to take a look when I feel overwhelmed with stress at work or home. It is the classic description of what we ...

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At least a few times a year, I am asked to prescribe antibiotics to people who are not my patients. From my point of view, there is only one answer that makes sense here – no. I have the same reaction when patients call me for a refill or advice when I have not seen them in a year or two. The patient may feel that I will refill their ...

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As a relatively healthy Medicare patient, I do not visit doctors often. I have had digestive issues most of my life — probably from too many antibiotics when I was a child with recurring strep throat, or so I'm told. My husband and I had just returned from living out of state for two months while he was treated with proton therapy for cancer. My stress levels were high. I was not resting well ...

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My husband is a type 2 diabetic with mild chronic kidney disease, which has been well controlled on 500 mg metformin BID plus saxagliptin (AstraZeneca's Onglyza). At the end of last year, he got a letter from his Medicare Advantage PPO, UnitedHealthcare (UHC), advising him that the Onglyza (UHC only uses brand names) would no longer be covered and recommending he have his doctor switch him to another DPP-4 inhibitor, either ...

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It was mid-January, and I found myself catching some rays on a rooftop in Cancun with 15 other physicians — all women of varying ages and medical specialties. Besides enjoying the sand in my toes and a martini glass in my hand, I was there to attend the TransforMD retreat, looking for clarity on my life choices, values, and goals. Daily Vedic meditation was to be integral to the agenda. That ...

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