I question the ethics of any doctor who sells supplements to patients

Physician
September 20, 2016

I was seeing a patient who brought me a bag of supplements she bought from another specialist. I looked skeptical and then she pulled out the list of lab results the other doctor ordered on her. I reviewed the results with her and asked why all these tests were ordered in the first place, some of which I had never ordered in my life. She said she told the specialist …

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I question the ethics of any doctor who sells supplements to patients

If doctors wanted to be wealthy, they would have become UPS truck drivers

Physician
September 19, 2016

figure-1-for-kevin-pho

Do doctors make too much money?

I don’t think so. I read with great interest the blog by Dr. Michael Kirsch defending physicians’ salaries: “If you think doctors make too much money, think about this.” Unfortunately, the public’s perception of physicians’ incomes has been that physicians make too much money.

Whenever I hear this remark from patients or even non-physicians, I show …

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If doctors wanted to be wealthy, they would have become UPS truck drivers

Reflecting on sepsis: Definitions, new ideas, and a continued commitment to patient care

Conditions
September 19, 2016

sepsis-blog-9-2016

CHEST_sig_horiz_PMS-TMSeptember is Sepsis Awareness Month, a month which aims to raise awareness of sepsis and strategies for prevention and treatment. Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when the body’s response to infection becomes dysregulated and white blood cells and chemicals cause injury to organs throughout the body.

Earlier this …

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Reflecting on sepsis: Definitions, new ideas, and a continued commitment to patient care

Pain patients are being cut off from their drugs. Here’s why.

Meds
September 18, 2016

In March, 2016, the CDC released guidelines for prescribing opioids.  The guidelines were a response to a serious and growing problem: millions of pain patients became addicted to prescribed opioids, and hundreds of thousands died as a result.

Since the guidelines were released, reports of pain patients being abruptly cut off of their medication or having their medication abruptly reduced have become rampant. These patients report they were using opioids long …

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Pain patients are being cut off from their drugs. Here’s why.

When treating chronic pain, don’t compromise your principles

Meds
September 17, 2016

One of the most difficult things I deal with as a physician is patients’ demands for pain medications. I treat patients with cystic fibrosis, a genetic disease present at birth with no cure, and its issues are indeed complex. There are legitimate causes for misery from the chronic coughing, abdominal pain, and joint pain recognized as common symptoms of the disease.

But the associated issues of depression, stress with family, and …

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When treating chronic pain, don’t compromise your principles

A medical student’s struggle with continuity of care

Education
September 16, 2016

“I can’t find the fetal heart tones.” The nurse states with a tone of underlying panic as she exits the patient room.

It’s around 7 a.m., and those of us working the night shift are getting ready for morning sign out before we can head home and get some much-needed sleep after a crazy 14 hours shift.

“Tessa, go scan her” the resident nods towards the ultrasound machine, and I cheerfully follow …

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A medical student’s struggle with continuity of care

The social history: Our patients are more than their diseases

Physician
September 15, 2016

“Any alcohol use? Any tobacco use? Any other drugs?”

These are the three main questions that most health care providers ask their patients when documenting a social history on a note.

“What stressors do you have in your life? What social support do you have? What is your home life like? What do you do for fun? Do you wear a helmet when you ride a bike? Do you wear a seatbelt?”

I …

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The social history: Our patients are more than their diseases

The inhumanity of medical residency programs

Physician
September 13, 2016

My mother-in-law died last week.

She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now …

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The inhumanity of medical residency programs

Medical eponyms: Where women are clearly underrepresented

Physician
September 13, 2016

The month of September has been Women In Medicine Month (according to the AMA) since 1989.

Statistics are always telling:

  • Currently 65 percent of practicing physicians are men, and 35 percent women.

Medical eponyms: Where women are clearly underrepresented

You can’t prepare for a rotation in the pediatric ER

Education
September 12, 2016

Walking into Riley Pediatrics Hospital in Indianapolis, Indiana, and having just completed two prior rotations in emergency medicine at two different level 1 trauma centers, I thought I would be able to easily fit in with pediatric population here. I thought I would be able to slide fluidly from patient to patient, oral reports to consults, while staying connected with the rest of the team. I thought I would be …

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You can’t prepare for a rotation in the pediatric ER

MKSAP: 34-year-old woman with very dry, painful hands

Conditions
September 10, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 34-year-old woman is evaluated for very dry, painful hands. She works in a daycare center and washes her hands 15 to 20 times daily, often for 2 to 3 minutes at a time. She has been applying lotion multiple times daily with no relief of the pain. She has a history of …

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MKSAP: 34-year-old woman with very dry, painful hands

The story of a neurologist who quit medicine and lives on a boat

Physician
September 9, 2016

I write this while sitting in our sailing catamaran, swaying in the wind and current eight feet above sand and sea grass.  I know this because I can see right through the water in the Bahamas.  There is clarity here.

When I started this journey thirteen months ago, I was burning with anger.  I was angry at insurance companies for developing complex, mutable formularies, coverage policies, and appeal procedures, maximizing my …

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The story of a neurologist who quit medicine and lives on a boat

How nurses and law enforcement can work together

Conditions
September 7, 2016

The recent horrible events involving racial profiling, excessive force, and gun violence are deeply troubling but not new. Who can forget the Bronx shooting of Amadou Diallo in 1999 when 41 bullets rained down on his unarmed body. I can uniquely identify with the black experience because of my own numerous experiences of being pulled over for no other apparent reason except for being in the wrong neighborhood, wrong state …

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How nurses and law enforcement can work together

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The cure for a poor historian? A good medical record

Physician
September 4, 2016

Think keeping your life organized is hard? Try keeping your doctors organized.

In this era of fragmented health care, patients find themselves in the impossible position of having to coordinate their care themselves — a task that many can’t meet. Having multiple chronic medical conditions often means being subjected to a dizzying assortment of specialists, medical terminology, and tests that can quickly overwhelm patients.

How many times have you found yourself in …

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The cure for a poor historian? A good medical record

How a board of optometry is restricting eye care to homebound adults

Physician
September 2, 2016

This spring, the California Board of Optometry shut down the only optometrist providing services to homebound patients in the San Francisco Bay Area. I learned about this because affected patients included several referred from our UC San Francisco Housecalls program, one of a few non-profit, non-concierge home-based practices in the state providing geriatrics care to homebound adults.

With over 1 million adults homebound in California, why would any board deliberately limit …

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How a board of optometry is restricting eye care to homebound adults

What kind of doctor do you want to be? Think about it.

Education
August 31, 2016

“A doctor’s mission should not be just to prevent death, but to improve the quality of life. You treat a disease, you win-you lose. You treat a person, I guarantee you’ll win, no matter what the outcome.”
– Patch Adams (1998)

It’s that time of year where everyone begins residency applications, and you commonly hear conversations along the lines of, “What are you going into?”, or, “what type of doctor are you …

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What kind of doctor do you want to be? Think about it.

To the doctors struggling with depression: You are not alone

Physician
August 30, 2016

By the end of my first year of residency, I knew I was in trouble.

I was overwhelmed by the 15-hour days, the unbearable sadness of the tragedies I witnessed, my feelings of impotence and my fears of making a mistake.

My life was my work, and everything else seemed to be falling apart: my physical health, my relationships, my ability to sleep after months of night shifts.

Yet, I came to work …

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To the doctors struggling with depression: You are not alone

Why are ERs so busy? It’s really no surprise.

Policy
August 29, 2016

If the emergency room is the most expensive place to receive health care, then why are more patients visiting the ER than ever before? There are no local doctors’ offices that can charge $1,000 to put a Band-Aid on your finger or $8,000 to tell you that your abdominal pain is due to drinking too much coffee.  But, I don’t think you would mind paying this premium if you were having …

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Why are ERs so busy? It’s really no surprise.

You failed your surgical boards. What’s next?

Education
August 26, 2016

“I graduated this July and took the QE (written general surgery boards) on July 19th. I got my results today, and I failed. Not only did I fail but my score placed me in the 5th percentile. Needless to say, I’m disappointed. You hear stories about CE (oral exam) failure but never about QE failure. I never blew the ABSITE out of the water (50, 29, 20, 34, …

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You failed your surgical boards. What’s next?

The bureaucratic hassles physicians face are extraordinary

Physician
August 25, 2016

Left to our own devices, most of us physicians try our best to provide high-quality care to our patients. But almost none of us provide perfect care to all of our patients all of the time. In fact, many of us get so caught up in our busy clinic schedules we occasionally forget to, say, order mammograms for women overdue for such tests, or we don’t get around to weaning …

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The bureaucratic hassles physicians face are extraordinary

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