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Patient refuses ED discharge: Admitted to the hospital against medical advice

FirstWorldEM, MD

Physician

March 27, 2015

The following article is satire.

In the first application of a new “reverse AMA” system put into place to improve patient satisfaction, a patient was admitted to the hospital for the first time against the wishes of her treating ED physician. Constance Dolor, a 37-year-old morbidly obese patient with chronic unexplained pain and a frequent visitor to the emergency department, became the first person in known history to be admitted the …

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I’m not apologizing for my part-time role in medicine

Physician

March 26, 2015

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Over the course of pre-professional and professional education, my colleagues and I have had numerous moments of self-doubt. Would the next organic chemistry exam eliminate my 3.99 GPA? Would the MCAT decide what medical schools would immediately ignore me without ever meeting me? Would the sheer volume of material weed out the persons sitting next to me in medical school or …

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The day that I truly became a cardiology fellow

Chiduzie Madubata, MD

Physician

March 24, 2015

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As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies.

As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is …

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The last breath can be seen as a the passage into eternity

Kathryn A. Hughes, MD

Physician

March 24, 2015

Eonia I Mnimi (Eternal Memory)
– Greek Orthodox Funeral Blessing

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.

***

My uncle had been declining for several years with Lewy …

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Television ruins your sleep. Here are 5 ways how.

Deep Ramachandran, MD

Conditions

March 24, 2015

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As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; any more than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of …

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Are cardiac risk calculators accurate?

Kenneth Lin, MD

Conditions

March 23, 2015

After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient’s estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline’s new risk calculator had not been validated in …

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What does it mean to live in the age of Abilify?

Steven Reidbord, MD

Meds

March 23, 2015

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S. To be a top seller, a drug has to be expensive and also widely used. Abilify is both. It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill. Annual sales are over $7 billion, nearly a billion more than the next runner-up.

Yes, you read that right: $30 a pill. A little more …

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8 reasons why you should marry a female physician

Jamie Coleman, MD

Physician

March 23, 2015

A couple of years ago, I asked a friend of mine how she met her husband. It was at a bar, and when she asked his occupation he replied, “I work for the city.” She took that to mean he was a construction worker. They began dating and quickly fell in love. Much to her surprise about a month into their …

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Heart-wrenching photo of a doctor crying goes viral. Here’s why.

Pamela Wible, MD

Physician

March 20, 2015

Outside of a Southern California hospital, an ER doctor is crouched down against a concrete wall grieving the loss of his 19-year-old patient. A paramedic snaps a photo of the tender scene. His coworker, a close friend of the doctor, posts the photo (with permission) online. Minutes after the photograph, the doctor returns to work “holding his head high.”

Thousands of people have …

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Eulogy for the doctor

Michael Brant-Zawadzki, MD

Physician

March 17, 2015

No physician, however conscientious or careful, can tell what day or hour he may not be the object of some undeserved attack, malicious accusation, blackmail or suit for damages … “
– Assaults Upon Medical Men. Journal of the American Medical Association, 1892

It’s happened again: A well-liked doctor is killed by his patient. Last year’s horrific death of a physician in our community, a …

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Want your ER physician to leave happy? Do these things.

Thomas Paine, MD

Physician

March 17, 2015

I have been doing emergency medicine for almost ten years — thirteen if residency counts, and I sure think it does. I face the same issues that cause my work colleagues, physicians and nurses alike, to burnout. I struggle with burnout myself, but I keep coming back. Many days (and nights), I ask myself why I continue to do what I …

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3 myths and 3 truths about hospice

Monica Williams-Murphy, MD

Physician

March 17, 2015

As I travel around speaking about preparing for peace at the end of life, I have found that there are three pervasive myths about hospice that might cause you to inadvertently rob yourself or your family of a peace-filled end-of-life experience.

So, I am taking on the job of myth-buster to clear the air. Here goes:

Myth #1: Hospice is a place. While hospice can be a place, it is primarily a service. …

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Surprise! When it comes to a vaginal hysterectomy, this insurance company gets it right.

Jennifer Gunter, MD

Conditions

March 16, 2015

The preferred route for a hysterectomy is vaginal. This means the entire surgery is done through the vagina with no incisions in the abdomen of any kind. The joke among surgeons is that it is a bit like taking a car apart through the muffler. While doing surgery entirely through the vagina may sound highly complex, it’s really just like any surgery. A vaginal hysterectomy done correctly it is an …

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We are overprescribing statin medications for high cholesterol. Here’s why.

Richard Young, MD

Meds

March 16, 2015

The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins.

One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication …

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10 secrets to success as a female surgeon

Lauren Crawford, MD

Physician

March 13, 2015

I bolted through the conference room door on the first day of residency orientation. The room full of interns shifted in their seats. All one dozen of the faces looking up at me were male. I got some crooked, goofy grins. So began my introduction to the world of surgery.

So, what would I tell my daughter about how to survive and …

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The ABIM response to Newsweek determines how far anti-MOC sentiment will spread

KevinMD

March 13, 2015

Regular readers here are well-versed on the controversy surrounding maintenance of certification (MOC) and the American Board of Internal Medicine (ABIM).

The story recently made mainstream news, with a comprehensive recap by Newsweek senior writer Kurt Eichenwald: The Ugly Civil War in American Medicine. Go read it.

The ABIM subsequently released a strongly-worded statement. They are clearly not happy with the mainstream media spread …

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A surgeon will always have two spouses

Robert Sewell, MD

Physician

March 12, 2015

I’m an old school general surgeon. I graduated from med school in 1974 and after a five-year surgical residency in San Antonio, Texas, I started out on my own, ready to cure the world. Boy, was I raw. Like many of my peers, I got married during medical school, and like every surgeon back in those days I told my wife, …

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Ease the transition to hospital medicine

Tracy Cardin, ACNP

Physician

March 11, 2015

I came to hospital medicine from the land of pulmonary-critical care. I had spent ten years dealing with septic shock, respiratory failure, and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes; I ran codes. In short I was a critical care bad ass. I thought I was hot stuff. But I …

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Why can’t physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants just get along?

Karen S. Sibert, MD

Physician

March 10, 2015

American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time.

In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is …

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Pay doctors and nurses for the time they spend charting

Physician

March 9, 2015

I have a unique perspective as a physician. Having traveled to many hospitals in the past two years, working as a locums emergency physician, I can comment on a variety of issues with a reasonable amount of experience.

One of those issues is EMR, or electronic medical records. I have spent plenty of time writing about this in the past, and I …

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