Why Les Miserables should resonate with every physician

Physician
February 7, 2020

“I dreamed a dream my life would be … so different from this hell I’m living.”

Twenty years ago, I would pull out my Les Miserables piano book and pound out “I Dreamed a Dream” while my fellow medical student/roommate would sing along with me to the line above with gusto.

In the scheme of things, we didn’t have it so bad. We hadn’t been abandoned by our lover-baby daddies. We weren’t …

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Why Les Miserables should resonate with every physician

A case for nephrology

Physician
February 7, 2020

In recent times, physician burnout has rightfully surfaced as a social concern for the medical fraternity. Physician burnout is a thing, and lately, I was thinking about it related to nephrology.

Many national physician organizations and local hospital systems are developing strategies to reduce work-life stress and improve the engagement of the workforce. In November 2018, I represented the Renal Physician Association at the interim meeting of the American Medical Association …

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A case for nephrology

How patients put my life into perspective

Physician
February 7, 2020

Today my clinic patient lost his wallet, including his cash, government ID, and his credit cards. He drove more than 130 miles to the clinic.  Still, somehow, he sat in front of me in the exam chair as patient as ever through all my history questions. When I asked about his day as I was washing my hands just prior to the exam, he told me his wallet story. I …

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How patients put my life into perspective

When a patient in jail lacks impulse control

Physician
February 6, 2020

“Under duress, we do not rise to our expectations. We fall to our level of training.”
– Bruce Lee (supposedly)

When I was looking for My Patient, well before his neighbor grabbed my butt, I remember noticing that most of the slots in the doors of the isolation jail cells were open. These slots are tall enough to pass a softball and wide enough to pass a clipboard. They are about three …

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When a patient in jail lacks impulse control

Antibiotic resistance is the climate change of medicine

Medications
February 6, 2020

Imagine a looming global crisis that threatens the health of countless people, confounding scientists and governments with its sheer magnitude and complexity and growing at a pace that will quickly exceed our ability to reverse course.

Sounds a little like climate change, right?

The existential threat I’m referring to in this case is microscopic: antibiotic-resistant bacteria and fungi.

In a way, antibiotic resistance is the climate change of medicine. It has potentially lethal …

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Antibiotic resistance is the climate change of medicine

Reconciling consent culture and bodily autonomy with pediatric care

Conditions and Diseases
February 6, 2020

Every day, children are cared for in clinics and hospitals. And every day, some of them are unhappy about it; some of them deeply unhappy about it.

The contemporary practice of nursing and medical care includes health care providers having to touch their patients. This may include an abdominal exam, listening to their lungs with a stethoscope, or even slightly invasive maneuvers, such as having to put an otoscope into their …

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Reconciling consent culture and bodily autonomy with pediatric care

How to build trust and therapeutic relationships in 15-minute office visits

Physician
February 5, 2020

It is well known by now that a physician’s demeanor influences the clinical response patients have to any prescribed treatment. We also know that even when nothing is prescribed, a physician’s careful listening, examination, and reassurance about the normalcy of common symptoms and experiences can decrease patients’ suffering in the broadest sense of the word.

This has been the bread and butter of counselors for years. People will faithfully attend and …

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How to build trust and therapeutic relationships in 15-minute office visits

Why physicians should have courageous conversations

Physician
February 5, 2020

Many doctors decide to pursue a career in medicine in their youth. They have experience that points them in this direction. Once the decision is followed by a firm commitment, we seldom change the course. Medicine, here I come! At that age and with such limited life experience, it’s impossible to truly grasp the depth of the commitment to this career.

Becoming a doctor is not a career decision; it’s a …

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Why physicians should have courageous conversations

Use technology to fix medical education

Medical Education
February 5, 2020

Medical training is lengthening as students increasingly take gap years before and during medical school. Excessively long training times contribute to many problems. Trainees show high rates of burnout, depression, suicidal ideation, and alcohol abuse. Crippling student debt, compounded by the opportunity cost of not earning a salary, make it difficult for under-resourced individuals …

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Use technology to fix medical education

Stressed is desserts spelled backward

Physician
February 5, 2020

Tiramisu, chocolate mousse, red velvet cake, freshly baked cookies, and warm brownies topped with ice cream. These are some of my favorite desserts and the things I start thinking about when I am under intense stress. I often gaze at the bakery section at the grocery store just to take a look when I feel overwhelmed with stress at work or home. It is the classic description of what we …

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Stressed is desserts spelled backward

Prescribing medication from a patient’s and physician’s perspective

Medications
February 4, 2020

At least a few times a year, I am asked to prescribe antibiotics to people who are not my patients. From my point of view, there is only one answer that makes sense here – no. I have the same reaction when patients call me for a refill or advice when I have not seen them in a year or two. The patient may feel that I will refill their …

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Prescribing medication from a patient’s and physician’s perspective

A health care headache from a patient’s perspective

Patient
February 4, 2020

As a relatively healthy Medicare patient, I do not visit doctors often.

I have had digestive issues most of my life — probably from too many antibiotics when I was a child with recurring strep throat, or so I’m told.

My husband and I had just returned from living out of state for two months while he was treated with proton therapy for cancer.

My stress levels were high.

I was not resting well …

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A health care headache from a patient’s perspective

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You think insurance is confusing? Try being a patient.

Patient
February 4, 2020

My husband is a type 2 diabetic with mild chronic kidney disease, which has been well controlled on 500 mg metformin BID plus saxagliptin (AstraZeneca’s Onglyza).

At the end of last year, he got a letter from his Medicare Advantage PPO, UnitedHealthcare (UHC), advising him that the Onglyza (UHC only uses brand names) would no longer be covered and recommending he have his doctor switch him to another DPP-4 inhibitor, either …

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You think insurance is confusing? Try being a patient.

A doctor’s foray into meditation

Physician
February 4, 2020

It was mid-January, and I found myself catching some rays on a rooftop in Cancun with 15 other physicians — all women of varying ages and medical specialties. Besides enjoying the sand in my toes and a martini glass in my hand, I was there to attend the TransforMD retreat, looking for clarity on my life choices, values, and goals.

Daily Vedic meditation was to be integral to the agenda. That …

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A doctor’s foray into meditation

The doctor who avoids answering your questions

Physician
February 3, 2020

Most of us are, to some degree, procrastinators. We avoid or postpone doing unpleasant things. In this sense, physicians who are avoiders are no different from anyone else. For a doctor, however, avoiding things often leads to poor, or at least less than frank, communication with parents.

One kind of avoidance behavior is when the doctor avoids answering your questions. These doctors do not behave this way because they are poor …

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The doctor who avoids answering your questions

Improve mental health by improving how we finance health care

Health Policy
February 3, 2020

It takes an average of 10 years between symptom onset for mental health conditions to be accurately diagnosed and therefore treated. In addition to general misunderstandings about mental health, the nationwide shortage of mental health providers is one unignorable cause for this devastating delay. But why is there a shortage? Well, the bottom line is … the bottom line.

In simple terms, insurance companies do not pay enough for mental health …

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Improve mental health by improving how we finance health care

Sharing medical records won’t work

Health Technology
February 3, 2020

A major goal of MIPS is to increase the sharing of information between providers and eliminate so-called data silos. Central to this goal is the implementation of fast health care interoperability resources (FHIR). FHIR allows one EHR to directly query and pull information from another EHR, and is based on the belief that medical charts can be reliably abstracted into resources. All …

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Sharing medical records won’t work

The questions people ask medical students

Medical Education
February 3, 2020

Wow, you’re in medical school? So you are going to be a doctor? What year are you? When are you going to finish? What are you going to go into?

You should become a skin doctor, what do they call them again? It doesn’t matter, but they do good. But they are not real doctors, so maybe it’s not worth it.

You should become a doctor that gives vaccines. Are vaccines real? …

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The questions people ask medical students

Talking about opioids can lead to strong emotions

Physician
February 2, 2020

About three years ago, I was chatting about pain with a friend at a social function, and she told me she was taking a prescribed opioid for her chronic pain. I quickly got the uncomfortable feeling in my stomach that comes from discussing and prescribing opioids in clinical practice. I responded with my concerns, based on solid scientific evidence: “Opioids aren’t really effective for the treatment of fibromyalgia, or chronic …

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Talking about opioids can lead to strong emotions

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