In India, when the first heavy droplets of rain meet dry earth it releases a particular kind of smell: a dampness arising from sizzling soil that in Bengal we call shnoda gondho. It is raining on the second day we go to visit my grandfather in the hospital.
He has been readmitted to the hospital, after spending a week recovering at home from a hospitalization for rib fractures and bleeding into his …
I drank the Kool-Aid early. We installed our first EHR in 1996 with me doing the lion’s share of pushing and pulling. While I’d ultimately turn my back on this passion, I had a number of notable accomplishments before walking down my road to Damascus.
What does real meaningful use of an electronic record look like? Not like this.
My first experience administering injections involved sitting in an ICU room, ten years old, drinking bitter diet Shasta colas and watching thrillers from the 90s starring Sandra Bullock. The nurses started me on oranges. Easy as pie — I could stab away, practicing insulin injections with saline and fruit. The oranges practically squealed with delight upon puncture, rewarding me with the scent of citrus and a plume of juice — …
My first experience administering injections
It was the boy who was unable to speak who ended up teaching me the most.
I was seeing patients in the epilepsy clinic during my neurology rotation. The attending physician with whom I was working, an internationally renowned pediatric epilepsy specialist with a penchant for attracting exceedingly complex cases, wanted me to observe the end of a patient session with one of the child neurology fellows.
I entered the patient’s room …
Medicine should never be about accepting the status quo
When I was a resident, I saw a middle-aged man, “Charles,” who came into the hospital after playing a round and a half of golf. When I looked at his right foot, he had an ulcer in the shape of a golf tee. He had played the entire day with a golf tee in his shoe and only noticed when he found drainage on his sock. The story sticks in …
When examining patients, don’t forget about the feet
Delivering bad news is part of my job, an important part.
It is fashionable nowadays to speak of the doctor-patient relationship as a partnership. In the sense that both doctor and patient have important roles to play for the patient to get good care, that’s very true. But even in the best of times, it’s a very asymmetric partnership. Even in a run-of-the-mill visit for a sinus infection the patient and …
Delivering bad news shouldn’t be easy
The recent Germanwings tragedy has called commercial aviation’s concept of fitness for flight into question. Although the official mishap investigation has not yet concluded, available information at the time of this writing points to an intentional crashing of the plane by the 27-year-old co-pilot, Andreas Lubitz.
Reports from the co-pilot’s medical records allege he had previously experienced episodes of depression and carried diagnoses for other psychosomatic disorders. Antidepressants and torn medical memorandums stating that …
Should there be zero tolerance for depression in the cockpit?
Yeah, it happened. The SGR is finally dead. Hooray! Sort of.
I mean, it’s great and all that — we’ll no longer have the annual threat of a massive payment cut from a poorly crafted piece of legislation from the 1990s; we’ll no longer have to endure the annual ritual of last-minute legislative theatrics to avert the yearly cuts, we’ll no longer have to waste our lobbying time and effort …
The 92-8 vote in the United States Senate to join the House in passing the Medicare Access and CHIP Reauthorization Act (MACRA), H.R. 2, represents a remarkable milestone for the Medicare program, and for ACP advocacy on behalf of internists and patients.
It is remarkable not only because it eliminates the failed Medicare SGR — how often does Congress admit it made a mistake, and then correct it? — but because it …
SGR repeal and MACRA: Here’s why it’s remarkable
Dear patients,
First of all, thank you for calling for an appointment. Seriously. Ever since I’ve gone open access, if the phone doesn’t ring I’m toast. And thank you for your interest in preventive care. The fact that it’s now free (well, no cost to you at time of service: trust me, it’s not “free”) has probably motivated more of you to call. That’s OK. But sometimes it seems that your …
Let’s clear up the confusion about what a physical is
How many times do we start out our day with the best of intentions? It’s probably most days, if you’re at all like me.
Even when we’re going through a spell of negativity, we all try to pull it together for the sake of our patients, our staff, our families.
A couple weeks ago, I was tempted to throw in the towel.
It was one of those days when the last straw was …
Crisis averted after a tense moment in the operating room
In medical school, class is scheduled for approximately 30 hours a week. This includes lectures on basic life sciences, histology, anatomy, and clinical examination skills. In addition, my first semester included approximately three hours of classroom time a month devoted to a supplemental curriculum called Health Systems and Policy, which covers the legal aspects of health care, public policy, and, briefly, health disparities. Now, in my second semester, these efforts …
How racism makes us sick: The medical repercussions of segregation
The tenets engendered by cancer have been slowly elucidated throughout the years. The hallmarks of cancer have been well documented by Douglas Hanahan and Robert Weinberg in Hallmarks of Cancer: The Next Generation. Some of these features are well known and are inclusive of sustained proliferative signaling, evading growth suppressions, and others clearly outlined in their review. These cellular processes have been discovered by basic science researchers and subsequently, modern …
We have already changed the way we think about cancer
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Forty is the new thirty. Orange is the new black. And failure is the new success.
It seems these days that no success story is complete without a failure (or two) along the way: the bankruptcy that gave birth to a successful company; the entrepreneur who lost it all just before hitting the Fortune 500. Entire issues of the Harvard Business Review and the New York Times Magazine have been devoted …
Why it is critical we learn from past health care mistakes
Party Weekend
– Joe “King” Carrasco
Fight for Your Right (To Party)!
– Beastie Boys
We Just Wanna Dance
– The Flirts
My favorite radio station, WHFS, had a ritual every Friday afternoon to start off the weekend, back in the day. DJs Weasel and Bob Here would exchange pleasantries as they exchanged shifts, and would launch the same set of songs at the same …
Is it time to abandon the 9 to 5 workweek in hospitals?
“He’s just expired,” said the nurse as I approached Ray’s room in the large inner-city hospital where I work as a patient advocate. “And his wife has just arrived. Why don’t you go in?”
I found Natalie bent over Ray’s body. His hollow cheek was drenched with her tears.
“I’m so sor –”
“I told him yesterday to talk to Jesus,” Natalie interrupted, speaking quickly. “I told him if the two of them …
The line between being compassionate and being unprofessional
The following article is satire.
LAS VEGAS, Nevada — As times have become harder for emergency departments around the country, one local hospital, Snooty Hospital and Casino (SHC), has come up with a solution to capture precious reimbursement from individuals with “enhanced diagnosis and treatment goals.” When checking into the ED either by ambulance or at the front desk, patients now have the ability …
Executive workups: The ultimate in patient-centered care
I’ve written before about various forms of complementary and alternative medicine — most recently about the use of essential oils for serious medical conditions. I’m planning to dive deeper into that topic in an upcoming post. But before I do, I want to take some time to reframe how we think about alternative therapies. And I want to make it clear from the beginning that doctors don’t get paid for prescribing medications; we …
We need to reframe alternative medicine in a new way. Like this.
Aaron Carroll, a pediatrician who blogs at the Incidental Economist, had a piece published a few weeks ago in the New York Times concluding that adolescents and college kids would be better off — given a choice of illicit substances — opting for marijuana over alcohol. Of course, he would prefer that his kids chose neither. But he is a …
Alcohol or marijuana? Rethinking what to take when you unwind.
The American Board of Internal Medicine is irrelevant. It has always been. I realized this when I first certified in internal medicine in 2002. The test was largely fact-based and filled with information that I would never need to know in practice. It did not measure my diagnostic acumen, or my physical exam skills, or my ability to listen and empathize …
When it comes to the ABIM, physicians must choose wisely
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