Thinking of starting a cash-based practice? Here are the pros and cons.

Physician
May 25, 2016

As an integrative medicine physician, I am often questioned about what I do and how I decided to diverge from the normalcy of allopathic medicine. I usually go into a short spiel about my love for thinking outside the box and creating solutions for patients that seek a kinder, gentler style of medicine; one that blends effective healing modalities from all over the globe with my traditional allopathic training.

Most people …

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Maybe it’s time to go back to index cards for medical records

Physician
May 25, 2016

During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child.  Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity.  His family physician pulled out the index card that served as this man’s medical record.  Yes, you read that correctly.  It was not a chart or computer printout; rather a 4 x …

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The enemy is not death. The enemy is needless suffering.

Physician
May 24, 2016

Among hospice staff, it is called “getting it.” One says, “He doesn’t get it,” “I think she gets it,” or, “They definitely get it.” It is a little hard to define, but as with pornography, you know it when you see it.   Nonetheless, given the importance of “getting” good end-of-life care, let us take a moment to try and explain.

The 92-year-old patient is bleeding into her head, but has blood …

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Foreign medical graduates get a raw deal. Here’s why.

Education
May 23, 2016

On my recent tour of residency programs, I had the pleasure of meeting many foreign medical graduates (a.k.a. FMGs; not to be confused with international medical graduates, who are U.S. citizens who go abroad for medical school).

Almost uniformly, they struck me as confident, mature and articulate. Many were older than me, some by as much as 10 or 15 years. Most had extensive research experience, and a few had even …

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What I learned after 41 years of practicing psychiatry

Physician
May 22, 2016

Now that I’m getting ready to turn 70, I thought I’d summarize what I’ve learned since I finished my residency, when I was 28. Of course, I didn’t learn all this only by being a psychiatrist, since I would hope that most folks have also learned lots in the last 41 years.

1. Psychotherapy is important, particularly if the patient is on the right medication. I won’t do “med checks,” since I …

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With doctors losing respect, perhaps it’s time to expose medicine’s dark side

Physician
May 22, 2016

The following is paraphrased documentation, authored by a physician I know, regarding an intoxicated patient in the ER:

1 a.m.: Patient is telling nurse, “Before I leave, I need everyone’s name for my lawsuit. Tell the phlebotomist that if he’s good, he’ll get a cut.”

1:40 a.m.: Patient is making inappropriate sexual comments and is verbally aggressive with medical staff. He is advised to stay in bed.

2:02 a.m.: Patient (who had been sleeping comfortably) wakes up and …

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Here are the limitations of virtual doctor visits

Tech
May 21, 2016

Virtual visits are increasingly the rage amongst forward-thinking healthcare providers that want to jump on the telehealth band wagon.  Extending the office visit across distance, using the same technology we use to keep in touch with loved ones (videoconferencing such as Skype and FaceTime), is a safe and logical way for providers to venture into a new tech-enabled world that may still be scary for some.

One way to think of …

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Is it possible to be a Christian and practice emergency medicine?

Physician
May 20, 2016

Many young physicians in training have asked me, quietly or by e-mail, “Is it possible to be a Christian and practice emergency medicine?”  I think that they ask a good question, and likely for good reasons.

In their rotations, they have witnessed, first hand, life in the ER.  They are uncertain, perhaps, because they see the frustration that boils over in the words and actions of otherwise compassionate and caring doctors …

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The inspiring reasons why this medical student wanted to become a doctor

Education
May 18, 2016

As a fourth-year medical student, I love introducing myself to patients as the “extra eyes and ears of the team, so feel free to tell me anything you forgot or would like to address, even if you think it’s irrelevant or burdensome. I will be your advocate.”

As I establish rapport with them, the walls come down, and they often provide important information that helps my team provide the best care …

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It’s OK for medical students to make mistakes. Here’s why.

Education
May 18, 2016

Aristotle said, “To avoid criticism: do nothing, say nothing and be nothing.”

Sometimes I wish I was nothing; surely, that would just be so much easier. I screw up all of the time. And I hate it. My latest gaffe was killing our simulated patient by causing him to aspirate. I’m sure no one in my group is still persevering on the events that unfolded during the sim. I also really …

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Your patient should get a health coach. Here’s why.

Physician
May 15, 2016

We are all familiar with the statistics. Chronic conditions like obesity, hypertension, and diabetes are present in our population at unacceptably high and costly levels. More than 78 million American adults are obese, and more than 1 in 20 is extremely obese. About 70 million U.S. adults have hypertension with only 52 percent having the condition under control. Just over 29 million Americans have diabetes and an additional 86 million …

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Why the 15-minute doctor appointment is dangerous

Physician
May 13, 2016

How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys.

Yet in medicine, it’s common for practices to schedule patient visits in 15-minute increments — often for established patients with less complex needs. Physicians face pressure to mind …

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It’s time to formally classify pediatric intensive care units

Physician
May 13, 2016

There are over 400 pediatric intensive care units (PICUs) in the USA, as most recently estimated by the Society of Critical Care Medicine. These units vary widely in size, from 4 or 5 beds to fifty or more. The smaller units are generally found in community hospitals; the larger ones are usually in academic medical centers, often in designated children’s hospitals, of which there are 220.

Given this size range, it is not …

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What John Stossel gets right, and wrong, about health care

Policy
May 12, 2016

I was saddened to hear that one of my favorite libertarians, the wonderful journalist John Stossel, has taken ill. True to form, however, he’s taking it in stride (he nonchalantly quipped, “seems I have lung cancer”), and I want to take this opportunity to wish him very well indeed. I enjoy his reporting and writing, and have learned a great deal from Mr. Stossel over the years.

But that doesn’t mean he’s always …

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Let’s apply a little reality to the referrals from the ER

Physician
May 11, 2016

I remember seeing so many charts in my career on which the well-meaning emergency room physician wrote the following:  “Follow up with your primary care doctor.”  Or, if they didn’t have one, “Follow up in one week with a primary care doctor.”  I laughed to myself.  Usually, the people we say that to have either no insurance, inadequate insurance or inadequate motivation to even call the persons to whom we …

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Not everyone can be a nurse

Physician
May 10, 2016

Thanks to all the nurses who take care of my patients and every other patient. I may be a doctor, but you are the ones who deliver the care. You give the medications and hang the IV fluids. You wash the patients and turn them. You check their vitals and listen for bowel sounds. You walk with them. You talk with them. You fulfill their needs. And you provide comfort to …

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The story of a man who was a very good cook

Physician
May 10, 2016

Once upon a time, there was a man who was a very good cook. He was just an ordinary man, but he had real culinary talents. He could create the perfect meal for anyone who came to see him in his modest café.

His maître d’ and waiting staff were warm and well trained, and the menu was designed specifically for the clientele of his eatery. He gave each person his …

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How a patient gave this doctor his first coaching session

Physician
May 10, 2016

In 1991, I took a sub-internship in cardiology with a clinically-minded attending named Eddie Atwood. One day he stopped me in the hall: “You have a few minutes toward the end of the day?”

“Sure. What’d I do?” I just knew some sort of defining verdict headed toward my Dean’s letter, to be shown to all residencies and preserved in an archive of medical student iniquities, was surely coming.

“You students are …

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The proctor seized during a USMLE Step 3 test. See what this doctor did next.

Physician
May 9, 2016

USMLE Step exams are a rite of passage in medical education. They mark the  transition from pre-clinical years to clinical years, from medical school to residency and from intern to resident. One of the more difficult aspects of the transition to residency was convincing myself that I really was a doctor. The habits of explaining my role as a student, of hedging every statement with “I’ll need to ask the …

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