Dear medical student, resident, or fellow,
You will one day forget something. We are currently in a systematic plot to have everyone forget something important. We are quietly unaware it is happening. We are asked to forget how we got here. I want to remind you. I want us all to remember.
You undoubtably were more mature than your peers. You undoubtably sacrificed to develop the persona that one day would impress …
Welcome to the medical profession
Summer is heating up, and so is the election rhetoric. In this year’s campaign for the White House, when it comes to verbally attacking each other, neither candidate seems to recognize any limits. Personally, I think this behavior reflects poorly on both candidates.
In heath care, it’s almost impossible to escape this negativity. The media devours and thrives upon it. In our hospitals, televisions in the doctor’s lounge, cafeteria and in …
It’s time to stop using the language of war in health care
My eyes open. The blackness of the call room envelopes me. Consciousness sets in with a lingering disorientation. A small green light, is speaking … ringing. “Are you standing up?” The resident on the other end knows her attending too well. She’s right not to risk my falling asleep mid-conversation.
A woman has arrived laboring at 24 weeks gestation. Records aren’t available, but she reports her fetus has a diaphragmatic hernia. …
This is the only time she will hold her daughter alive
Why must we keep repeating history?
NCLB significantly increased the federal role in education by holding schools accountable for the academic progress of all students. NCLB held teachers responsible for education of children; MACRA-proposed changes will hold physicians responsible for the medical progress of our patients. The largest problem with this approach is students and patients go home each day to whatever environment in which they live. Neither teachers nor physicians …
MACRA will do to medicine what No Child Left Behind did to education
Dear Dad,
I often think about the night you passed away. I was caring for you while you were dying from metastatic colon cancer. Every hour I woke up to give you Dilaudid so you wouldn’t feel pain and Ativan so you wouldn’t be scared. You had only just been diagnosed eight months before. Despite aggressive chemo, radiation, abdominal surgeries, and all the hope and prayer in the world, the cancer …
I will not let medicine dehumanize me
Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent — in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to …
Fixing the breakdown in patient satisfaction
Now that the dust has settled in the wake of America’s most recent mass shooting, the odds seem high that history will repeat itself, and our legislature will again fail to enact any meaningful reform.
Like it or not, we as a country, through our elected representatives, have decided that we value unfettered access to deadly weapons over an individual’s right to feel safe in public spaces. Why …
Access to guns is easy. Access to trauma care is becoming more difficult.
The morning my patient Evan tried to end his young life, I woke up early to make banana pancakes. It was a warm spring day, and I pushed up the windows in my kitchen. That same morning, Evan opened his window with a different intent. He had argued with his parents the evening before, not unexpected at 16, yet this was different. Evan is transgender, and his parents were not …
We are all connected to the well-being of LGBTQ youth and their families
Starting this fall, second-year students will no longer have the stress of grades at our medical school, Washington University in St. Louis (WashU). In extending the pass-fail system from the first year to the second preclinical year, WashU joins the other 18 of the top 20 research medical schools on U.S. News and World Report that grade the entire preclinical curriculum on a pass-fail basis. (The sole holdout is Penn, …
Pass-fail is here to stay in medical schools. And that’s a good thing.
For many people with chronic disease, the toughest thing is convincing themselves they’re not crazy. This is especially true for those with an illness with no clear etiology.
For millions of people around the world suffering from multiple sclerosis, lupus, fibromyalgia, chronic abdominal pain, ALS, rheumatoid arthritis, certain types of cancer, chronic fatigue syndrome, and hundreds of other illnesses, just making it through the day is overwhelming. Not only do many of …
A guide to surviving chronic disease
With Obamacare and creation of health insurance exchanges, many believed that health insurers would compete for patients much the same way hotels, rental cars companies, and airlines compete for customers. By comparing identical benefits packages from different insurers, patients could select their insurer based on the monthly premium and the extent of the hospital and physician network.
In a recent Vox article, Ezra Klein urged insurers do “something like …
Will integrated health care startups make health care better?
In the medical field, it is said that July, not April, is the cruelest month. It even has a name, the July Effect. In June, hospitals hum and smoothly operate after a year of working out the kinks. In July, they welcome, or dread, the arrival of new recruits: newly minted physicians and medical students, eager to prove themselves, yet raw and untrained. For me, as a senior resident, it …
This is what makes a good doctor
It’s that time of year where upcoming fourth-year students are frantically preparing applications for their chosen specialties. Statements like “I LOVE psoriasis,” and “’I’m fascinated by the colon,” are heard from eager, smiling, seemingly-passionate faces when asking preceptors for a “strong letter of recommendation.’”
But what about you? You know, the one whose specialty decision-making process feels more like being tossed into an M.C. Escher lithograph than the instant, undeniable attraction …
You don’t have to love your specialty. Here’s why.
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I sat across from her and in my most official yet trusting psychiatrist’s tone gave the spiel I delivered many times.
“Amanda, I’d like to start you on a medication that might help your depression. Like every medication it can cause side effects, however, many people have no side effects or only have minor ones. This drug can cause weight gain, increased risk of diabetes, and increased risk of heart disease.”
A …
The psychiatrist with a psychiatrist
Recently, physicians in small private practices and rural areas breathed a collective sigh of relief. There is a possibility the implementation of changes to physician reimbursement (known as MACRA) could be delayed. Thank you, Mr. Slavitt, for listening. I am grateful to Orrin Hatch (R-UT) and Ron Wyden (D-OR) for keeping our rural needs in mind. We have a window of opportunity for rural health care to survive, but we …
To fix rural health care, you have to understand it first
I had just taken over three other residents’ phones and pagers when 2-year-old “Bryce” jumped off the couch in our oncology unit, landed on his chin, and bit completely through his lower lip. I quickly reviewed his platelet level from that morning, examined him, and began calling plastic surgery and anesthesia for sutures. While I was on one phone, a second one started ringing. I declined the call and tried …
It’s time to disrupt basic communications in hospitals. Here’s one idea.
When diagnosed with abdominal mesothelioma, a rare cancer with a blighted future, evolutionary biologist and writer, Stephen Jay Gould, turned his attention to the statistics; specifically, the central tendency of survival with the tumor. The central tendency — mean (average), median and mode — project like skyscrapers in a populated city and are the summary statements of a statistical distribution.
The “average” is both meaningful and meaningless. The average utility of …
The most powerful driver of medical costs is hope
I am blessed to love being a doctor. As the child of two physicians, and the fifth generation of physicians in my family, I had no choice but to go to medical school. But from the first day of medical school, I loved it. What a privilege, to know how the human body works! And I didn’t think medical school was particularly fun: I thought it was hard. The first …
10 pieces of advice for new physicians
“Code fifty-two, emergency room. Code fifty-two, emergency room,” blared over the loud speaker in the hospital. Simultaneously a chorus of beepers went off, like crickets on a sticky summer day.
I glanced down at my pager that echoed the same message “CODE 52, EMERGENCY ROOM.” The same message flashed across the screen three more times as I ran quickly down the main hallway. Code 52 meant trauma. I was about to …
A medical student’s first trauma
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