Involuntary discharge from dialysis: A health care practice like no other

Physician
January 9, 2017

Chronic kidney failure is a serious disease. When progression to end-stage renal disease (ESRD) occurs, dialysis is required to sustain life.

It is shocking, then, that in the United States, it is estimated that over 1,000 patients annually are involuntarily discharged from their dialysis clinics. Further, they are often “blackballed” from other local clinics. The consequences for such patients, predominately African-American, are dire. A patient may be unable to find a …

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Do primary care physicians increase life expectancy?

Physician
January 9, 2017

U.S. life expectancy declined in 2015 for the first time in more than two decades, according to a National Center for Health Statistics study released last week. The decline of 0.1 percent was ever so slight ― life expectancy at birth was 78.8 years in 2015, compared to 78.9 years in 2014. However, this reversal of a long-time upward trend makes these results significant.

While many researchers are scratching …

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Medical students need to fail more often. Here’s why.

Education
January 7, 2017

We need to fail more tests in medical school. I’m serious.

In first year, our class had two of the most memorable weeks of our schooling: A crash course on biochemistry taught by a professor who is widely accepted as one of the best teachers in our medical school. His in-class lecture style kept students engaged and entertained; I, and many of my classmates, learned tremendous amounts of his material and …

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Don’t engage in fishbowl emergency medicine

Physician
January 6, 2017

How in the heck would three nurses and I ever orchestrate ECMO in the middle of the night in my community ED? I pondered this over tuna tartare while listening to ivory tower docs discuss cutting-edge modalities like they were part of treatment algorithms everywhere. The conversation turned to REBOA, and I wondered how many academicians had ever manned a single-coverage ED.

Ivory tower medicine and my world, where there is …

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Stop saying these 7 shaming words in medicine. Right now.

Physician
January 5, 2017

shamingwordsimage

In medicine, our motto is first do no harm. Words matter. Choose them wisely. Here are 7 words that shame, blame, and injure people who need our help.

1. Don’t say COMMITTED suicide. Committed implies a crime. Committed rape, burglary, murder. Suicide is not a crime; it’s a medical condition that has been taboo for too long. Let’s come out of the dark …

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A harrowing C-section, performed on a close friend

Conditions
January 4, 2017

We chat about the day, as I use a sharp knife to cut into her. We joke about my kids, as the blood is spurting. We reminisce about our friendship, as I rip open her tissue.

For most surgeons, their patients are asleep as they perform their surgery. In obstetrics, however, we want our patients awake, not only to witness their baby’s arrival, but also because it is safer. When I …

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We need a more humane approach to medical education

Education
January 4, 2017

A recent study in the Journal of the American Medical Association concludes that 27 percent of medical students around the world exhibit symptoms of depression and 11 percent have thought of taking their own lives. Equally troubling is the fact that, among students experiencing depressive symptoms, only 16 percent seek psychiatric treatment.

Other studies have suggested that the prevalence of depression in medical students may …

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The difference between male and female physicians. Here’s what it means.

Physician
January 4, 2017

About a year ago, Yusuke Tsugawa — then a doctoral student in the Harvard health policy PhD program — and I were discussing the evidence around the quality of care delivered by female and male doctors. The data suggested that women practice medicine a little differently than men do. It appeared that practice patterns of female physicians were a little more evidence-based, sticking more closely to Read more…

Not all residency programs are bad. Here’s what to do if yours is.

Physician
January 4, 2017

A response to “This resident works 100+ hours per week, but is still a poorly trained surgeon.”

I am truly sorry your experience in a urology residency thus far has been far below your expectations. I am finishing residency in June, and I know how hard it is. There are sleepless nights, thankless tasks, and residency feels like a learning process that crawls forward in inches rather than feet. …

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An ode to a beloved ICU nurse manager

Conditions
January 3, 2017

Once upon a time, I worked for a large hospital in the surgical-trauma ICU. It was just a six-month gig, and I had to travel from home further than I wanted. But my son would be starting college soon, and the $10,000 bonus was too irresistible.

Diane was the manager. The most kind, skilled, and helpful person I have ever met as an ICU manager.

She had every possible attribute as a …

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Should doctors’ personal judgments affect their patients?

Physician
January 2, 2017

Medicine is a paradox. To save, we cut with sharp knives. We ignore pain so that it will light the path to diagnosis. We give toxins to destroy toxic disease. We scold our neighbors when they neglect their health, even as we work ourselves to exhaustion, eat too much and evade exercise. We comfort the families of our patients while ignoring our own.

There is one contradiction, which, by its very …

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Going to a walk-in clinic? 6 essential things you must know before you visit

Physician
January 2, 2017

A friend of mine recently had a very sore throat. She knew how to manage her symptoms — lozenges, warm tea and the like. But she was worried she might have strep and would, therefore, need antibiotics. That should be a simple question to answer with a quick trip to the primary care clinic. Except that her primary care physician was booked, and if she wanted an unscheduled appointment with …

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Corporate health care is doomed. Here’s why.

Physician
January 1, 2017

As health care increasingly propels itself into the world of corporations and big business, it may seem like the practice of medicine has entered an irreversible new era. Gone are the days of good old Dr. Wilson in his solo private practice around the corner, loved and respected by all his patients and the community. Nowadays, it’s all about mega multi-specialty groups, health care mergers and hostile corporate takeovers.

Being someone …

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A letter to her physician husband

Physician
December 28, 2016

Dear Husband, MD

I see you. I hear you cough all night, knowing your flu vaccine has failed and you have it. I hear you wheeze with your post-flu pneumonia. I feel you shiver in the bed beside me while you sleep for 5 hours before you get back up and start getting ready for the next “shift.”

I put quotations around “shift” because we both know you will not work 8 …

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The word that best describes this medical student’s experience

Education
December 28, 2016

It’s 4:17 a.m. as I begin this entry. I’m scheduled to be at the hospital in 43 minutes for one of my last days on surgical rotation, and I’ve been working on the following text message since 3 a.m.:

“Hi, team. Im afraid that im burned out and anxious. I will be taking today off. Sorry to be blunt but i felt it better than to make up an excuse. Thanks …

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Are surgical residents really doing the cases they scrub on?

Education
December 25, 2016

According to the Residency Review Committee for Surgery, “A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative care, selection, and accomplishment of the appropriate operative procedure, and direction of the postoperative care.”

In nearly all instances, resident “determination or confirmation of the diagnosis, provision of preoperative …

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How an oncologist used Pac-Man to teach his patient

Conditions
December 20, 2016

The most exciting and difficult part of my job is keeping up with all the rapid changes occurring in the field of cancer treatments.  It is amazing how each day there seems to be a breakthrough treatment coming along, shifting old cancer paradigms.  Although this is a good problem to have, finding time to stay current is easier said than done.  Even more difficult is making sure we can explain these …

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Essentialism for health care professionals

Physician
December 18, 2016

An excerpt from Physician—Time to Invest in Yourself: Work-Life Balance, the Needs of the Patient, and Medical-Legal Risk Management.

What is an essentialist? What is an essentialist lifestyle? Essentialism focuses on identifying the important signals in life and eliminating the noise. The noises are the distractions that add no value to your life and frequently monopolize time and meaning. When you assume the role of an essentialist you will discover that you …

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