Soon after match day, I became concerned. I knew I was going into emergency medicine. However, I felt unprepared to manage a clinical encounter with limited time and incomplete information. At the time I entered residency, the only published guides available on “how to be an intern” reviewed the medicine I already knew. The only books available on decision-making included statistics, which I knew wouldn’t be immediately useful in a ...

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As a rising fourth-year med student, these are my words of wisdom for all students who are on their clinical rotations. Your mental health is paramount; do not neglect how you are feeling! There is not one med student that I know of who hasn’t felt anxiety, paranoia, or depression. Some of your peers may even be diagnosed with psychiatric disorders and take medications. And that is OK! As a mentor of ...

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One of the most valuable jobs I held following fellowship was working as a full-time deputy editor at UpToDate. My “territory” was breast, gynecologic, and genitourinary oncology, and I helped launch cancer survivorship and palliative care. I learned to really and critically read the literature, and how I could summarize it quickly so that my ...

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He came to the office in search of help as many patients do, but the circumstances that compelled him to seek medical attention were all too similar to me. I’ve seen it time and again. He said that he couldn’t sleep at one visit. At another, his blood pressure was high. At a visit after that, he’d share more information, and his wife would attend with him. He wasn’t making enough ...

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"Boxed warnings" or "black boxes" are the strictest FDA label warnings. They appear on cigarettes, fluoroquinolones (for tendon rupture), Lamictal (for SJS and TEN), Accutane (birth defects), and other products with well-known risks. The industry obviously dislikes black boxes since they reduce sales (though their lobbyists charge the boxes "confuse" and "unnecessarily alarm" patients). So it was no surprise that when the
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In a shocking development that could transform the medical profession, the International Journal of Health Services published the findings of a study titled, “Primary care, specialty care, and life chances.” Using multiple regression analysis, the researchers concluded that “primary care is by far the most significant variable related to better health status,” correlating with lower mortality, fewer deaths from heart disease and cancer, and a host of other beneficial health outcomes. By contrast, ...

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What if I told you just a few years ago that Amazon — a budding e-commerce startup — would come to disrupt the multi-billion dollar retail industry. I seriously doubt that anyone could have given it a serious thought. At least not in the magnitude that will force a slew of big-box retailers to shut their doors for good. I am sure the same response would have been elicited about Uber and ...

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"Compassion fatigue" is a phrase thrown around easily when talking about the health care professions. It is often spoken in the same breath as "burnout" and "turnover" while discussing the crisis of a diminishing workforce and increasing demand in health care. The phrase brings to mind the burnt-out nurse who doesn't have the emotional energy to care anymore. I can see her: deep frown lines, flat facial expression, dimmed eyes. The light ...

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Wiley Boynton is dead. I first heard the news when Katie, a colleague, called me on my cell phone. Wiley had been taken to the hospital with a knife wound. I asked her right away: "Self-inflicted?" "I think so," she said. A self-inflicted knife wound might be possible, I figure with someone like Wiley, considering the violent world he came out of. I know quite a lot about him. Wiley is around 40 years ...

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We knew that the most powerful way to provide substance abuse treatment is in a group setting. Group members can offer support to each other and call out each other’s self-deceptions and public excuses, oftentimes more effectively than the clinicians. They share stories and insights, car rides, and job leads, and they form a community that stays connected between sessions. Participants with more experience and life skills may say things in ...

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If you talk to anyone you know, it’s very likely they will tell you that they are on some form of social media. Whether this is Facebook, Twitter, Instagram, Snapchat, TikTok, or YouTube, most people are on at least 1 to 2 forms of social media these days. Video is one of the most powerful tools in marketing. According to Google, 64 percent of consumers use video to research health care ...

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We constantly argue about how to fix the U.S. health care system. But what we must understand is that the most important issue isn’t how to fix health care. The issue is how to get our Congress, the President, and the health care industry to allow anything of importance to change at all. The problem is that all three have a vested interest in the current system. The health care ...

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A recent excellent piece by Dr. Karen Sibert, an experienced anesthesiologist at my institution, raised some critical issues regarding how physicians are thought of by non-physicians, and how misguided that thought process is. Indeed, our stress levels associated with the moves we make and the decisions we contemplate, some of which are made and done in milliseconds, do not come with a price tag, but do ...

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When I finished my training, I wish that I had known all of the options I could practice medicine.  Most of us categorized our options as either “academic” practice or “private practice,” but in reality, these two options only cover the tip of the iceberg.  Was my limited understanding a shortcoming of my medical training?  Perhaps.  I doubt that many medical schools back then actually had seminars on practicing medicine. ...

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I write this hoping to appeal to common sense. When are we going to stop putting the cart before the horse? 99 percent of the rhetoric surrounding health care costs centers on a “fair” way to pay for it, “fair” reimbursement levels, and who should pay this “fair” level of payment, when the real issue is the amount being charged in the first place. What exactly is “fair”? The real central, ...

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They say you learn a lot from your clients. Not in anesthesia, where I frequently feel great empathy for my sick patients and their families. Our connection in the peri-operative environment is too short-lived for this, I believe. But in therapy, where the relationship is both critical and deeper, and where I have more recently turned my attention, I have come to appreciate that observation personally. I specialize in “burnout,” that ...

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In a New York Times article, “The Huge Waste in the U.S. Health System,” it stated that the estimated waste is at least $760 billion per year: “That’s comparable to government spending on Medicare and exceeds national military spending, as well as total primary and secondary education spending.” Why is waste so prevalent? There are many sources. The biggest one, and the one that should most concern ...

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“Oh, you’re here to take me to my test.”  I have heard this too many times to count, and I have come to perfect my response. “No, I am not patient transport, your social worker, or your nurse. I am your doctor.” After a moment of confusion, I usually see a facial expression signaling that the patient is reframing his or her initial thoughts. Maybe I am misidentified because I am young, or ...

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I recently discovered a fact about the United States of America that should be a source of embarrassment for all Americans. What I found out is this: There is not a single safe injection site anywhere in the entire country. Safe injection sites save the lives of people addicted to opioids, such as heroin and fentanyl. These sites exist in countries around the world, and they are working every day ...

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On a rare Sunday morning, I woke and had the time to make breakfast for my kids and their cousin, who'd stayed the night. My nephew said, "Thanks, Aunt Erin, I feel like I never see you." To which my oldest (10) stated very matter-of-factly, with no ill-intent: "That's because she's never home." Being a full time, private practice physician and mom to 5 kids, with a healthy social life, it's extremely ...

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