I am an emergency medicine physician in an inner-city emergency department, and I would like to start by stating a simple truth: coronavirus is not going away any time soon. Cases are climbing in practically every state and show no signs of slowing down. From my personal perspective, things are getting worse. Every day I am treating more and more patients who are ill with COVID-19 …
If you don’t want to wear a mask, come to work with me
I have written, or more accurately ranted, about electronic medical records (EMR) systems throughout this blog. While the systems have clearly improved since their mandatory introduction into the medical universe, they have still not delivered on many of their promises.
Of course, EMR has brought tremendous advantages to the medical profession, and we are all grateful for the technology. But this progress has exacted a cost. Many of them are clumsy …
An EMR frustration that is still torturing us
Judging from the shortage of canning jars and lids in grocery stores recently, the COVID-19 pandemic has spurred fresh interest in home canning (a potentially dangerous practice that has declined since its peak in 1943); and because the public expects doctors to know everything about health, it may be educational for physicians to consider the tragic case of the unpeeled potato.
I recently read a Facebook post in a …
Food safety and the neglect of the unpeeled potato
During the COVID-19 pandemic, a glaring trend has emerged, one that has long helped forge the American religious cultural landscape, but has now blossomed in full force, particularly within many Christian fundamentalist circles. As a physician who is also an evangelical Christian, I constantly live with the tension of balancing the practice of my faith and the results of sound scientific investigation with the opinions of patients and others within …
Science and faith in the time of COVID-19
Do you know how much your time is worth? Those of us who are 1099ers can easily tell you our hourly wage. Now, what about everyone else?
Well, there’s a quick trick. Take your yearly salary and divide it by 2,000. So if you make a salary of $200,000 per year, you are making roughly $100 per hour.
Now there are a few assumptions. To start off with, there are actually 2080 …
Don’t make the mistake of equating an hourly wage for the value of your time
I’m my breaking point! Frustrated, exhausted, caffeine-deprived, and surrounded by people who don’t listen to me, I’m not trained for this, and I am ready to tag out. OK, granted, it is only day two of distance learning for my third grader and kindergartener. However, this could also describe my first two days as a castaway on Survivor island.
It’s been about nine years since I was chosen to appear on …
A physician’s journey from Survivor to Shark Tank to quarantine
Thinking, Fast and Slow is a well-known masterpiece of psychology by the formidable Daniel Kahneman. He diligently illuminates two different pathways of thought, which he arbitrarily titles System 1 and System 2. System 1 describes our quick thinking, our snap judgments, our gut feelings. System 2 encapsulates our deeper thoughts, the way we systematically review information, the analysis that requires time and mental effort. The work thoroughly lays out many …
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 …
Why are so many community hospitals transferring children to larger facilities?
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 …
So you want to be a doctor? Here are 10 myths debunked.
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 …
Call a consult: depression vs. burnout
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 …
Are the life sciences the best premedical majors?
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 …
After 4,380 days, a pair of Danskos — and a calling — fall apart
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 …
Intentions don’t sanitize impact
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 …
Why doctors should be trained to speak out and lead the movement for social justice
An excerpt from Medical Marijuana: A Clinical Handbook.
Imagine two patients sitting in the waiting area of a clinic. The first is a man in his sunset years who has recently begun treatment for stage 2 lung cancer. His treatment involves the use of chemotherapy, which has …
Clearing the misinformation surrounding medical cannabis
An excerpt from Butchered by “Healthcare”: What to Do About Doctors, Big Pharma, and Corrupt Government Ruining Your Health and Medical Care.
Doctors help patients, and they love us for it. We fix bones, replace joints, cure killer infections, and control diabetes with insulin. We use painless …
How I was wrong about health care
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 …
Medical student suicide is the trend that must end
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 …
Now is the time for postpartum home visits
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 …
Direct primary care: Great for some doctors, but challenging for patients
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 …
2 tales of physician assistant burnout
Get free updates delivered free to your inbox.
