Why are so many community hospitals transferring children to larger facilities?

Policy
September 13, 2020

A recent edition of Pediatrics has some disturbing research: “Trends in Capability of Hospitals to Provide Definitive Acute Care for Children: 2008 to 2016.” What the paper really does is document what many of us who work in referral hospitals have noted for some time: More and more community hospitals are transferring children who appear in their emergency departments to other, larger facilities instead of admitting them to …

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So you want to be a doctor? Here are 10 myths debunked.

Physician
September 10, 2020

I’m glad you’re looking at a career in medicine. I hope you will be happy with your choice forever. To help you out, these are a few myths I wish somebody told me about when I was in your shoes.

1. You’ll be rich. You likely won’t. After two decades or so of med school and residency, you’ll be paying back student loans with exorbitant interests for a few more decades …

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Call a consult: depression vs. burnout

Physician
September 8, 2020

CC: “I feel like crap.”

HPI: 29-year old female internal medicine resident. Hasn’t seen sunlight in over three months due to 100 hour work weeks.  Crying at work. Always exhausted and irritable.  Isolated from friends and family.  Feels guilty that she is not effective at work and home.  States recent labs were normal.

ROS:

Gen: hypersomnia
HEENT: teeth grinding
CV: chest pressure, palpitations
GI: decreased appetite with weight loss
Neuro: headaches
Psych: apathetic, not suicidal

Meds: none

Social: alcohol on …

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Are the life sciences the best premedical majors?

Education
September 8, 2020

The medical school admission process can be overwhelming. There is no definitive path that guarantees admission. Prospective students are meant to create their own way that could bring them an acceptance letter. That is why some individuals with a 3.6 GPA and a 508 MCAT score get accepted, and others with a better academic record get rejected. They might be considered an outlier, but some are not necessarily …

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After 4,380 days, a pair of Danskos — and a calling — fall apart

Finance
September 8, 2020

My Danskos literally disintegrated last month.

I was in the hospital team room, finishing up my patient notes at the end of a busy hospitalist shift. I happened to look down at the floor, and there they were: black chunks on the carpet.

I thought, “Who left such a huge mess under the desk?”

I looked at the bottom of my black Danskos. There was a sizable chunk of the sole missing.

Finally, the …

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Intentions don’t sanitize impact

Physician
September 7, 2020

While there are certainly instances of malicious intent in thoughts, feelings, and actions, most people operate with the intent to do good, be good, offer good to the world – but what we do isn’t always received in the way we set out to offer it.

In the words of Oscar Wilde, “No good deed goes unpunished.”

It can be frustrating and even paralyzing to consider this consequence, resigning us to, “What …

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Why doctors should be trained to speak out and lead the movement for social justice

Policy
September 7, 2020

Dr. Anthony Fauci, National Institute of Health Director of Allergy and Infectious Disease and White House Coronavirus Task Force member, recently underwent surgery to remove a vocal cord polyp. This is not surprising given that a major risk factor for developing vocal cord polyps is overuse of the voice, something Fauci has likely experienced during the COVID19 pandemic as he has been called upon to speak …

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Medical student suicide is the trend that must end

Conditions
September 5, 2020

Last November, our medical school’s community faced a devastating loss, as second-year student R took her own life. As she was rushed to our hospital’s emergency room, some of R’s classmates, as well as her physician mentor, were on rotation and bared witness to her getting rolled in. Understandably, the loss of R cut deeply. While not often discussed, medical student suicide has been no stranger to medical schools both …

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Now is the time for postpartum home visits

Conditions
September 4, 2020

I ring the doorbell, waiting patiently outside.  I hear a weak “coming” and some shuffling.  Who greets me is a mother in her robe, hunched over at the waist, supporting her protruding postpartum belly.  Her hair is disheveled.  Her mask is revealing exhausted eyes with attempted mascara to look a “little freshened up,” she confesses a little later.

“My husband is just getting the baby; please come in.”

I …

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Direct primary care: Great for some doctors, but challenging for patients

Policy
September 3, 2020

The COVID-19 pandemic and the consequent drop in patient visits have led some observers to conclude that primary care physicians would be better off financially if they were capitated than if they were paid fee for service. If they received a fixed amount of money per health plan member per month, they’d have a guaranteed income stream regardless of how many patients came to their offices.

However, a growing number …

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2 tales of physician assistant burnout

Conditions
September 3, 2020

For the first 12 years as a physician assistant, I thought provider burnout only happened to wusses, those better suited to working in health insurance or doctoring at a summer camp.  Sure, I felt overwhelmed at times, but I planned to soldier on in clinical practice, happily serving my patients until retirement.

That was before.   Before dreading Sunday nights, feeling heaviness in my gut, a tightness in my neck, and bouts …

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The transition from resident to attending: Setting the stage for your new life and career

Physician
September 3, 2020

You’re finally at the point in your career that you’ve been waiting for! Training has been strenuous, and you have spent many years of your life readying yourself professionally for this moment. It is now time for you to transition from a resident to an attending physician.

At this time, you may be tempted to jump right in and start working.  I recommend taking a little time off for yourself first. …

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Hassle-free real estate investing for busy doctors

Finance
September 1, 2020

A few short years ago, I started to worry about my family’s financial future while vacationing. During our annual ski trip, I took a nasty fall, landing on my wrist. The pain in my arm made me take notice of just how fragile our financial situation was.

As a self-employed periodontist, I asked myself:

  • What if I was injured while playing sports with my kids?
  • What if I became permanently disabled?

If …

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A letter to my first patient

Education
September 1, 2020

It was only my first week in the hospital as a third-year medical student when we met. I entered your room early Tuesday morning. Only knowing your chief concern, I knocked on your door and entered the room. You didn’t complain when I awakened you. You didn’t complain when I asked many questions about a story you had already relayed multiple times to others. You didn’t complain when …

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Where is the line between faith and medicine?

Education
August 31, 2020

The long debate about rationality and conformity in both medicine and religion has been intense on many levels. Some people claim science requires certainty, validity, and reliability; others believe faith and optimism are essential for scientific advancement. Some reasons for this argument might include the enormous prosecution of scientists Read more…

An ode to hospital cafeterias

Physician
August 30, 2020

I have been nourished by cafeteria food since elementary school. I remember the public school pizza squares with its melted artificial cheese, the fruit cocktail drenched in sickeningly sweet syrup, and 2 percent chocolate milk pints—costing $1.65 per meal. In college, I enjoyed access to a wider selection, including $6.50 custom omelets and midnight mozzarella sticks to fuel late-night study sessions. However, nothing came close to the quality and …

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