The idea behind surgery is a really simple one: You come to me with a specific problem, I fix it, you go away happy. And when you come back, you’re still happy. What’s so wrong with that? If I wanted to be miserable, I’d have gone into primary care.
When a surgeon screws up, his/her role is clear: Admit it, make it better, or as good as possible, and stick with …
Managing unhappy patients after surgery
How do we motivate physicians and other health professionals to work at their best? How do we create systems of high performance? Is it by a series of top-down highly specific mandates or by setting up general guidelines and providing tools?
I believe it comes down to one’s vision of physicians. Are physicians knights to be empowered in their service of patients …
Improving health care: Are physicians knights or pawns?
The world is a big place and here in the U.S., we are fortunate to live in a part of it where we have access to technology and advanced medical care, clinical trials, and new therapies, even before they are approved by the Food and Drug Administration. Indeed, even new agents approved for one indication can be prescribed off-label in …
Cancer care for international patients
In pediatrics, almost all of our patients are healthy. We’ve got some doozies of special-needs kids, but by-and-large your ordinary pediatric patient is doing well, and does not need extensive testing or elaborate procedures to ensure good health.
Still, we do run across some occasional problems. Some children have poor vision, or hearing problems, or kidney disease, or hypothyroidism. Or autism, or Tay-Sachs Disease, or a penny up their nose. A …
Pediatric screening tests: You can’t have it both ways
It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications.
“It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer.
There are …
How do we fix the high blood pressure problem?
Recently, I had what I’d call a true banner day in my office. One late afternoon, after I had finished seeing patients, I had started in on that iniquitous pile of paperwork that awaits all of us doctors after office hours. As usual, I was finding the task alternately arduous (can my patient comfortably carry five-to-ten pounds for five-to-ten minutes?), rewarding (the patient does not have lupus), and monotonous (there …
Can doctors ever work together with insurance companies?
The Food and Drug Administration (FDA) recently released a statement about power morcellation during hysterectomy and myomectomy (surgery to remove uterine fibroids), raising concerns about these devices spreading unanticipated cancers. There have been several reports in the literature and the press alike of this happening and when it does it significantly worsens the prognosis. The American Congress of Obstetrician and Gynecologists (ACOG) is now re-exploring this issue. Pending a full review the FDA …
Power morcellation: Answers to your safety questions
I recently served as a preceptor for first year students at our Hofstra-North Shore LIJ School of Medicine who were doing one of their RIA (reflection, integration and assessment) sessions. The students do these sessions every 12 weeks, and are generally scheduled with the same preceptor over time. It may be routine for the students, but I found it absolutely remarkable.
Each student is responsible for doing a complete history and …
Medical students today are getting richer clinical training
In the contest to get a creative name, few pathogens have done worse than hepatitis C. In the 1970s there were two known viruses that caused hepatitis: liver inflammation. You might have already guessed that these two viruses were called hepatitis A and hepatitis B. It was known at that time that people sometimes developed hepatitis after blood transfusions and that the majority of those patients tested negative for hepatitis …
Curing hepatitis C, but at what cost?
It’s another Monday morning at the substance abuse clinic. It is my turn as the doctor in the black swivel chair in the corner office overlooking a half-vacant strip mall.
Today’s first inductee is a pregnant 22-year-old with track marks on her forearms. Her obstetrician and case worker at the Department of Human Services made her come. It is obvious she is less than thrilled.
“How long have you been doing opiates?” …
A morning in the substance abuse clinic
The process of becoming an excellent physician is one of mastery. The passion of the child is replaced by the studiousness of the teenager, and the bottomless energy of the young adult. The leap from decision to clinician takes decades. Forged in the steel of experience, trampled by pain and tortuous repetition, ability accrues.
The apprentice guards his knowledge closely. He bows …
Demonizing doctors won’t solve our problems
Why does is seem that so much information given to us comes with disclaimers? The weight loss product ads on TV that promise more than they will deliver, are always accompanied by 5 nanosecond disclaimers in a font size that can’t be discerned by the human retina stating that the results are not typical.
It seems deceptive to be advertising a product by showcasing a performance that the vendor admits is …
Maybe doctors should have disclaimers
Change causes distress for most people. In medicine we have a hierarchy that disdains most change. Medical students, residents, attending physicians all seemingly reject change. Practicing physicians dislike change. Yet change occurs and is necessary. I learned a great deal about change from my mother. This anecdote may help put change into perspective.
Many years ago, we lived in a 3 bedroom house. In the evening we all sat in the …
Physicians must be part of the change process
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The doctor-patient relationship is under threat from state laws that try to shape what we can and can’t do for our patients. Many state legislatures are proposing laws that limit the questions doctors can ask patients in our confidential clinic visits. Do you smoke? Drink soda? Exercise? Do drugs? Is there a gun in the home?* Do you want to be pregnant? Is there fracking near your home?*
The questions followed …
State legislatures should not enter the exam room
Recently, there was an issue in my O.R. No, the surgery went well. The patient was healthy and tolerated the procedure just fine. And, yes, we had the proper equipment and it all functioned perfectly.
This was another kind of issue, something that I had not encountered before. It turned out to be a life lesson. My team and I were getting started in the O.R., for a fairly routine day. …
A life lesson in the operating room
This letter was received and edited for clarity by Pamela Wible, MD.
Dear Dr. Wible,
This will be my last email to you because I am giving up on my dream of being a doctor.
I’ve contacted so many colleges and medical schools hoping to find one that would help me become a doctor for my tribe. Today, I finally got a response from the …
Is medical school just for rich kids?
Pamela Wible, MD, a family physician who is an expert in physician suicide prevention, recently asked other physicians why so many in the profession kill themselves. The answers were plentiful, tragic and not at all surprising.
One physician confessed to having post-traumatic stress disorder after medical school. Another cited constant sleep deprivation. Yet another mentioned the combination of a crushing workload, a difficult boss and payers who are more …
A physician’s story of mental illness
May marks Celiac Disease Awareness Month, with the goals of raising awareness of the disease and its potential health complications, and also to help elucidate which patients warrant diagnostic testing for the disease.
A few days ago on Twitter, I noticed that #glutenfree was trending (again). It is fascinating to observe how gluten-free businesses are beyond booming as diseases and conditions such as celiac disease, wheat allergy, and non-celiac gluten intolerance …
When should we test for celiac disease?
Whether you are a veteran of not, the recent report of waiting lists, and possibly preventable deaths of veterans, has implications for all citizens. There is no large health system which functions perfectly. But I would say that the efficiency of any given system is inversely related to its size. If this is true, then the VA health system is, and has always been, a bureaucratic and wasteful mess. Like …
What happens in the VA health system matters to all of us
The man who saved more lives than any other physician (in the history of humanity combined) died in a mental institution — unrecognized and shunned by the medical community. He was beaten by guards and died a miserable death. Dr. Ignaz Semmelweis was a Hungarian obstetrician practicing in the mid-1800s, years before Louis Pasteur came up with his germ theory and Joseph Lister popularized hand washing.
While working as an assistant …
Ignaz Semmelweis and the lessons of fear and medical innovation
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