The first time I spoke to her was in the hospital when I was a relatively new intern caring for her. She was ailing for a while with complications of liver cirrhosis. She was new to the area. She had relocated from a different city to live close to her family. I eventually ended up becoming her primary care physician in the ambulatory setting as that was the quickest way …
Losing my first patient as a primary care physician
As July draws near, it is a moving day in medicine. For physicians, it signifies entering the next level of professional growth.
Let’s think about what moving entails. When we move from one physical location to the next, like into a new apartment or from one city, state, or country to another one, there is the process of sorting through our belongings. We make two lists: what stays and moves with …
Packing for the next level of your medical career
Our 20-bed ICU finally captured 10 intensivists — all board-certified in critical care medicine. We were fortunate enough to have one of these doctors in our ICU 24-7.
Of course, they all practiced professionally with expertise.
But I remembered this one the most: Dr. Jason McKenzie (name changed for privacy).
He easily became our friend and “go-to” person.
Clocking in at night and finding out that Dr. J was our doc, would give me …
Remembering a physician, suddenly taken away
For many years after I became chronically ill, I blamed myself for failing to recover my health. I told myself: “You get sick; you get better. It’s as simple as that.” As a result of this stubborn attitude, I refused to set limits, even though it would have been a tremendous help, not only in managing my symptoms but in keeping them from flaring.
Learning to set limitations
I have a background …
If you’re chronically ill, setting limitations can make your symptoms manageable
Today’s fee-for-service oncology business model misaligns incentives by rewarding practices for keeping margins and service volumes high — even when it’s wasteful — rather than for optimizing patient outcomes.
While discussions of drug pricing dominate the cost control conversation, we, as practitioners, have been abdicating responsibility and missing the opportunity to address cancer’s financial toxicity. We can do better. The practice-level assumption of financial risk for patient care — or the …
Cancer care costs everyone too much. What can we do about it?
I can tell you why there is a high burnout rate in the medical profession, but to do so, I have to explain why there isn’t one for small private practices.
When I was finishing up medical school, I went to see a general practitioner. Now, this doctor had an unbelievably high level of charisma. To say he was engaged in his patient’s health care would be an understatement. Not only would …
Physicians have been reduced to overpaid dairy farm labor
An excerpt from Human Rights Violations in Medicine: A-to-Z Action Guide.
From sex trafficking to censorship, the range of human rights violations is immense, some more heinous than others. Abuse may be perpetrated by dictators in war-torn countries and administrators in first-world hospitals. Inside this action guide are the top …
Our doctors are suffering from human rights violations in medicine
Back in medical school when you chose a residency, you probably thought you had to do most everything that came with your chosen specialty.
Then in residency, they for sure made you do every last part of your specialty (and more!).
Now you’re out of training, and you’re a practicing physician. And what you may not have realized is that at this point — something glorious happens.
You get to choose what you …
How to Marie Kondo your medical practice
“Mens sana, in corpore sano,” goes the old Latin saying. “A healthy mind in a healthy body.” It’s vital that way pay proper attention not only to our physical existence but to our minds and souls; to the intangible but essential part of who we are.
While I write a lot about things we need to do to keep our bodies healthy, it’s important to remember that our eyes and minds …
Why social media may be causing real emotional harm
I would like to share six lessons that I learned from my dad. Parents have a big responsibility in bringing up the next generation. Our kids learn from watching what we do more than hearing what we say. So doing what’s right pays dividends with our kids. As physicians, we miss a lot of time with our family due to our schedules. When we do have time with our family, …
6 lessons this physician learned from his father
Words have meaning. And when it comes to cancer, especially advanced cancer, there aren’t many words that have more meaning than the word “cure.” It is that very word and concept that is top of mind for some of us these days.
We clinicians are guilty as charged when it comes to reluctance declaring those who have had a remarkable response to treatments for advanced cancer “cured.” Experience has taught us …
What should a cure for cancer look like?
Every day I receive all kinds of emails and other ads telling me about services offering me help to meet MIPS quality metrics. While they may be helpful, most doctors don’t see the need for such a program. It drives up costs in administering and time in needless metrics reporting. Yet, give us a new regulation and a whole industry is going to pop up to profit off of our …
Why MIPS is a useless mental exercise
Whenever I tell people outside of medicine how bad doctors are with money, they are always shocked. Almost universally, they wonder why we don’t save enough money. They understand that – to become a doctor – you must be hardworking, intelligent, and dedicated to the cause. These are the same attributes – when they are applied correctly – that result in financial success. How in the world can …
4 reasons why doctors are bad with money
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The common practice in this country (although not everywhere — Europe, for example) has long been to treat all acute middle ear infections (otitis media) with antibiotics. This is not necessarily needed. We now know that for many children another reasonable approach is to wait a day or so to see if the symptoms get better on their own without antibiotics. Parents have an important role in making this choice. …
Are antibiotics needed for your child with an ear infection?
Every week there is another health pronouncement saying what is now good for you and what is going to kill you. Unfortunately, the “what” is often interchangeable — what was supposed to kill you last week is now suddenly good for you or vice versa.
Foods, supplements, and activities, all studied extensively and determined to be either good or bad, then subject to a new study, with the opposite conclusion. How …
When medical science becomes fake news
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old woman is evaluated during a follow-up visit for recently diagnosed stage IIIA high-grade serous ovarian cancer. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy and completed six cycles of chemotherapy with cisplatin and paclitaxel. The patient’s paternal aunt was diagnosed with breast cancer at age 52 years. …
MKSAP: 62-year-old woman with ovarian cancer
A patient walks into the doctor’s office and says:
I hate feeling this way. Yes, I know it’s not cancer and it won’t kill me, but this shaking has made me a different person. I can’t sign my name. I drop and spill things all the time. I’m afraid to pick up my baby grandson. I don’t go out anymore because I’m embarrassed. And I don’t know what can be done. …
Steadying patients’ fears about shaking hands
An excerpt from In Two Voices: A Patient and a Neurosurgeon Tell Their Story.
Linda, the patient, writes:
Years later a compassionate optometrist acknowledges my eye pain and frequent headaches. I try different lenses, various prescriptions. When they don’t work, he arranges for me to see one of his mentors at …
A patient and a neurosurgeon tell their story
Long-time “Jeopardy!” host Alex Trebek announced in March that he had been diagnosed with stage 4 pancreatic cancer. Within days, he offered thanks to “the hundreds of thousands of people who have sent emails, texts, tweets, and cards wishing me well regarded my health.” Then last month, Trebek reported that his cancer was in “near remission,” saying that his doctors “hadn’t seen this kind …
The Trebek effect: the benefits of well wishes
An opinion article was recently published in Stat by Daniel Sokol, PhD, who is a London-based bioethicist and lawyer specializing in medical law. His article, entitled “Doctors should use social media with restraint,” discusses the role of doctors on social media. This was very interesting timing for me as I have only very recently embarked on a professional online presence. Mr. Sokal uses Sir William Osler as …
A physician shares her positive experience with social media
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