For years, scholars have thought the perfect surgery consult was impossible. Comedic ophthalmologist Will Flanary, a.k.a. Dr. Glaucomflecken, characterizes the golden consult as one in which the surgeon is not consulted too soon — because the patient is not sick enough to require his or her services — and one in which the surgeon is not consulted too late, or else …
The “golden consult” revisited
Last year, I witnessed the extreme consequences of untreated childhood trauma as a medical trainee rotating through multiple safety-net hospitals in Los Angeles County.
I helped care for children who arrived in our emergency departments after multiple suicide attempts due to trouble in the home. Some children confided in me about their parents’ struggle with untreated substance use or mental illness and how witnessing these conditions deeply affected them.
Other children were …
It’s time to invest in trauma-informed ACEs interventions
An excerpt from Reality Check: In Pursuit of the Right Questions.
I was on the floor of the International Meeting on Simulation in Healthcare conference when I heard screaming in the near distance. I turned toward it and saw some people gathering and others running. It sounded like an …
Chaos and order: the simulated context
Mistakes and errors are regrettable but inevitable risks of the job for any patient-facing role in health care. As nurses, we are trained to report mistakes and errors when they happen. The maintenance of transparency in this way is an important element of our profession, intended to inform improvements that will, in turn, reduce the likelihood of a recurrence of the error.
The context in which Radonda’s error occurred may be …
Florence Nightingale. Clara Barton. Radonda Vaught?
When I was eight years old, I was a star soccer player on a state championship team. During shirts-off practice and while down at the local pool, I noticed how different my body was compared to my peers. After I referenced my scientifically approved human body anatomy book, most of my peers’ bodies looked just like the standard human body image in the book, with all the muscles developed …
My journey being gaslighted about obesity, skinny fat, and body type
Over 30 years ago, this man began working for our hospital system.
He was assigned to our ICU/CVICU units. Though some health care employees hadn’t even been born yet, Charles was a tried and true “lifer.”
He was our housekeeper. And he was our friend — our family.
He was a man with energy and stamina. He was a hard worker. Relentless. He could spin circles around a pack of 20-year-olds put together.
His …
He was more than a housekeeper
I see your comments on social media, and I wonder: Why are you upset? How do the negative comments towards physician colleagues serve you?
This is not an attack (that would be hypocritical). Rather, I invite you to genuinely ask yourself these questions as I sense something familiar — a projection of frustration and pain, perhaps? And I wonder how we may stop projecting and, instead, indeed start healing together?
While I’ll …
Stop bashing physician-entrepreneurs
Recently, I was sitting in the DFW airport after my son’s soccer tournament witnessing multiple flight cancellations. Travelers became upset because their plans were ruined due to “staff shortages.” I felt lucky as my flight was just delayed, and I had patients scheduled the next day. I needed to be there for them. Because of the increasing frequency of cancellations noted in the news, I had plans to rent a …
Health care’s band of brothers and sisters
That the United States spends the most on health care is unsurprising.
What’s questionable is paying so much for the worst health care system amongst high-income countries and being far behind many countries that could not be considered high-income by any stretch of the imagination.
Other than doing brilliantly at mammograms and seasonal flu vaccines, the U.S. is found appalling. Not just Canada and Mexico, but when the likes of Chile, Saudi …
Corruption in health care: when the mice mind the cheese
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“Medical advances can often stir up ethical issues, which ripple into two courts: the court of law and the court of public opinion. These news articles described a public relations nightmare brewing at the National Pituitary Agency (NPA), which operated with NIH funding. …
Historical lessons to improve health care today [PODCAST]
The recent article by Danielle Crittenden, “The Danger of Fat Acceptance: The Average American Woman Is Now a Size 18” is more of the same perpetuation of our society’s deeply internalized diet culture, weight blaming, and shaming of the individual and collective pursuit of thin privilege.
The article was sent to me by a friend, but I didn’t need to read it because I’m so familiar with the …
Fat acceptance is a human acceptance movement
From a new attending and the former resident and fellow physician union president, congratulations on starting your residency! You’ve dedicated decades of your life to medicine, and your years of studying and extracurricular achievement have brought you to this moment.
As you are well aware, residency will be tough. You will likely work long hours while being exploited by your employer as cheap labor, but you’ll be expected to drink from …
Activism is a part of medicine and we cannot remain neutral
New resident physicians who have earned their MD degrees will be heading to hospitals to start their residencies during the last two week in June and the first week in July. What can a beginning doctor do during the first month of internship to get his or her career off to a good start, and in so doing, also learn to provide the best care to patients? Here are 10 …
Top 10 things new interns should do
On June 24, 2022, the Supreme Court ruled 6–3 to uphold Mississippi’s Gestational Age Act and 5–4 to overrule Roe v. Wade and Planned Parenthood v. Casey. The political temperature was already heightened because Politico released a leaked draft opinion on May 2, 2022.
The pending ruling threw the United States into an emotional pressure cooker spurred on by heavy (some would say irresponsible) news coverage and social media fervor that …
Abortion debates need to happen, but both sides need some ground rules
The first week of my big attending job, I saw a patient with fever, sore throat, no cough, and tonsillar exudates. Well-trained to manage septic shock, but having no idea how to practice in a primary care clinic, I crafted a vast array of infectious and inflammatory diagnoses. With a quick glance, my senior partner said, “You don’t know that this is strep?” Flushed and wanting to hide, I thought, …
What is the narrative that you hear when faced with uncertainty?
An essay from 1989.
Some day one of my children will likely ask what I once asked my stepfather, “Dad, do you think I should try for med school?” I feel that it will most likely be our inquisitive middle child, Clayton John (“CJ”). And, when that time comes, what will I say to Mr. CJ?
For many physicians in the past, the answer to this question would have been a resounding, …
Should your child try for medical school?
There are situations where I have told a patient they had no options: a cancer recurrence not responding to any treatment, detecting no heartbeat in a 37-week pregnancy, or telling someone their family member coded and didn’t survive. The worst part of these situations wasn’t just the diagnosis but the lack of options to improve the outcome. Let’s not remove choice in situations where a patient has a chance to …
These are the women who are being told they are not a priority
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.
A decade of working in quality and patient safety has taught me a painful lesson: Don’t say “quality” or “patient safety” to frontline health care workers. Too often, they become immediately defensive or evasive. How did q#^l&ty and s^f*ty become four-letter words? …
How did quality and safety become 4-letter words?
According to data gathered by the American Cancer Society (ACS), more than 1.9 million new cancers are projected to be diagnosed in 2022. In addition, missed cancer screenings due to the pandemic are expected to potentially increase the number of cancers that are diagnosed at a more advanced stage. But the ACS data also highlight an important fact—approximately 42% of the new cancers projected to be diagnosed …
The building blocks of a cancer risk management strategy
It is the time of the year in which freshly graduated residents and fellows finally enter the health care systems as an attending after years of hard work and training. A time of celebrating and reflection, and a time to stop and think of what you have done and what lies ahead of you. I am sorry, this may not be what you want to hear, but I am tired …
A hard lesson for new attending physicians
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