Do you know what it’s like to sit in a meeting and learn that something you hold close as a fundamental principle is probably not as fundamentally true as you thought?
That’s the way I felt earlier this week while attending a meeting on the quality of pharmaceuticals, sponsored by the Food and Drug Administration and Duke University’s Margolis Center for Health Policy.
The meeting—a Read more…
How can we improve the quality of medications?
Doctors make bad entrepreneurs. I know I told you they make great entrepreneurs. But there are always exceptions. There are a couple of reasons why:
Perfection stagnation
Our GPAs had …
Doctors make bad entrepreneurs
As someone who graduated from medical school with six-figure student loan debt, I’ve looked into several different loan forgiveness programs that will help repay what I owe. One of the most popular loan forgiveness programs is Public Service Loan Forgiveness (PSLF). Through PSLF doctors can get hundreds of thousands of dollars in student loans forgiven, tax-free. Although this seems great, when I attempted to …
9 things I learned when I signed up for public service loan forgiveness
It had been a long day. Our progress notes were done. The last scheduled case in the operating room was done, and it was time to wrap up loose ends and sign out my patients to the night team.
But that’s when Room 4 died.
I walked onto the Burn Unit. The nurses were frantic. Can you page the Intensive Care Resident? He’s bradying down. The patient’s heart rate was steadily declining …
Death still affects me. I’m not numb. I’m human.
I did a peer review once of an office note about an elderly man with a low-grade fever. The past medical history was all there, several prior laboratory and imaging tests were imported, and there was a long narrative section that blended active medical problems and ongoing specialist relationships. There was also a lengthy review of systems under its own heading.
In an over ten-page long printout, the final diagnosis was …
Where’s Waldo: Finding what’s important in the medical record
If I had $100 for every time I walked into a patient’s room, introduced myself as the doctor, and was immediately asked, “Hey, how old are you?” I might be able to retire right now — at the age of 28. Of course, I am exaggerating, and yet this question echoes for my baby-faced colleagues and me constantly.
Whether it’s simple curiosity or blatant reverse-ageism, I find this question erodes trust …
Does your doctor’s age matter?
Residency and fellowships are tough. While most trainees come in and expect medicine to be the most challenging thing they have to deal with, what makes a training program challenging to navigate seems to be entirely something else. Having trained in programs in both the U.S. and Canada, I felt some trends had to be addressed. I want to take a deep dive into some of these trends, …
A seasoned trainee: A doctor who shouldn’t have been
Meniscus injuries of the knee are common. There are lots of treatment options, including meniscus tear surgery or injections. But which one is the best to address your meniscus tear pain? The data surprises almost everyone.
History of meniscus tear treatments
Orthopedic surgeons used to perform a total meniscectomy for patients with meniscus tears. This procedure involved taking out the entire meniscus. If you have a tear that causes you pain, why …
Meniscus tear surgery and treatment: What you need to know to decrease your pain
Each year, medical students across the country prepare to start the long-anticipated core clinical rotations. Suddenly, we’re thrust into a world of constant adaptation and evaluation, with many highs and many lows.
As I finish up the year and new students get ready to start, I’ve been asked time and time again for my advice. I decided to aggregate my key takeaways from the year, and what I wish I had …
13 tips for medical students starting their clinical rotations
It has always been financially rewarding for doctors to take care of rich patients. People with more money … well, they have more money to spend on health care. But shouldn’t this more money/higher payment relationship go away in Medicare?
It doesn’t, and some recent payment reforms may be making matters worse.
Medicare is a federal program to reimburse medical costs in people who are disabled, have kidney failure, or are …
Clinicians shouldn’t be punished for taking care of needy populations
”I long, as does every human being, to be at home wherever I find myself.”
— Maya Angelou
Before starting my dive into medicine, almost four years ago, I was an avid violinist, pianist, disc golfer, and novice chef. Each of these activities felt comfortable and familiar–like “home.” But when I began medical school, I somewhat wistfully set them aside to focus on becoming a doctor.
If I can get through this grueling …
Finding a common chord with a patient
On January 19, the first case of the coronavirus in the United States was announced. Initially, COVID cases were detected in Washington. As time elapsed, other states did best to prepare for if and when COVID came to our area. As spring break arrived, my husband, an intensivist, debated the best course of action regarding our vacation. We decided we could not take a vacation with heavy hearts while our …
Doctoring in the age of COVID and the possibility of dying in the near future
The good
Italians star at disorganization, disobedience, and discord. They sneak past no-entry signs, light up under no-smoking signs, barrel along at 80 in 35 mph zones, fasten their seat belts under their butts. Plus, they had the worst COVID-19 epidemic in Europe.
So how come they’re doing so well …
COVID-19 in Italy: the good, the bad, and the ugly
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As the coronavirus pandemic has unfolded, the uncertainty of this crisis has stoked heightened awareness and precaution in each aspect of our lives. We have incorporated personal protective equipment into our human interactions, and we are compulsively practicing sanitation rituals. Our social connections have been tethered at a distance for months on end. As a society, we are experiencing collective grief. Grieving hundreds of thousands of lives lost and the …
Racial disparities and maternal mental health during COVID
Taking a break from technology is a fine idea, but we don’t need a pseudoscientific new name for it: dopamine fasting. Launched with viral Silicon Valley memes, online reports, and articles in the New York Times and elsewhere, dopamine fasting is now a thing. Basically, the idea is to temporarily deprive oneself of the usual stimulations of life — largely …
Dopamine fasting, debunked by a psychiatrist
An excerpt from Dying with Ease: A Compassionate Guide for Making Wiser End-of-Life Decisions. Used by permission of the publisher Rowman & Littlefield. All rights reserved.
In 2017, there were 2,813,503 deaths in the United States. About a quarter of Americans die of heart disease, some 22 …
Death is personal for this physician
You are doing all the right things: washing your hands frequently, wearing a mask when out in public, getting the requisite sunlight needed to reduce stress and maintain your health. And the reward you’re getting for all your diligence?
Dry skin, damaged nails, acne, and sunburns.
As we continue to live with the threat of COVID-19, more people find themselves wrestling with skin issues they never anticipated. Fortunately, there are easy and …
From a dermatologist: How to beat “maskne,” dry hands, and other safety-related skin problems
We were surprised by the “So you want to be a doctor? Here are 10 myths debunked.”. It did not represent our collective experiences as family physicians. We offer an alternative perspective:
1. You’ll be rich. An average family physician, at a salary of about $230K, makes more than 93 percent of other households. The average medical student debt from 2019 was just over $201,000 (AAMC). A …
So you want to be a doctor? Here are 10 truths.
Despite the advances in modern health care, chronic wounds remain highly problematic. For the critically ill and those with mobility issues, missing just one routine repositioning could send them down a protracted path of intensive wound care therapies. Even our ambulatory patients develop non-healing ulcers from neuropathy and microvascular disease. For purposes of this discussion, the question of how the wound formed isn’t nearly as important as why it persists …
Using a treatment without having any understanding of how it works is often thought of as unscientific, and suggesting that a placebo can help a sick patient has until now been viewed as unethical.
The New England Journal of Medicine just published an article about placebo (making you feel better) and nocebo (making you feel worse) effects, two of the most intriguing aspects of the supposedly scientific practice of …
We need to give more thought to informed consent
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