The year was 1976. I was graduating from a small branch of my state university with a bachelor's in chemistry when I first applied to medical school. I was living at home and paying my own tuition. There were no physicians in my family, but I became interested in medicine after I was impressed with a surgeon who had operated on my shoulder. I had a better-than-the-medical-school-acceptance-rate average on my ...

Read more...

Dear President-elect Trump, You have stated that one of the first things you will do in office is to overturn Obamacare. You state that you will keep coverage for pre-existing conditions and children to age 26 but beyond that is unclear. Speaker Ryan said it would be "patient centered" but what that means remains to be seen. You now have a former surgeon as head of HHS. If I may, I would ...

Read more...

"If you do not cooperate, doctor, we will have no choice but to label you as being 'disruptive' and take whatever steps are necessary to remedy the situation." What physician does not dread hearing these words? Over the past several years, the term "disruptive" has been increasingly used to characterize and intimidate a physician who is perceived as not being a "team player." With hospitals increasing the difficulty in navigating a ...

Read more...

One of the latest trends in health care is “patient choice,” meaning the patient is in charge of their own care. Our job as a physician is to educate patients about the diagnosis, discuss the various treatment options, go over risks and benefits, then allow the patients to choose the best course of action. Of course, this assumes that patients always make the right choices and are solely motivated to ...

Read more...

One very late spring evening during my last year of residency, I was driving home and got stopped at a police DUI checkpoint. I was exhausted from being up all night from being on call the night before and having been very busy had no time to shower, shave or change into my street clothes. I also got called in at 4 a.m. the previous day and had not showered or shaved that ...

Read more...

I remember the first time I experienced the paradigm shift when it came to pain management. Sometime around the late nineties while I was on call, I received a phone call from a floor nurse stating that a patient that had their ankle operated on that day by another surgeon was having increased pain that was not controlled by the pain medication that had been ordered. As I had been doing for ...

Read more...

Orthopedic surgeon Thomas Guastavino often alludes to his "rules of medicine" in the comments.  Here they are in their entirety. Efficacy, safety, and cost are of chief concern. If two treatments are of equal efficacy, choose the safer. If of equal efficacy and safety, choose the cheaper. Cost never trumps efficacy or safety. If you want the fastest, most efficient and cost-effective care, go to the physician with the most experience in dealing ...

Read more...

Last year, I retired from full-time practice and moved to a new area. At about the same time, my wife was diagnosed with breast cancer, and because she was in good health prior, she had relatively little contact with the health care system as a patient. Before our move she worked as a part-time school nurse, so we were able to share provider horror stories from different perspectives. Since we moved ...

Read more...

shutterstock_52832917 Daytime TV advertising is dominated by two players. Pharmaceutical companies with direct to consumer pitches and the so-called "toxic tort." How confusing it must be to the average person to see a new drug pushed by one commercial, to be immediately followed by another commercial from a lawyer trying to sue for the known side effects of the exact same drug. It ...

Read more...

shutterstock_95651341 There can be little doubt that these days that political correctness has run rampant. Terms like "racist," "sexist," or "homophobic" are thrown around so frequently and early now that one has to wonder what is actually being accomplished. If you were to ask a physician what PC label they most fear, it would be "disruptive." Let's face it. We are no longer ...

Read more...

Get KevinMD's 5 most popular stories.