At the national conference of the American Academy of Pediatrics (AAP), I got to hear Hillary Clinton talk about the AAP’s partnership with her Too Small to Fail campaign. It made me happy — and sad.
The partnership is a great idea. It’s all about improving early childhood literacy, which is way more crucial than most people realize. It’s not just about an income gap when we talk …
The reading gap: Too small to fail or too big to care?
This article adapted from a lecture presented by Pamela Wible, MD, at the 2014 American Academy of Family Physicians Scientific Assembly in Washington DC.
Why did you go to medical school?
I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I’m unhappy with the direction …
Physician suicide 101: Secrets, lies and solutions
Drug prices are a difficult issue to write about because real data about the workings of pharmaceutical companies is very difficult to uncover. Still, I came face to face with something that seemed extremely not right and so I feel I should at least make some comment. It started when I prescribed a patient sumatriptan for her recently more frequent migraines. …
Anesthesiology used to be a job that was attractive for people who don’t like patients very much. The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done. Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the …
Anesthesiologists have to start to truly care for patients
I remember when I first started in oncology; I had joined the faculty at Brown three years after fellowship and was seeing a patient* with newly diagnosed breast cancer. She was in her 40s, an advertising executive, married, with two small kids. The diagnosis was unexpected (as it usually is), with a lump found while showering. She had come …
When patients seek a second opinion: It’s not about you
As we learn of new suspected cases of Ebola infection in the United States, causing worries among the population and renewed efforts by the Centers for Disease Control and Prevention to contain the epidemic.
A student in the postgraduate course in research ethics that I teach at Albert Einstein College of Medicine recently asked whether we could discuss the Ebola epidemic in class. Because I had prepared the syllabus for the course months ago, I hadn’t …
The ethics of researching Ebola
Every time there is a terrorist act or a mass murder, reporters start calling with questions on the psychiatric diagnosis of the perp. The default position seems to be that every religious extremist or political fanatic or mass murderer must be crazy. How else to account for their weird behavior?
Naming a diagnosis somehow satisfies a deep human need to explain what otherwise seems an unexplainable act. But names can only …
Giving extremists a fake psychiatric diagnosis
Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals …
It’s time to tell fast medicine to slow down
Medicine is not about money, except when it is.
When I was in my residency training, pharmaceutical reps still roamed the land. Vast herds of gorgeous young women in tight skirts and stilettos traveled through doctor’s offices, clinics, hospitals and residencies all over creation. Their appearance was always a thing of joy, especially for sleepy, hungry physicians-in-training. Someone would run to the …
Money has always been and will always be a big part of medicine
I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference — she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through.
I have a different thought.
Although every experience …
When you can’t share experience: The power of listening
An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine.
A doctor’s self-worth can be tied up with a lot of issues.
How well can we make a diagnosis?
How elegantly can we perform the surgery?
How happy are our patients? Our staffs? Our families?
How many articles have we had published or how many lectures have we given?
The list goes on and on, doesn’t it?
For me, …
Fall in love with medicine again
The documentation I get from everyone is terrible. Seldom does it tell me what I actually want to know, and if there is useful information it is buried in an avalanche of yada yada. The main reason for this is that documentation is driven by our ridiculous payment system, which requires us to follow arcane rules to generate notes that justify the obscure codes we submit for money from the …
Building a better EMR. Read how one doctor is doing it.
I am currently a pharmacy student, and although I have not yet dispensed a medication, I had my first experience concerning the cost of care a few months ago. My ear hurt very badly when I woke up in the morning, and being that I had to go to work later that evening, I decided to go to the local clinic in order to get my ear treated.
The physician was …
Ask for a generic: The sticker shock of brand name drugs
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While studying for my recertification exam as required by the American Board of Pediatrics, I came across this question:
A 7-year-old girl is having difficulty establishing relationships with other children despite repeated opportunities to do so. The girl prefers to stay near her mother or her teacher and will avoid other children. She sometimes cries and can be difficult to calm down after being dropped off at school, so her mother frequently remains …
Cognitive behavioral therapy: Why parents should be involved
Another day, another pacemaker, at least so it seemed at first.
The usual greeting the patient, answering the last questions, consent signing, placement of the IV, EKG leads, prepping of the surgical site and initiation of the preoperative antibiotics were all recent memories. He laid there, smiling, knowing he’d made the right decision after years of struggling with his arrhythmia in other ways. His heart was showing signs of slight weakening and …
When the patient treats the doctor
I talk a lot with different physicians about integrating NP/PA providers into their practice. I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians. Many times a doctor will have a medical “horror story” with the NP/PA playing the villain. One bad encounter or event seems to justify a complete rejection of the many positive …
5 ways to ease the integration of NPs and PAs
Pamela sits on the examining-room stool, looking at me expectantly.
I am in my first year of medical school. I do as I’ve been told to do in medical skills class: I observe my patient — without judgment or assumptions — and try to figure out what questions to ask, based on the information I am given.
Pamela has curly, strawberry-blonde hair and looks to be thirty, just a few years older …
Interviewing people is hard: A medical student keeps trying
As people select health insurance during open enrollment, what many don’t realize is how the creation of the health insurance exchanges or health insurance marketplace via the Affordable Care Act (a.k.a. Obamacare) will ultimately result in Americans becoming less healthy and more insolvent. Let’s review the pros and cons.
Although the Affordable Care Act provided important benefits of expanding and ensuring coverage with preventive benefits, insurability of all regardless of prior …
Health reform will make us less healthy and more insolvent
The practice of medicine is changing faster than anyone can keep pace with. As a hospital physician at a relatively early stage of my career, I’d say that a sizeable number of physicians that I work with are towards the latter end of the spectrum.
I find that these doctors, typically over the age of 50, are struggling the most to keep …
Glory days: Is a golden age of medicine on our doorstep?
Life is full of choices and each choice has the potential to open certain doors and close others. I choose medicine. It is a demanding career, but even as a 7th grader, I knew what I was signing up for.
What I didn’t know was how much this profession could influence the trajectory of my personal life and the types of relationships I’m able to maintain. I grew up genuinely thinking …
Serving two masters: Balancing medicine and family
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