My eyes flitted down to the electronic medical record in front of me. I was conducting a physical assessment of a patient new to my clinic and the area. The forty-five-year-old male sat down before me, and I noticed immediately that he was morbidly obese and sweating profusely. I tapped away as he rattled off his various diagnoses which included: cervical radiculopathy, depression, chronic low back pain with radiculopathy, and …
When pain management goes right
When I served as president of the New Jersey Neurosurgical Society, I met a lot of people from around our great state. One question that I heard from many parents and coaches was, “After a concussion, when is it safe to let a student-athlete return to play?”
It is an important question because hundreds of thousands of high school students in the USA suffer concussions annually. I have given this question …
How a neurosurgeon recommends approaching concussions
An excerpt from Mirth is God’s Medicine: Coping with Cancer as a Physician.
“As iron sharpens iron, so one person sharpens another.”
– Proverbs 27:17
In the coming weeks, after the biopsy returns positive for cancer — and after the initial shock wears off — I am trying to plan ahead, and …
A physician diagnosed with cancer, and the importance of mentorship
Here we are, coming down the home stretch and about to finish residency. With an increased income comes some new financial decisions. The need for life insurance is one of those decisions. If you don’t have any, now would be a good time to consider getting some.
The purpose of life insurance is to support the people who are dependent on your income if you die and aren’t there to provide …
You just finished residency. It’s time to consider life insurance.
In 1976, we couldn’t wait to be nurses. Our starched white dresses with the nurse caps and stripes symbolized our graduation status as we were called one by one to receive our diploma and a rose.
We took an oath to care for the sick, to be professional, to critically think, to respect doctors and to respect patients and family members.
And to respect each other.
It was the age before computers. We …
Nursing’s newest problem: The young eating the old
Across the country, many doctors, nurses and other health care workers have remained silent about what is being called an epidemic of violence against them.
The violent outbursts come from patients and patients’ families. And for years, it has been considered part of the job.
When you visit the Cleveland Clinic emergency department — whether as a patient, family member or friend — a large sign directs you toward a metal detector.
An …
The epidemic of violence against health care workers
I am a few days away from graduating medical school. Throughout these four years, I have given back to my medical school by passing on the knowledge and wisdom I have accumulated. I share my reflection on the importance of having medical school mentorship and teaching not just from interns, residents, fellows, and attending physicians, but from medical students themselves.
As first-year medical students, (almost) all of us are overwhelmed by …
Promote a culture of medical school peer education
The eulogy of a profession should be a relatively uncommon undertaking. And yet, the death of the physician appears to be such a fait accompli that one feels late to the wake. It has been a long and lingering death, like the proverbial frog in the pot, and but there are moments, increasing in frequency in my day-to-day clinical practice when it seems so sudden, unexpected and even surreal. This …
The self-inflicted death of the physician
1. Bipolar disorder
2. History of postpartum psychosis
3. No custody of her children
4. In treatment for cocaine abuse
5. Regular smoker
I digest each of these facts on the computer screen in rapid succession, progressively cementing the picture of Renee Pryce, a 28-year-old woman in her final months of pregnancy.
I’m a first-year resident in a large urban county hospital. In the course of my training, I’ve learned that some people (mostly older doctors) …
Don’t assume your patients’ character based on their diagnoses
Physicians have the highest rate of suicide of any profession in the U.S., including military service. We lose about one doctor per day in the U.S. to suicide. The high levels of stress, lack of sleep, ease of self-medication, and reluctance to seek mental health treatment are among the reasons for these high numbers. But those are not the only reasons.
If you’re like me, you’ve been hearing about how physicians …
How secondary post-traumatic stress contributes to physician burnout
There is a pervasive tendency to turn to medicine looking for magic. Patients and health care professionals alike generally expect medicine to be able to cure diseases, alleviate symptoms, and relieve suffering. Historically, medicine has met and exceeded these expectations in a variety of ways.
However, in some cases, these expectations can cause a blurring of the lines between hope and reality, resulting in false “promises” and preventable disappointment.
You may be …
The breakthroughs and failures of medicine
Would you take an exam without studying? Would you run a marathon without training? If not, why would you show up for surgery without physical preparation for a life-changing event? Few patients capitalize on the opportunity to improve the odds of a successful surgery and a speedy recovery. Recently, an explosion of medical research suggests cardiovascular training before surgery, or “prehab,”can make this happen. As operating room …
Shorten recovery with prehabilitation before surgery
This article is about learning to protect yourself and your standard of living as a nurse. Now that I am considered a seasoned nurse, I have concluded that there are many essential aspects of the nursing profession that are not discussed during nursing school. It is a shame because many of these topics should be discussed so that new nurses can prepare themselves for issues that may and often occur …
Protect yourself and your standard of living as a nurse
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“He died because he’s Black!” screamed his mother, inconsolable in the intensive care unit as her unresponsive teenage son underwent a formal neurologic examination. We had done all that we could. Mr. M had experienced a cardiac arrest for unknown reasons at home, and his mom felt the emergency medical technicians treated her son differently, possibly even withholding care, because of his race. She already knew what the result of …
A family physician changes the culture of his department
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 48-year-old woman is evaluated at a follow-up appointment for elevated liver chemistry tests over the preceding 6 months. She reports no symptoms. She has type 2 diabetes mellitus and hypertension. Her family history is unremarkable. She drinks two glasses of wine one or two times per month. Her …
MKSAP: 48-year-old woman with elevated liver chemistry tests
These are trying times for health care optimists. Despite all the hype surrounding breakthroughs in clinical practice and technology, American medicine is stuck in in neutral. Though the engine is revving loudly, little progress is being made.
This unfortunate truth came into clearer light last week when I was preparing lesson plans for the health care strategy course I teach at the Stanford Graduate School of Business. During the first class of …
Pay people for their kidneys? It’s time.
An excerpt from Hindsight: Coming of age on the streets of Hollywood.
During my medical school clerkships, an attending recognized a truth within me that I’d hidden for many years. Just a few hours into my pediatrics rotation, the …
The story of how a homeless teen became a physician
As calls for radical health reform grow louder, many on the right, in the center and in the health care industry are arguing that proposals like “Medicare for all” would cause economic ruin, decimating a sector that represents nearly 20% of our economy.
While exploring a presidential run, former Starbucks chief Howard Schultz called Medicare for all “not American,” adding, “What industry are we going to abolish next — …
Medicare for all will kill jobs. But it may be necessary.
Recently I had the wonderful, yet solemn opportunity of attending my ninety-three-year-old paternal uncle’s funeral. I purposely choose the word “wonderful” to describe this experience because honoring the life of such a remarkable man, surrounded by my family who will continue to love him dearly, was such a special gift. Amid today’s increasingly complex world of business and “social” media, it is often a challenge to pause, to reflect, to …
Compassion is never a sign of weakness. It’s a sign of greatness.
Society gives short shrift to older age. This distinct phase of life doesn’t get the same attention that’s devoted to childhood. And the special characteristics of people in their 60s, 70s, 80s and beyond are poorly understood.
Medicine reflects this narrow-mindedness. In medical school, physicians learn that people in the prime of life are “normal” and scant time is spent studying aging. In practice, doctors too often fail to appreciate older …
Ageism in medicine is real. How can it be stopped?
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