When I began to gather my thoughts for this piece, I asked my husband what he thought. It was eye-opening. Even after twelve years of illness, I forget that his life has been impacted as much as mine by my health limitations. This is partly because he’s changed his major task in life to that of caregiver and partly because we can no longer do most of the things we …
What chronic pain and illness make me miss the most
No one goes to a hospital to heal. They go because they must–as I did three years ago, when a one-hour colonoscopy turned into a four-day surgical sleepover.
My grandfather had warned me long ago against hospitals. “You don’t want to go there,” he said. “That’s where the sick people are.” Pop died at the age of ninety-four, at home.
His warning came strongly to mind as I walked into the place …
It took cancer surgery to see a more profound dimension of life
I made a big decision recently: I decided to give up my Blackberry smartphone.
Why? Like a good geriatrician, I considered the benefits and the burdens of sticking with the Blackberry. And since the burdens seem to outweigh the benefits, bye-bye Blackberry.
This was a difficult decision for me, however. To begin with, becoming comfortable with a new device for one’s daily work takes time. During the transition phase, one is slower …
The burden of frequent technology transitions
I attended a medical staff meeting recently. These are required meetings and attendance is taken, as was done when we were in kindergarten. While some folks are interested in these meetings’ content, many are not and simply sign the attendance sheet and then slither out in a stealth fashion. Sly doctors grab their pagers and then leave hurriedly pretending that they were summoned to an urgent medical situation, when they …
How the medical profession is being forced to game the system
I must confess that I love my job as a hospital medicine doctor. To me, very few specialties in medicine can be as rewarding as the one I’ve had the privilege of practicing for the last five years. We manage an array of medical illnesses, interact with staff from across the hospital in every different specialty, and follow our patients all the way through their—hopefully very short—hospitalization. We take ownership …
Please don’t call me a hospitalist
I still recall my first rotation as an inpatient attending at Memorial Sloan-Kettering Cancer Center (MSKCC). Perhaps it was the anxiety that I remembered most; that I was “in charge” of a service. Fortunately, having done fellowship at MSKCC, the system was not a foreign one, and I knew exactly where to go to get oriented—I went to Jane and Dorothy, …
Why I rely on non-physician providers
Recently, a member of my family was involuntarily admitted to the psychiatric unit of a major teaching hospital in New York City and remained there for two and a half weeks. During that time, the unit kept him safe and provided medication for mood stabilization and thinking. After seeing my family member, my first priority was to talk with the attending physician and care team.
Evidently, the attending doesn’t like to …
Visiting my family member: A tale of two facilities
“My wife gets migraines—really bad ones—and now my daughter seems to be getting them too. She’s only 7! Is she just copying what her mom does? Can a child really start getting migraines?”
Oh, yes they can. Migraine is very much a childhood disorder. About 5% of adults have migraines, and half of them started having their migraines as kids.
As in adults, migraines in children can be severe and debilitating. However, …
Migraine is very much a childhood disorder
I read the New York Times. I read the health section as much as I can to keep track of what the paper is saying about health-related issues. I read Jane Brody. I like Jane Brody. I’m not sure what Ms. Brody is, but I don’t think she’s a clinician.
In her article “Avoiding Emergency Rooms,” she makes some suggestions on how people should get care if they need …
Saving the patient a trip to the ER is harder than it looks
The position paper from the American College of Physicians and the Federation of State Medical Boards, is a humbling reminder of the challenges that today’s physicians face when entering the online space.
Their recommendations for online medical professionalism, written by ethics committees for the two organizations, “provides recommendations about the influence of social media on the patient–physician relationship, the role of these media in public perception of physician behaviors, and strategies for physician–physician …
Blurring the lines of ethics when doctors use social media
An excerpt from Collateral Damage: A Patient, a New Procedure, and the Learning Curve.
To make the scars inside Pam’s heart, Wu was “learning by burning” with the Chilli Cooled Tip ablation catheter. One big problem with cardiac catheter ablations, which they discovered as the procedures got more and more popular, was that blood tended to coagulate near …
The safety data behind this ablation catheter
The Baylor PCP chapter co-hosted a screening of Escape Fire at Rice University. I had heard about the film some time ago when it first came out and had always wanted to see it myself, but now I am convinced that it should be screened at every medical school orientation.
The film provided a poignant portrayal of several all-too-familiar stories: the overworked, underpaid primary care doctor who cannot afford to spend …
Why isn’t primary care idolized?
Angelina Jolie discovers she has a breast cancer gene, the same one that caused her mother to die an early death, and she decides on a proactive, and possibly radical, prevention – double mastectomy. By doing so, she lowers her risk of genetic breast cancer from 70% to 5%. No guarantees, but definitely improved odds of survival. Assuming she continues her lifestyle changes to support her good …
What Angelina Jolie and bariatric surgery patients have in common
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Are you tired of waiting fifteen minutes only to spend ten minutes with your psychiatrist? Do you hate rearranging your busy schedule, fighting traffic, and trolling for a parking space just to spend a few minutes with your doctor? Wouldn’t it be easier if you could take care of your mental health according to your schedule, instead of someone else’s?
We are pleased to introduce the Automated Psychiatrist Machine (APM). The …
Introducing the Automated Psychiatrist Machine
In that riveting courtroom scene we all know from the movie A Few Good Men, Jack Nicholson’s character famously tells us: We can’t handle the truth. That often seems the case with regard to food.
I have encountered the resistance to fundamental truths about food often, but I am committed to doing the best I can to tell them even so. I tell them in narrative every chance I …
Resistance to fundamental truths about food
Medicine is about balancing risk and benefit. Certainly, as healthcare providers, we attempt to provide the best care for our patients based on available evidence. Physicians often are seen as shepherds, helping to guide patients through disease and therapy. As I have mentioned in previous blogs, ultimately medicine will be personalized and tailored to one’s particular genetic make-up. However, the need for a clear discussion of treatment options …
We must change how we discuss procedures with our patients
Colorectal cancer.
Shudder. That’s the knee-jerk response that most of my patients give me when mention of their 50th birthday creeps into the conversation and I reveal that it is time for their screening colonoscopy.
Admittedly, a colonoscopy is not an experience that the overwhelming majority of the human race embraces with excitement and anticipation. Instead, it is a life event that is filled with …
What’s scarier than a colonoscopy?
We think the reason doctors rarely make house calls is money. Doctors can charge, but it is hard to charge enough to justify the time it takes to drive door-to-door, fill the tank and attend lengthy visits. Thus, the house call has faded into history. However, I have another theory about the end of this valuable service: perhaps it is increased emotional distance between patients and their doctors.
I watched an …
Another reason why the house call is dead
A psychiatrist in Seattle had picked out the bridge. At 3 a.m. he would swerve across his lane and plunge into the water. Everyone would assume he fell asleep.
A surgeon in Oregon was lying on the floor of her office with a scalpel. Nobody would find her until it was too late.
An internal medicine resident in Atlanta heard an anesthesiologist joking about …
What I’ve learned from saving physicians from suicide
Amid massive change in our healthcare delivery systems and seismic shifts in many regional markets, physicians are increasingly being faced with a simple choice: be acquired or become employed as part of a large healthcare system, or stay independent while offering a compelling service that hospitals and health systems value.
The changes occurring in our care delivery systems have generated great interest, innovation, and yes, fear among many in healthcare, doctors …
As health care consolidates, physicians face a choice
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