Kahlil Gibran writes, "In friendship or in love, the two side by side raise hands together to find what one cannot reach alone." What types of outcomes can physicians and patients achieve in healing, living, and life when Gibran's message is incorporated into the physician-patient relationship? Can humanism in medicine become even more humanistic? "Humanism in medicine" is characterized by the Arnold P. Gold Foundation as respectful ...

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I think it’s time for physicians to end the assault on the clinical practices of PAs and NPs. Are you worried about PAs and NPs taking your job? If you’re a good doctor, you should stop worrying. Great PAs and NPs are everywhere, and I think it’s time physicians embraced them. PAs and NPs have excellent skills My first rotation as a third-year medical student was in the emergency department. There was a ...

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During a day of shadowing during my first year of medical school, the physician I was following had been running behind schedule and instructed me to keep the final patient company until he caught up. I knocked on the door and found myself facing a wide-eyed, middle-aged man staring down apprehensively at his severely bloated stomach. As I asked the patient what was going on, he suddenly looked up at me and ...

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The issue of noncompliance comes up repeatedly in patient care. Whether in the context of primary care or allied health care, in most situations, patients seem unreasonable and irresponsible when it comes to taking their medication, attending consultations, adjusting lifestyles, or heeding the advice of their providers. A critical examination presents the term "compliance" as negativistic and synonymous with victimization, powerlessness, and the inability to self-determine. Due to the gravity of some ...

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“Listen to your patient; he is telling you the diagnosis.” This quote from famous physician William Osler is as true today as it was 100 years ago. And yet the latest version of President Trump’s executive order on Medicare threatens what patients overwhelmingly want: a physician involved in their care. Section 5-C of the President’s order focuses on payment parity and supervision of mid-level providers. Changes to either issue would create unintended ...

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I ran late the other morning. My first patient, an internal transfer, was already waiting. Booting up my laptop seemed to take forever. Usually, I try to poke around at least a little in the EMR before I enter the exam room, even when I know the patient well in order to remind myself of what we are supposed to do in today’s visit. I decided to walk in cold because I ...

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I wanted to go the extra mile for my patient. The resistance I found was unexpected. She was young. Her life — an incredible journey in diplomatic circles — was crippled too soon by a recurring disease that would ultimately prevail. Day after day, I'd round on her in what seemed like a pointless exercise, waiting for the inevitable to come. Another round of chemotherapy would have to wait for her ...

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Because everything around us usually works, it can be easy to forget how fragile some of the workings are. My patients see this with their bodies, as they fail, but not so apparent to them are the fragilities of the health care system that we doctors get to see. Despite what the if-it-bleeds-it-leads press might have you thinking, our health care system is pretty good. Good, however, is never good enough, ...

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Medicine is for the birds, or it should be.  Hear me out.

A day before I wrote this, I was on the trail in northwest Ohio, binoculars in hand, trying to tell one warbler from another.  This was the final weekend of the biggest week of birding in Magee Marsh on the shore of Lake Erie.  Birders converged here from neighboring states and even from foreign countries ...

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Time is of the essence.  The very utterance of this phrase connotates a sense of urgency for an impending crisis or adversity if some essential action is not taken. I find myself most unexpectedly at this crucial junction. I am a seasoned, experienced general internal medicine physician, trained traditionally in hospital medicine, and subsequently evolved into outpatient care of comorbid complex chronic disease management. From everything I read and hear ...

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Graduation from my residency program was a bittersweet experience. At the time, my specialty was suffering from a crippling job shortage, so our futures were uncertain, and a dark mood had come to permeate my radiology residency. We were disgruntled with the specialty, with the system, and with medicine in general. I attended my graduation without any guests and only stayed long enough to receive my certificate. I was, however, honored ...

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Recently, a fellow physician mom ended her life. While outwardly, a very vibrant, lively, and happy woman, she fought her own internal demons for some time. From what we know, she struggled with depression but was still committed to being a good mom, physician, and wife. Sadly, a few days before her birthday, she could no longer bear her sadness and decided to end her agony. I know many physicians’ ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. In many ways, the patient-physician relationship is seen as being mostly one-sided, with doctors possessing medical knowledge and wisdom, and patients with less medical information being in a position where they need a physician’s help and guidance in managing their health issues. Consequently, ...

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Imagine if your bank handled all your online transactions for free but charged you only when you visited your local branch -- and then kept pestering you to come in, pay money and chat with them every three months or at least once a year if you wanted to keep your accounts active. Of course, that’s not how banks operate. There are small ongoing charges (or margins off the interest they ...

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The theme of the conference is the medical humanities. After Lawrence Hill's keynote speech, the lineup of people waiting to speak with him is long. At the end of the day, I'm inspired by the lectures I attended, but disappointed that I didn't get the chance to speak with Dr. Hill. I should have just stood in line. While waiting on my Uber outside in Hamilton, Ontario, Dr. Hill emerges from the ...

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Earlier this month Ross Douthat wrote a piece in The New York Times titled “The Age of American Despair” where he posed the question “Are deaths from drugs and alcohol and suicide a political, economic or spiritual crisis?” Douthat writes:

The working shorthand for this crisis is “deaths of despair,” a resonant phrase conjured by the economists Anne Case and Angus Deaton to describe the sudden rise in ...

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“I don’t know.” That is an answer patients hate to hear. It is also an answer doctors hate to utter, and in truth, many of us fail to say those words when it would be proper to say them. Doctors spent long hours over many years of training, sacrificing personal time and family life. Most of us are perfectionists, and not knowing a medical diagnosis often feels like failure. Perhaps, the ...

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It’s no secret that America (and indeed a lot of the western world) faces an unhealthy lifestyle crisis. Shocking statistics suggest that over 70 percent of the United States population is overweight or obese (defined as a BMI over 25). The consequential health effects are well known, and don’t need further explaining. As a country and health care community, we simply cannot allow ourselves to get to a place where ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old man is evaluated during a routine examination. He feels well and has no symptoms. Medical history is significant for hypertension. He does not smoke, and he does not have diabetes mellitus. He is active, performing aerobic exercise for 20 to 30 minutes four times per ...

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I have been fortunate in that I have not had to hospitalize any patients in the past four weeks.  This means I have an extra 60 minutes or more to prepare for the workday in my office. The streak ended this weekend when my associate, taking his rotation of being on call, hospitalized one of my patients with pneumonia. In many cases, pneumonia is treated as an outpatient. You receive an ...

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