How we spend our days is, of course, how we spend our lives.
-Annie Dillard
I wish I could add up all of the moments I spend waiting for things to happen.
I wait for computers to boot up. I wait for computer screens to load. I wait for programs to ask for and accept my user name and password for the umpteenth time so I can view a CT scan and then re-enter a different …
Quiet moments are a precious and rarely appreciated gift
I’m proud to announce my new book, co-written with Susan Gay: Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
The Foreword is written by Robert Wachter, MD, with endorsements from Eric Topol, MD, Abraham Verghese, MD, Jerome Groopman, …
Online reputation for doctors: A comprehensive social media guide
You’ve probably watched the Super Bowl as I have many times, faithfully, elevating the occasion to some kind of macabre family tradition. It is a spectacle of athletic agility, drama, and struggle; the pinnacle of American sporting contests. Despite the heavy onslaught of commercialism, faux halftime culture, and evident violence on the field, we suspend our awareness that this event may not …
7 reasons to boycott the Super Bowl from a medical standpoint
It happened again today. A youngish man, age 59 (youth being relative these days) comes in for a consultation. His history began eighteen months ago when he started to notice hoarseness. Thinking he had laryngitis, he saw his primary care doctor. He was indeed diagnosed with laryngitis despite the fact that he had not been shouting for his grandson at the local soccer playoffs, nor had he had upper respiratory …
In oncology, hoofbeats are nearly always from zebras
“Sometimes, how you feel at the end of an interview can be clinically revealing,” my preceptor says. “How does this patient make you feel?”
***
“Mr. M?” I ask gently, knocking on the hospital room door. “May I come in?”
“Hello? Hello?”
I enter at what I think is an invitation to me, but see that 79-year-old Mr. M is speaking into the phone instead.
“I’m sorry, I can come back…” I start to say. …
Countertransference is a reality that must be grappled with
Adam Smith would disagree, Karl Marx would be appalled, and heck even Milton Friedman and Ayn Rand would be raising objections. But for some peculiar reason, there are enough contemporary lesser economic minds scattered throughout the entire philosophical spectrum, that are advocating for, and enabling the execution of, a government induced transition of our health care system to an oligopoly model …
Is consolidation the answer to healthcare’s fragmentation problem?
As far back as I can remember, I’ve deliberately spent my life on the high road. I was the seventh-grader who was told by adults that she was very serious. I was the college student who majored in chemistry because it was the strongest premed major. I became a doctor.
Before becoming a doctor, I imagined that I would be the epitome of compassion. I envisioned pausing for a moment before …
Seemingly small connections with patients refresh and revitalize me
Those who forget history are doomed to repeat it. Most of us have not had personal experience with illnesses like measles, mumps, German measles, or polio. Thank goodness for that. It is because a generation ago individuals, families, and doctors choose a different path. They witnessed loved ones stricken with these diseases. When the opportunity arose to protect themselves from these …
Vaccines: Those who forget history are doomed to repeat it
I was engaged in one of my pleasures, sitting in a coffee shop leafing through medical journals. Usually, I am perusing newspapers. I spend many hours each week combing through various newspapers and routinely forward items of interest to folks of interest. No newspapers today. I have a few gastroenterology journals to look through. My professional reading habits have evolved over my career. I am more interested in reading about …
Who really won when Accutane was pulled off the market?
Terry is a particularly difficult patient. She is not hard because of her cancer, which is in remission, nor is there a problem with pain, of which she has little, and Terry is not particularly demanding for the nursing staff. No there real problem, the challenge, the thing that makes her so difficult is that Terry is married. Terry is married to Dr. P and he is a particularly difficult …
Taking care of other physicians and their families
Junior Seau had CTE, chronic traumatic encephalopathy, the degenerative brain disease known to afflict individuals who have sustained repeated head injuries over time.
Junior Seau played football his whole life and was never officially diagnosed with a concussion. Last May he sat down one day and shot himself in the heart. Dave Duerson, the former Bears safety, did this too, as a way to …
Why I’m saying goodbye to football
I mustered up the courage to visit Mary today.
Pulling into her driveway, I was greeted with the majesty of autumnal brilliance—golds, rusts, and crimsons set against a brilliant azure sky. A bold display of nature’s defiance against the upcoming long winter’s sleep. Not to be ignored, those leaves that had flamed out early chattered against my every step as I slowly ambled toward the doorway.
I took a deep breath and …
A hospice visit: We will sing together again some day
Sorry for not posting for a while. It’s not that things have been quiet; they definitely haven’t been.
Here’s the update:
The only way to accomplish big things is to do the little things
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A sample agenda as the consulting psychiatrist at a geriatric adult home:
8:20am. Arrive at the concrete building. Wave through the locked glass door at the woman sitting behind the desk. She pushes a button and the door buzzes. Pull the door open. Say good morning. She never sounds cheerful when she replies, “Good morning.”
Because there is no open stair access, take the elevator up one floor. It travels slowly. The …
One day of a psychiatrist at a geriatric adult home
Like most Americans, when I learned that twenty children and six adults had been massacred in Newtown, Connecticut, I recoiled. Like most parents, my next thought was for my own son, the image I retain of his happy, smiling self for one moment replaced by an image of his tiny body lying twisted on the ground. Even as I write these words, an emotion I rarely feel—one I often can’t …
Why should I try to find compassion for Adam Lanza?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 71-year-old man is evaluated in the emergency department for new dyspnea on exertion. He has a 15-year history of type 2 diabetes mellitus and has had a number of changes in his medications over the past 12 weeks to improve glycemic control. His dosage of metformin has been increased to 1000 mg/d, glyburide …
MKSAP: 71-year-old man with new dyspnea on exertion
I wrote in a previous post about what life was like growing up in Newtown, Connecticut. It truly is a picturesque New England town. But what might be surprising is that within that town sat a gem. A hundred acres of wooded rolling hills within which sat an inner campus of professionally landscaped and meticulously manicured grounds crowned with stately and handsome brick buildings in a colonial architectural style. These …
The closing of a mental health facility in Newtown
I recently heard from an aging and respected physician the old adage that “what is good for the doctor is good for the patient.” The room full of physicians of all ages and specialties nodded their heads in agreement. This saddened me, as it represents a physician-centric system that oftentimes leaves the patient’s needs and desires completely out of the equation.
An area of emerging importance in medicine, whose impact should …
Patients need to be involved in quality metrics
Should physicians use a consultant to help choose a practice management system or EHR for their practice? According to recent Medical Group Management Association surveys more than 50% of physicians used the services of a healthcare consultant or firm at least once in the previous 3 years.
But did they have to? Was it a smart move?
The answer: It depends
Not every practice needs a consultant’s assistance when replacing and choosing …
When should physicians hire an IT consultant?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old man is evaluated during a routine examination. He was diagnosed with ulcerative colitis 10 years ago and is currently asymptomatic. His last colonoscopy, performed at the time of diagnosis, showed mildly active extensive colitis extending to the hepatic flexure. There is no family history of colon cancer or colon polyps. His only …
MKSAP: 38-year-old man with ulcerative colitis
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