“She’s ready to push, doc.”
It’s 2 a.m. I’ve been up for the better part of the evening, doing my part in the process of labor. I groan; I have a full day of clinic patients six hours from now.
But these are the wonderful times.
These are the times, in the rural hospital that I work, where it’s completely and totally about that laboring soon-to-be mom and her soon-to-be child. There are …
These are the times why I got into medicine
As the New Year arrives and health care continues its rapid evolution, one of the most critical challenges that we face is the interaction of information technology with frontline clinical medicine. If you were to ask, at the start of 2016, any physician (or even nurse) what their biggest daily frustrations are — most would list health care IT at or near top of the list. And it’s not just …
A 2016 wish list for health care IT
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 …
A daily decision to prioritize my patients over my notes
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2015 was a hard year for my father. He’s a remarkably healthy 89 year old, with no diabetes, no hypertension, and (most importantly) he’s got a sharper mind than I do on most days. Perhaps that’s a low bar to cross, but it’s pretty good for him. I think this is from all the crossword puzzles he’s done over the years.
Dad’s troubles started around the middle of the year when …
Wanted: Medical Sherpas to guide patients through the unfriendly world of health care
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is evaluated in follow-up after hospitalization 6 months ago for a large bleeding gastric ulcer. Tests performed for Helicobacter pylori infection at that time were negative. However, for the 3 months before hospitalization he had been taking ibuprofen for chronic back pain. He was discharged from the hospital on omeprazole, and his ibuprofen …
MKSAP: 50-year-old man with a large bleeding gastric ulcer
Over the past year, I’ve read countless publications concerning the relationship of customer service and patient care. Many have alluded to the fact that customer service in health care is not only unfeasible, but also detrimental to patient care. As a huge proponent of customer service, it was quite natural to take a defensive stand, posturing against these “absurd accusations.” Over the years I’ve learned, quite often the hard way, …
In health care: It’s not a customer service problem. It’s communication.
One of my most memorable experiences was more than a decade ago while working for a level one trauma center on the East Coast. I was sitting in a hospital break room during one of my breaks as an inventory coordinator when a nurse walked in. I simply asked how her day was going, and she fell into the chair next to me crying.
Surprised by her reaction, I asked, “What’s …
Reduce nurse burnout by treating nurses as well as we treat patients
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 …
A letter to myself as a first-year oncology resident
While lying on a hard metal table with my legs spread open and a clamp on my cervix, I was instructed to “relax.” My audience included a nurse, two radiologists, and my OB/GYN’s partner, who I met minutes earlier when she rushed in apologizing that my OB/GYN was called away to a delivery.
A delivery: the culmination of those nine months of a pregnancy that I so eagerly desired. I got …
During a physician’s infertility journey, another doctor offers hope
“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 …
Doctors grieve too: A lesson I did not learn in medical school
The last time I cried was this past May in the brand new National Center for Civil and Human Rights in Atlanta. As I stood in the room where you hear and see clips from the day of Martin Luther King Jr.’s assassination, I was overwhelmed with emotion and began to cry uncontrollably. I was reminded of all the sacrifices millions of people have made that has allowed me to …
How this physician celebrates Martin Luther King Jr.’s legacy
By now you’ve surely heard that Medicare is going to pay doctors and other qualified health care providers for advance care planning with patients in 2016.
Aren’t you excited?
OK, so if you are not utterly thrilled or even if you are nonplussed about the whole issue, then let me give you a different perspective on why you should rush into your friendly local doctor’s office to make a living will and …
8 unexpected reasons why you should have an advance care plan
At the J.P. Morgan Healthcare Conference in San Francisco, Mr. Andrew Slavitt, acting administrator at the Centers for Medicare & Medicaid Services (CMS), announced on January 11th that, “The meaningful use program as it has existed will now effectively be over, and replaced with something better,” and later clarified on Twitter that, “In 2016, MU as it has existed– with MACRA– will now be effectively over and replaced with something …
Meaningful use is dead. Is it time to celebrate?
In 2013, I wrote a post, “How Can Physicians Retire Gracefully?” Being on the cusp of retirement, I offered up some thoughts and predictions. Having fully retired this past year from the cardiology group that I began in 1982, I thought it was time to revisit my thoughts and predictions.
I have been able to keep structure to a minimum. I go to tai chi classes two to …
This physician retired years ago. So how’s he doing?
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, …
10 rules every primary care doctor should read
While I recognize that I have a better chance of contracting dengue fever in my suburban city than there is of you actually reading this, I will try anyways. Here it goes.
My name is Megan. I am a family medicine doctor practicing in Northern California, and I love my job. I’m nothing fancy. I don’t spend my day in the OR. I don’t spend my day in the emergency room …
An open letter to Justin Timberlake
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 …
The story of how this doctor lost his first patient
I’ve been asked previously what I think is the biggest challenge facing medicine or surgery in the future. Many physicians and futurists would suggest that personalized medicine, genetic therapy, cancer cure, public health, nanotechnology and many other things are going to form several of the biggest challenges ahead of us.
The more I spend time in medicine and surgery, the more I reflect on the future of medicine, the more I …
It’s time to reclaim the heart of medicine
There has been on average one mass shooting (involving at least 4 people) for every day this year. In the wake of the San Bernardino shooting — the most recent widely-covered mass shooting, America has reopened the debate over gun control, pitting a bereaved public beckoning for gun reform against strict Constitutionalists. Yet, in this polarizing debate filled with a seemingly binomial future, there are other options: Namely those that …
Repeal the federal ban on gun research and physician gag laws
A few months ago, I came across a young man who had come in with increasing fatigue and shortness of breath that was limiting his quality of life. As a barber, he looked forward to cutting hair and talking with his clients about the events that were happening in their lives. On the surface, it appeared that things were going well for him overall, but people were not aware that …
Miracles are happening in medicine. We just need to learn to recognize them.
