If you’re done with your residency or fellowship, you’ve paid your dues. And I am excited for you. Life is about to get better. A lot better.
If you read my prior article about going unmatched, you know that things have not always gone smoothly for me. But now, after a reasonably good first year out of training, I feel compelled to reflect on why things are going well, and also—to offer any …
10 tips for success after you finish residency
A piece of advice I would give to any younger physician, especially one who is just graduating residency, would be to expect a whirlwind ride into the realities of frontline medical practice. It’s something that you are totally not prepared for in the controlled environment of education and residency training. A steep learning curve awaits you once you start practicing medicine. And one of the biggest things you will have …
Physicians: Do not be intimidated by administrators
We had just exchanged “I love yous” about 15 minutes before the intercom blared: “Code blue.”
Just like that, my sister was gone — all from what seemed like a simple knee surgery. Simple in the fact that the type of surgery my sister was supposed to have had that fateful morning was an open reduction and internal fixation (ORIF). Thousands of these surgeries have been performed every day. But something …
Pulmonary embolism: the killer clot in your veins
“Complementary and alternative medicine” (CAM) is a category that includes all the methods of physical or mental healing that do not fall under the umbrella of western medicine. Examples include comprehensive healing traditions from other cultures, such as Chinese or Ayurvedic (Indian) medicine; herbal remedies; and a wide variety of mind-body treatments, such as meditation and yoga. CAM treatments are popular everywhere, including here in the U.S. …
The allure of complementary and alternative medicine
I received an email from our hospital accreditation coordinator/quality coordinator in a manner that wasn’t clear if it was directed to me personally or if it was sent to the entire medical staff. It said that she was reviewing the Joint Commission’s recent survey which found that the charts did a poor job of reflecting the patient’s “code status.” The institution only received a 40 percent rating.
Some patients were listed …
Don’t ask caregivers to be data entry clerks for the Joint Commission
The HPV vaccine saves lives. It does so by reducing a person’s chance of being infected by the human papilloma virus, a virus that causes a whole range of cancers including, most importantly, cervical cancer. Vaccinate your teenage daughter against HPV, and you will increase the chance she will live to old age. Simple as that.
Yet currently, the majority of American teenagers, boys and girls, are reaching adulthood without the full …
If we don’t pay now to vaccinate our children, they will pay later
Global climate change is reaching a critical mass.
Since the advent of the industrial revolution, we have seen the global mean temperatures increase by 1°C (1.8°F), and significant steps must be taken by 2030 to mitigate an even larger global temperature increase of 1.5 to 3C as predicted by 2030. In other words, we are in dire need of change.
This change is not only reliant on governmental policy change but is …
How climate change affects your skin
I’ve finally stopped thinking about the process of getting into medical school. But with friends going through the application cycle, waiting on and making decisions, I’ve been reflecting on my process and remembering just how terrible the whole thing felt. To offer some support to those going through it, I wanted to confess a few things. These confessions feel silly and small in retrospect, but I hope they’ll help at least one …
5 confessions of a medical student
It’s no secret that society has encountered a student loan crisis. Politicians from both sides of the aisle share similar concerns but promote widely disparate solutions. With over $1.5 trillion of student debt outstanding and default rates skyrocketing, it’s clear that student loan debt management is important for all student borrowers, particularly medical professionals.
Some 75% of medical school graduates start their careers with student …
The quest to cure medical professionals’ student loan debt
Being a physician has served me well. It has given me purpose and identity throughout my career. It has also provided me with a stable income. I knew, however, from the beginning that things were changing. From the earliest days of practice, I pursued lazy side hustles and real estate. I learned about investing. You might suspect that I did this …
Physician compensation is on the chopping block
For centuries, doctors felt that their notes were their property, and none of the patients’ business. This attitude slowly shifted, and the Health Insurance Portability and Availability Act (HIPAA) of 1996 put into law the fact that patients must be allowed to review and get copies of their medical records. Despite this, access to records has remained a daunting task for many. A study done in 2017 of 83 hospitals, …
Why patients should read their medical notes
“At least seven children are known to have died in immigration custody since last year,” according to a NBC News report last month.
I recently spent a Saturday working with amnesty-seekers that had been detained at California detention centers in the desert. They were dropped off at bus and train stations in the desert in Southern California, most with no money and no ability to …
A physician volunteers with migrants. Here’s what she saw.
“I want to see the doctor. Not you. I don’t like your kind. I want to see a white doctor, a man,” a patient gasping for air in an emergency room says to the dark-skinned resident assessing her vitals.
“Speak slowly, I don’t understand you people,” a male patient says as an ethnic attending discusses a complicated procedure to obtain consent.
“Are you sure you are old enough to be a doctor?” …
Discrimination against doctors is costing us
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Earlier this year, California’s new governor, Gavin Newsom, promised to pursue a smörgåsbord of changes to his state’s health care system: state negotiation of drug prices, a requirement that every Californian have health insurance, more assistance to help middle-class Californians afford it and health care for undocumented immigrants up to age 26.
The proposals fell short of the sweeping government-run single-payer plan Newsom had supported during his …
Can the states fix our national health care disaster?
I recently graduated from medical school and will soon start residency. Yay! Although I’m happy with my decision to become a doctor, I can’t help but notice that there are several ways that going to medical school and becoming a physician helped — and hurt — my ability to build wealth.
Ways it helped me build wealth:
1. I will have a high income. Most of us doctors will make at least …
How becoming a doctor can help and hurt the ability to build wealth
My husband and I are nearing the completion of a fifth and final year of residency. I say “we” because, as all residents know, the training years involve the entire family. As I reflect on the struggles and successes over the past five years, there are a few things that I know have helped us cope with the challenges, and one of those things has been travel.
We made significant life …
Travel during residency: perspective of a resident’s spouse
Yesterday, I went into an exam room to print out some orders for a patient who needed to get his labs done at an outside facility.
Due to his insurance, he cannot get his labs drawn in our office during a scheduled appointment, but must do it at one of the laboratories that his insurer has contracted with.
Not a terribly big …
Medicine is the last bastion of faxes and printers
The incidence of brain trauma has been rising in recent years. According to the Centers for Disease Control and Prevention (CDC), emergency department visits related to traumatic brain injury (TBI) increased by 53 percent in the U.S. from 2006 to 2014. For 2014 alone, the CDC reported about 2.87 million TBI-related visits, hospitalizations, and deaths. Reports of concussions in high school athletes have also increased in recent …
Concussion treatment centers: 5 red flags to watch for
We’re all gonna die.
It’s a simple truth that an astounding number of people neglect to acknowledge or accept. Some people die sudden, unexpected deaths, but most eventually fall victim to chronic or terminal conditions like COPD, heart failure or cancer. As a palliative care physician, I often meet patients who have had conversations with their families about their end of life wishes and have completed supporting legal documents.
While I appreciate …
How to have an exciting death: 5 tips from a palliative care physician
I recently had the pleasure of participating in an administrative law judge (ALJ) hearing. Novitas, the Medicare administrative contractor had denied the E/M code 99291, critical care.
The case was appealed to the qualified independent contractor, who also believed that the care, in this case, did not meet the CMS and CPT definitions of critical care. Subsequently, the case was appealed to the administrative law judge. The encounter occurred in an …
A lack of understanding for what physicians really do
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