The vast majority of births and deliveries are joyful ones. Families celebrate the wonder of the new addition to their families, and clinicians go home at the end of the day with a sense of pride, deriving meaning from their professional lives. This is one of the reasons that many of us chose obstetrics in the first place. But unfortunately, that is not always the case. As an obstetrician, I know firsthand ...

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Physicians do not have a lot of power these days. But if you know when, where and how to look, we can, on occasion, score some victories. Case in point: hospital bylaws that every physician is required to acknowledge and sign before being granted privileges. It is always a good idea to carefully read before signing anything, and I did the just that before signing my hospital's bylaws. I asked a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 78-year-old man is evaluated for symptoms of dysphagia that began 2 weeks ago. When he eats, he starts coughing after the first bite of food and occasionally has nasal regurgitation. On physical examination, blood pressure is 135/90 mm Hg, pulse rate is 78/min, and respiration rate is 12/min. Left-sided weakness is ...

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"I feel very dizzy when standing," was Ms. A's* chief complaint. She originally came to the ER for sudden onset double vision and severe balance issues. After briefing myself, I took the stairs to the fourth floor and found her. When I arrived, Ms. A was the only person there. She was wearing a silver visor and a crisp white shirt. As a native of west Texas, she loved her BBQ, ...

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Nothing troubles physicians more than an unforeseen outcome and a malpractice lawsuit. It cracks open self-doubts and assumptions about medicine and may be life-changing. It commonly fuels burnout, loss of confidence, PTSD and early retirement. And there are links to depression and physician suicide. There's another side to this story, though. Like all of life's great challenges, a patient's unexpected loss, and professional litigation present us with huge opportunities for growth. I am ...

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In his lifetime, William Shakespeare wrote almost 120,000 lines and about 900,000 words. His 37 plays and 154 sonnets burnished his reputation as the unrivaled wordsmith of the English language. So what would the Bard, who had something to say about everything, have said about palliative care of the suffering of the sick? Although I couldn’t resurrect him from his venerated grave, I could unearth quotes from his collective works ...

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Recently while traveling overseas, I found myself in a predicament not often encountered nor taught to health professionals. I was requested to address an emergency at 30,000 feet in the air. This got us thinking: How many patients consider the possibility of a medical emergency in the air? People with chronic illnesses and the older population (who find themselves retiring and having more time to travel) need to be prepared so ...

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As a system, we don't invest as much time in understanding the broader context of the patient in front of us. The before/after factors that we don’t notice have a far-reaching impact on care. Recently, I shadowed a patient through a day procedure at an endoscopy center from the time that the nurse checked her weight to the time that she was discharged. Let's call her Nancy. She was 82 years old ...

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It’s that time of year again. Over 30,000 medical residents are about to finish their training and start their first job. Many of them will make some big financial mistakes during their first year that will haunt them for years to come. One of the biggest errors many doctors make is to buy a house right after they leave residency. Society gives us a big push to own a house, after ...

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I made the decision to get an MD/MBA when I was still in high school. I had an interest in medicine but hated the idea of being yet another Indian doctor. How unoriginal. So when my dad introduced me to someone who had done this dual degree, it was my “aha!” moment. As far as I knew, this was something different. It could set me apart, and no one else ...

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According to Bloomberg, Americans spend more on prescription drugs per year than any other country in the world at around $1,100 per person. Additionally, the CDC reports that four out of five new heroin users started their addiction by using prescription opioid painkillers like hydrocodone or oxycodone. And we know from the Partnership for a Drug-free America that ...

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Seeing patients in my OB/GYN office this morning, I try to stave off the mild nervousness rumbling inside of me. My good friend Monica is having a C-section this afternoon, and I'm performing it. We met ten years ago when I walked my three-year-old daughter into Monica's preschool classroom for the first time. Monica sat on the floor, a child in her lap and others playing around her. Like them, I ...

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I visit him in the ICU day in and day out. It's the man with the fedora. I see him every day because he is not going anywhere. The metastatic cancer has ravaged his colon, bones, liver, and lungs. His oncologist is willing to try more chemo — but not now — maybe someday “when he is stronger.” The man has already failed several other regimens. The oncologist hasn’t seen ...

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Seventy percent of the children and adolescents I see in clinic are obese so I have many opportunities throughout my clinic day to talk about exercise and nutrition. Although the general message is the same, precisely how I deliver the information matters more than I could have imagined. I found this out quite accidentally. It was toward the end of the day, two months after the firestorm in Santa Rosa, California. ...

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I return there sometimes in my dreams.  Plodding down the streets of my childhood, I turn sharply to the right and push through the door as the bell clangs announcing my presence.  A middle-aged man is bent over rummaging; he peers past the display case and calls to me in acknowledgment.  The air is warm and humid inviting me to peel off my jacket, hat, and gloves.  I throw them ...

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To complement Aaron Lacy’s post on treating colleagues with respect, I’d like to expand that concept to include treating patients with respect too. That means if a patient says she’s freezing, and adding insult to injury, has been sick as well,  adjust the thermostat a little, please, even if you as the doctor isn’t cold. When a stray cat came to our door in the dead of winter, ...

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While infertility may be a problem affecting nearly 7.3 million women in the United States between the ages of 15-44, it is a topic that women often don’t discuss. Rather, they suffer from the emotional pain that accompanies hormone injections, multiple procedures, and sometimes miscarriage. How is it best to treat this vulnerable population that rarely gets the attention it deserves? The answer lies in a team approach to medicine. According ...

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What is borderline personality disorder (BPD)? According to the National Institute of Mental Health, unstable moods; impulsive and reckless behavior, and unstable or volatile relationships may be indicative of BPD. People with BPD often have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides. They often make poor life choices and take unwise risks. Thus, adults with ...

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Less than one year ago, on an early fall evening in Las Vegas, 59 people were killed at the outdoor Harvest music festival. A single shooter injured hundreds more, using firearms purchased through lawful channels. There have been many mass shootings in our country, before and since, and in 2015, deaths from gun violence eclipsed for the first time deaths from motor vehicle accidents. Not long after Las Vegas, discussion emerged in ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. Her name is Wanda Poltawska. She is currently 96 years old and showing the physical signs of advanced aging, but remains mentally sharp and insightful. What makes her special is that in 1941, at 19 years of age, she was sent to a concentration ...

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