When doctors are incorrect in their prognosis of terminal illness

Physician
April 18, 2012

In January, when my close friend’s lymph node biopsy came back as a rare form of T-cell lymphoma, I scoured the scientific literature. What was his prognosis?He was 56, a little overweight but otherwise healthy. He had helped us move into our home more than a decade ago, and I was like an uncle to his son and daughter.

In the literature I found jagged graphs plunging downward, indicating that my …

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When doctors are incorrect in their prognosis of terminal illness

Tips for successful home blood pressure monitoring

Conditions
April 18, 2012

Sometimes, the simplest tools in medicine are the ones that give us the most useful information.

Take the humble blood pressure machine, for example. It’s been around for years, and it’s cheap, compared with a lot of other medical devices. It’s simple to use, and it doesn’t require a medical or a nursing degree to operate. But the numbers it reports are valuable in helping predict a person’s risk of a …

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Tips for successful home blood pressure monitoring

Bullies are not born, they are raised

Physician
April 17, 2012

People often wonder what causes children to bully.  Why is it that some children feel the need to hurt and humiliate other children?  What do they really stand to gain from this cruel behavior?

Some studies indicate that some (not all) bullies have naturally aggressive and/or hyperactive personalities from the start. Some.  But that doesn’t mean that all “spirited” kids will bully while all “mellow” kids will be perfectly empathic and …

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Bullies are not born, they are raised

CME limitations and how we can improve Continuing Medical Education

Education
April 16, 2012

Some people critique Continuing Medical Education (CME) programs as spoon-feeding. As a young physician struggling to learn a lot of material, I actually appreciate a bit of ready-to-consume content that I can learn quickly and effectively. The American College of Cardiology (ACC) and other reputable institutions provide CME programs that, overall, help to keep physicians up on the literature and integrate new findings with existing knowledge. However, despite the basic …

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CME limitations and how we can improve Continuing Medical Education

Tips to fight depression during medical residency

Physician
April 15, 2012

Even though I love my job, I’ve been feeling a little burned out lately. I think it comes from being stretched too thin, which is something I’ve coped with off an on ever since med school.

As the saying goes, there are never enough hours in the day, and sometimes that really gets to me. While my practice is incredibly important, I also place a lot of value on my family. …

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Tips to fight depression during medical residency

The implications of provider versus doctor

Physician
April 13, 2012

I am used to being called a “medical provider” instead of a doctor or a physician these days, but it makes me think about the implications of our choices of words. The word “provider” was first used in non-medical contexts over 500 years ago. It is derived from the Latin providere, which means look ahead, prepare, supply.

“Medical provider” is part of the Newspeak of America’s industrialized medical machine. …

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The implications of provider versus doctor

End stage colon cancer becomes even more tragic without hospice

Physician
April 11, 2012

Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …

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End stage colon cancer becomes even more tragic without hospice

The future of medicine for aspiring young doctors

Physician
April 11, 2012

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March 29, 2012

Calhoun Lecture Series
Strom Thurmond Institute, Clemson University

Thank you for the invitation to speak tonight. I’m very humbled to stand before you. And what a delight to speak to people who are neither bleeding, intoxicated nor asking for Percocet! And in a setting where no one will burst through the back door on a stretcher!

As you know, I’m an emergency physician …

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The future of medicine for aspiring young doctors

Why my patient ran away from the hospital

Physician
April 10, 2012

My patient ran away from the hospital.

This ordinarily is almost common place for a hospital bordering the south side of Chicago. In the last two years at the hospital, I had first grown surprised, and then helpless and finally weary to such mysterious absconding. This time however, it struck a chord.

Long before Mr B ran away, I had an inkling the new diagnosis of HIV would be difficult for him …

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Why my patient ran away from the hospital

Does contracting with third party payers compromise ethics?

Policy
April 9, 2012

Physicians have historically been fairly well compensated for their efforts and thus have enjoyed many of the comforts of modern life. Most would agree this is the result of years of hard work, perseverance, intellect and dedication. In general these are also traits along with professional integrity, which raised physicians to a position of relative prominence and trust within our society. But in recent years that social position and economic …

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Does contracting with third party payers compromise ethics?

When it comes to medical care, honesty is essential

Physician
April 9, 2012

Have you ever said, “I’m going to be perfectly honest with you” or something to that effect?  Have you ever had someone tell you that they were going to be perfectly honest with you?  Have you ever thought about what statements similar to these really mean?  You should.

Trust is an earned commodity and hard to get back once lost.  “Doc, I’m going to be perfectly honest with you” means that, …

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When it comes to medical care, honesty is essential

When doctors are called providers

Physician
April 7, 2012

Impersonal and self-absorbed as Manhattan may be, it’s still embarrassing to cry on West 32nd Street.  I looked for a store, any store, and ducked inside.  The pace of my steps and angle of my head as I buried myself into a back corner, thumbing through pants twice my size, gave me away.  A store clerk walked over and asked if I was okay.  I knew I’d have to meet …

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When doctors are called providers

8 reasons why I love my patients

Physician
April 6, 2012

A few months ago, I came out with a post on why I love my own doctor. Today I want to celebrate my patients, both past and present.  For me, without the experience I have had over the past 14 years, I would not have enjoyed medicine quite as much as I do.

What I like the most about medicine is the ability to interact with people. That’s what clinical medicine is all …

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8 reasons why I love my patients

Is medicine a science?

Policy
April 2, 2012

Here’s something I read recently in a blog post (The Limits of (Neuro)science at Neuroskeptic) that started me thinking: “Will science ever understand the brain? … The notion that humans are complex and hard, while nature is easy, is an illusion created (ironically) by the successes of reductionist science. Some of the biggest questions facing mankind for eons have [been] answered so well, that we don’t even …

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Is medicine a science?

The cutthroat pre-med culture needs to change

Education
April 2, 2012

I eyed my chat screen with a good amount of suspicion. A friend of a friend who I had rarely spoken to had initiated a chat conversation with me with the opening line “How are medical school apps going?” The cursor blinked in anticipation.

I began to think about possible ulterior motives that she, another pre-medical student, could have had. Perhaps she just wanted to use me as a comparison for …

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The cutthroat pre-med culture needs to change

Why full code should not be the default status for patients

Physician
March 30, 2012

Full code is the universal default status for patients who haven’t chosen otherwise, but I suspect most physicians believe this policy is wrong. We know in our hearts we’re doing harm when we perform CPR on poor souls at the natural end of their lives, whose bodies can do nothing more than suffer.

Appropriately timed end-of-life discussions are the supposed answer, but for doctors, they are emotionally draining, interpersonally complex, and …

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Why full code should not be the default status for patients

Honesty is the basis of communicating with patients

Physician
March 27, 2012

I recently came across two articles in the press concerning doctor-patient relationships and communication. I began to reflect on what makes communication between doctor and patient most successful and many questions surfaced.

In the New York Times, a new study published in Annals of Internal Medicine was referenced. In this study, the way in which doctors communicate non-verbally was examined. Non-verbal communication was often discordant to the message being relayed, particularly …

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Honesty is the basis of communicating with patients

MKSAP: 32-year-old man is disoriented, combative, and agitated

Conditions
March 25, 2012

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old man is brought to the emergency department after becoming disoriented, combative, and agitated earlier that day. He is accompanied by a friend, who states that the patient has a history of alcohol and drug abuse, including inhalants.

On physical examination, the patient is uncooperative and …

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MKSAP: 32-year-old man is disoriented, combative, and agitated

Mexico needs more pediatricians

Physician
March 21, 2012

Being a child in 21st century Mexico utterly differs from any other era. The last decade has been a constant whirlpool for Mexico. Political, cultural and economical changes have shaken the country to its core. Primary care physicians, particularly pediatricians, have a burdensome challenge at hand.

Problems like obesity have quickly emerged in all age groups. Obese children, childhood type 2 diabetes and sedentary lifestyles have invaded Mexican homes. Nutrition related customs …

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Mexico needs more pediatricians

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