For doctors leaving clinical practice: Do not consider utilization review jobs

Physician
October 23, 2021

When I decided to leave practice and explore non-clinical career options, I found no shortage of opportunities, ranging from the pharmaceutical industry to the health insurance industry and many points in between. I chose to work in the health insurance industry because jobs were plentiful, and the focus of work remained on the patient.

A typical entry-level job in the health insurance industry is that of utilization …

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I’m your primary care doctor. May I take your order?

Physician
October 23, 2021

My Tuesday out of clinic started off like any other Tuesday. I got up (sluggish, still chronically sleep-deprived), scrubbed my face and brushed my teeth, slipped into workout clothes then set to getting my two girls ready for school. After packing lunches, brushing hair, and waiving to the bus, I sat down to do what most of us do on our days out of clinic: check the dreaded inbox. Who …

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Expanding health care access and equity through telehealth

Policy
October 22, 2021

The COVID-19 public health emergency (PHE) has been an amplifier and catalyst for numerous issues. The pandemic has impacted health care delivery significantly, and inequities for the Black community are more apparent. Federal and state rules for telehealth compliance/reimbursement were relaxed to preserve health care access during the PHE. While we are still in the data collection and observation phase, some concepts are clear: Telehealth positively impacts health care access, …

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Crossing the liminal space of the pandemic

Physician
October 21, 2021

We have been walking down a long hallway for many, many months. We left the room we resided in pre-COVID, but we have not yet found a room to rest. We are in the liminal space of COVID. This is unsettling and unnerving — liminal space often is.

Liminal space in architecture is the area between discrete, functional spaces, a way of passage, but not the place where beds are placed, …

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Stratified reproduction in medicine

Conditions
October 21, 2021

Shellee Cohen defines “stratified reproduction” as the practice in which society assigns value to offspring and, therefore reproductive capacity of different groups of people. While commonly race or socioeconomically based, this can be based on any category we can divide people.  This concept is ever-present in medicine, even in the most progressive environments. This became most evident when  I was sitting at my desk in an outpatient gynecology office, clicking …

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Breast cancer’s silver lining

Conditions
October 19, 2021

asco-logo In many ways, this woman was similar to other patients I have seen after a diagnosis and treatment of breast cancer. Her hair was growing back, and I immediately noticed that she was comfortable enough to not be wearing a wig or head covering for our Zoom visit. I keep my hair very short by choice and I find this …

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Does pro-vaccine always have to be pro-mandate?

Physician
October 19, 2021

“They are firing me for not getting the COVID vaccine. I can make more money working at Michael’s than I do at this job. I was only doing this because I like to help people. But this is it for me. I’m quitting. I’ll miss the patients, but I cannot be forced into doing something that I don’t believe in.”

The patient care tech said to me after putting my patient …

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How the board certification exams infantilize resident training

Physician
October 18, 2021

Not long ago, my patient in a complex thoracic case developed progressive bradycardia followed by a malignant-looking multifocal atrial arrhythmia that didn’t generate any blood pressure.

“Get out some epinephrine!” I said to my resident, who was standing closer than I was to the drug cart. The resident quickly drew up a milligram of epi, but then paused. I could almost see the thought bubble overhead: “Should I print out a …

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Some health issues should not be evaluated in the office

Physician
October 18, 2021

I received a phone call from an elderly gentleman who was closer to ninety years of age than 80, was taking an aspirin, and had just suffered a fall and hit his head. He did not know why or how he fell. He asked for an appointment the same day to “check me out.”

My staff asked all the pertinent questions and immediately brought the information to me. After reviewing it, …

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Ivermectin is a Nobel Prize-winning wonder drug

Meds
October 18, 2021

Ivermectin is an over 30-year-old wonder drug that treats life- and sight-threatening parasitic infections. Its lasting influence on global health has been so profound that two of the key researchers in its discovery and development won the Nobel Prize in 2015.

I’ve been an infectious disease pharmacist for over 25 years. I’ve also managed patients who delayed proper treatment for their severe …

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I’ve broken free from time, and I am a better doctor for it

Physician
October 17, 2021

How many minutes have you given yourself to read this post?

There was a time when none of us could tell time. Imagine not knowing what the ever-moving hands of a clock are trying to reveal. My memories skew, but in that era before I could tell time, all I remember is laughter, effervescence, and the occasional injury. (The first time I hit my “funny bone” was quite the scare!)

Now, we …

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Compassion fatigue and the unvaccinated

Physician
October 17, 2021

“Do you get compassion fatigue when you take care of smokers or patients with obesity or diabetes?”

This was in reply to an article on compassion fatigue I had posted on my Facebook page. The article was written by an exhausted physician caring for unvaccinated COVID-19 patients. My initial reaction was, “Of course not. That’s my job!” But it made me think, why was it that caring for unvaccinated patients seemed …

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Why it’s important to take charge of your own health

Conditions
October 17, 2021

Little did I know that after October 2, 2020, my life would completely change forever. I want to start by saying I am a pharmacist by profession, and I now finally understand the saying, “take charge of your health.”

My brother and I had taken my dad to a hospital in Philadelphia on the morning of October 2, 2020. Caught by surprise, we found out my dad had four blockages. My …

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The inverse relationship of efficiency and resilience

Physician
October 16, 2021

I was recently coaching a bright, energetic primary care physician in her first few years of practice. She was working through her Life’s Purpose statement, an exercise we often recommend. At the end of her admirable statement, she tagged on “with efficiency.” Naturally, we explored this a bit. Our conversation meandered toward an interesting conclusion: the more she focused on efficiency, the more likely she was to feel overwhelmed and …

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If you think a mother’s pain is unimaginable, you should see her strength

Physician
October 15, 2021

“If you think a mother’s pain is unimaginable, you should see her strength.”

You were visiting your mother when, while in another room, you became unresponsive and fell to the floor. She heard the thump of your fall and raced into the room to find you pale and barely breathing. Drug paraphernalia sat beside you.

Your mother screamed. She cried. She fell to her knees and tried to wake you, slapping your …

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When the family wants to speak to the doctor

Physician
October 15, 2021

Being a doctor is often more about talking to people and communicating than it is about the scientific practice of medicine. This is something that is unfortunately not taught enough in medical school, and it’s left to newly qualified doctors to realize very quickly as they start their careers.

Throughout the busy and hectic day of any hospital-based physician—no matter what their specialty—one of the most common requests we hear from …

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The American food conspiracy

Physician
October 15, 2021

Everybody knows how to operate smartphones and understands complex modern phenomena, but many Americans are frighteningly ignorant about basic human nutrition.

I am convinced this is the result of a powerful conspiracy fueled by the (junk) food industry. Here are just a few examples:

Milk has been advertised as a healthy beverage. It is not. No other species consumes milk beyond infancy. Milk-based products like ice cream and yogurt are on top …

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Why storytelling is critical in medicine

Physician
October 14, 2021

I love stories, either told, written, or listened to. Songs tell stories, as does art. Blogs such as the rich content open so many doors for rich conversations. Telling stories is part of who I am. My father loved to tell them, as did my grandfather, whose name I took. They were called bull-sh*tters – and perhaps some refer to me that way at times. In medicine, I find storytelling …

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Honor your oath. Set boundaries. Demand respect.

Physician
October 14, 2021

This morning, while scrolling through social media, I encountered a resounding theme. Multiple physicians posting about being challenged, disrespected, and made to feel worthless by the very people they were trying to help: their patients. Being brought to tears by the disrespect of the patient’s family members. Physician expertise blatantly questioned. Advice ignored.

Patients telling doctors – to their faces – that they “don’t like their tone” and then telling nurses …

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