Your vagina doesn’t need a herbal cleanse. Here’s why.

Conditions
January 25, 2016

I woke up to someone forwarding this tweet.

Yes, some company is selling tiny bags of herbs (they call them pearls) to stuff in the vagina for three days to cleanse your uterus or shrink your fibroids or treat bacterial vaginosis or tighten your vagina.

This is not only pointless it could be very dangerous. Here’s why.

Your uterus and vagina want you to leave them alone.

Your uterus isn’t tired …

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Your vagina doesn’t need a herbal cleanse. Here’s why.

The unintended consequences of the night float rotation

Education
January 24, 2016

This past month has been a particularly difficult one for me because I’ve been on our float rotation. I have worked only night and swing shifts throughout our hospitals; this means my work hours are primarily from 8 p.m. to 10 a.m.

There are certainly other rotations during which I worked longer hours and had more emotionally draining conversations, but I have never felt as burned out as I have this …

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The unintended consequences of the night float rotation

Physicians should invest time in work-life balance: It’s priceless

Physician
January 19, 2016

“As a mom and a doctor, what advice would you give a third-year medical student trying to choose a specialty?” the bright-eyed med student asked me.

Her smile was ear to ear, and I didn’t want to burst her bubble. This is a complicated question to ask and the answers change as life changes. I chose OB/GYN because it was the only specialty I truly fell in love with. For me, …

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Physicians should invest time in work-life balance: It’s priceless

A daily decision to prioritize my patients over my notes

Physician
January 16, 2016

It’s been a long day in the psychiatry clinic.

Seeing patients is never dull, and each interaction is meaningful in its own way. From the moment they walk into my office to the moment they leave, I try my best to be fully present with the patients sitting in front of me. That means listening to every word, watching every nuance of body language, hearing every concern — both spoken and …

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A daily decision to prioritize my patients over my notes

A letter to myself as a first-year oncology resident

Physician
January 15, 2016

I’m writing to you from the future — approximately ten years from where you are now. You’re a few months into your medical oncology residency, just beginning to assimilate to the flow of your daily responsibilities as a doctor committed to the diagnosis and treatment of cancer.

You hate living in upstate New York, and are dreading the upcoming winter and the associated endless piles of snow and sub-zero temperature nights …

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A letter to myself as a first-year oncology resident

Doctors grieve too: A lesson I did not learn in medical school

Education
January 14, 2016

“She is not yours to grieve.”

That statement, from another physician, hours after Ava died and as pent up tears rolled down my face, left me embarrassed and ashamed.

The message: She was my patient, not my child.

Never mind the amount of time and tenderness I had poured into her care during the month she spent in the pediatric ICU. I had no right to mourn her death. I am a doctor.

As …

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Doctors grieve too: A lesson I did not learn in medical school

10 rules every primary care doctor should read

Physician
January 13, 2016

Primary care medicine is intense and chaotic, a constantly mutating kaleidoscope of data, emotions, goals and obstacles. It is designed to confuse and distract, and will find and magnify any tendencies towards ADD in even the most organized clinician.

During my 30+ years as a family physician, I’ve come to depend on some core principles and concepts to stay grounded and maintain focus. Here are ten rules I have found useful, …

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10 rules every primary care doctor should read

The story of how this doctor lost his first patient

Physician
January 13, 2016

During medical school, we are taught the physiology, anatomy, and pathophysiology of hundreds of disease processes. One thing medical schools don’t teach well is how to cope with losing a patient. Some physicians will go many years as a physician before having their first patient die on them. Others will lose a patient earlier on during their career. I was the latter. I hadn’t even graduated from medical school yet …

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The story of how this doctor lost his first patient

The struggle of mommy-guilt in physician-mothers is real

Physician
January 11, 2016

What does a 3 year old know?

If you don’t like our toddler’s opinion, just wait; she’ll change her mind in a few seconds.  The ever-changing mind of a 3-year-old is what makes the fact that I decided to be a  doctor at that age all the more amazing.  But, that’s how old I was when my parents took me on a mission trip to Haiti, and I decided I wanted to …

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The struggle of mommy-guilt in physician-mothers is real

Prevent your baby from dying: 9 tips every parent should know

Conditions
January 10, 2016

Dead babies aren’t something anybody likes to talk about. But while it may be an uncomfortable topic, it’s also an important one — because there are things we can do to make it happen less frequently. The loss of an infant is something parents never really get over, and something that no parent should have to experience. Here’s a look at the most common causes of infant mortality and some things you …

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Prevent your baby from dying: 9 tips every parent should know

This medical student went to rehab. Here’s what she learned.

Education
January 9, 2016

As physicians, we are trained to look for change. We look for changes in lab findings and change medications, and we ask our patients, “what has changed since I saw you last?” We are always trying to get our patients to change in one way or another. Doctors are hardwired to seek changes that produce a dopamine release in our brains. We love it when patients see an improvement in …

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This medical student went to rehab. Here’s what she learned.

This doctor won’t prescribe Addyi, the “female Viagra.” Here’s why.

Meds
January 9, 2016

Addyi (flibanserin), the drug to increase female libido had a timid entry into the market with very few prescriptions considering the “hype.” Bloomberg Business reported 227 prescriptions in the first month. That’s a pittance considering Valeant paid $1 billion for the drug.

I am unlikely to help Valeant recoup their investment, because the more I read about this drug, the worse it looks. Here’s why:

It barely works

One of the study endpoints (meaning …

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This doctor won’t prescribe Addyi, the “female Viagra.” Here’s why.

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From medicine intern to radiology resident: Is the grass greener?

Education
January 8, 2016

When I was an intern in medicine, I couldn’t wait to start my role as a radiology resident. Even though I cared for my patients to the best of my ability and studied their diseases, I knew that my time in the department was limited. I wish I could say that I put my whole heart into my work, but with all of the extraneous demands of intern year — …

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From medicine intern to radiology resident: Is the grass greener?

This is why patients cannot be customers

Physician
January 7, 2016

The customer is always right, or so the saying goes.

If you have ever worked in retail, you may have been frustrated by buyers who ransack neatly folded tables of sweaters and leave them strewn about like tornado wreckage. If you are in the food industry, you may be annoyed by a diner who complains his soup is too cold even as you see steam rising off the bowl.

It can sometimes …

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This is why patients cannot be customers

Physicians aren’t burned out. They’re abused.

Physician
January 5, 2016

burnout

Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right.

We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get so f’d up so fast? Attention medical students and doctors: It’s not your fault.

Burnout is physical and mental collapse caused by overwork.

So why …

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Physicians aren’t burned out. They’re abused.

How partnering with urgent care created a dream primary care job

Physician
January 3, 2016

I have a dream job.

I make my own hours, working three 12-hour shifts on Tuesday, Wednesday, and Thursday.  I’m off Friday through Monday, and I don’t take any call.  I take as much vacation as my budget will allow, and if I wake up with the flu, I call off from work without the usual feeling of guilt and anxiety.

It wasn’t always this way.  Like all new doctors recently out …

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How partnering with urgent care created a dream primary care job

10 tips to make residency more enjoyable

Education
January 3, 2016

As a second year resident, I often do not feel like an expert in anything.  Every day I learn more about medicine and realize how much more I still want to learn.  In spite of the emotional, physical and mental challenges that being a young doctor entails, I have remained positive and have grown stronger throughout residency.  As I reflect on the past year and a half, I appreciate the …

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10 tips to make residency more enjoyable

I’m not worried about colon cancer. I’m worried about the potential colonoscopy.

Physician
January 2, 2016

“Don’t forget to bring that stool card back in, OK?”

As he walked out of the room, carrying his portable oxygen, he turned back, with the nasal cannula in his nose, and replied, “I’ll get it back to you soon.  I’d hate to have colon cancer.”

At this point, I’d hate for him to have a positive occult blood card.  I could really care less about colon cancer.  Colon cancer isn’t going …

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I’m not worried about colon cancer. I’m worried about the potential colonoscopy.

MKSAP: 48-year-old man with newly diagnosed hypertension

Conditions
January 2, 2016

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

A 48-year-old man with newly diagnosed hypertension is referred for an echocardiogram to assess findings of left ventricular hypertrophy noted on the electrocardiogram. He is asymptomatic, and his medical history is unremarkable other than hypertension. His only medication is chlorthalidone.

On physical examination, blood pressure is 128/70 mm Hg, pulse rate is 60/min and regular, and …

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MKSAP: 48-year-old man with newly diagnosed hypertension

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