This past week was one of those weeks looming ahead of me that I was already dreading as I entered into it. I was to be working through another holiday and following a string of nights, and I would have a quick turnaround into a mid-shift. As a nocturnist by choice, I rarely work mornings or mid-shifts. I find the nights busy but also less intrusive — i.e., less administrative …
I’m thankful that medicine is a small world
“Wisdom is nothing more than healed pain.”
–Robert Gary Lee
One of the recurring expressions I heard throughout training, from preceptors and attendings to doctors ignoring a lowly medical student/resident eating lunch in the doctor’s lounge, was: “I’m living the dream.” It didn’t take long for me to realize that it was a code meaning anything but. In the last few weeks, I’ve discussed what steps I’m taking towards personal healing and …
Let’s heal the health care community
As a teaching clinician in an internal medicine residency program, it is safe to say that September is one of the more exciting and busier times of the academic year. Walking through the hallways of our department, we encounter bright-eyed fourth-year medical students scurrying about in a frenzy as they make some big decisions about what field of medicine to pursue, where to apply and whom to ask for letters …
A change of clothes might do the residency interview process some good
I saw two patients with a chief complaint of bubbles in their urine this month.
One middle-aged woman had eaten some wild mushrooms she was pretty sure she had identified correctly, but once her urine turned bubbly a few days later, she came in to make sure her kidneys were OK.
Even though she was feeling quite well, they were not, and she ended up going straight to Cityside hospital for IV …
It’s the physician’s job to think of worst-case scenarios
I practiced general internal medicine from June 1979 until November 2003. Immediately after training, I became an employed physician of an older internist covering my employer’s patients and building my practice for two years before embarking on my own.
I saw 20 or more patients per day in addition to providing hospital care and visiting patients as they recovered in nursing homes. As managed care made its clout felt by kidnapping …
A physician celebrates 15 years in concierge medicine
While walking through the duty-free at Dulles International Airport in Washington, DC, I happened upon the price tag of an imported French purse. Looking around, I wondered how many travelers could afford a $2,000 handbag.At the gate, I found a seat and logged on to the internet, where I happened upon a story about the CEO of Nostrum Laboratories, Nirmal Mulye. In an interview, Mr. Mulye explained why he raised the …
The way U.S. drug makers price their products is legal, but it’s not moral
I have talked in the past about coping with financial freedom. Once we reach the mountaintop, we undergo a number of emotional changes. It is, however, a mistake to believe that the transformation only begins once we have attained our goal. In my humble opinion, there are five stages of financial independence. These stages begin with conception and meager bank accounts, and end with financial freedom and hopefully …
The 5 stages of financial independence
To lighten the mood, when patients ask me where I went to medical school, I sometimes joke that I got my medical degree online. This usually invites laughter because it is preposterous that medicine could be taught virtually. After all, medicine is a noble professional with time-honored traditions of passing down experiential information and hands-on training provided to students who need years of face time with patients before being able …
The alarming possibility of virtual medical school
“Education is not preparation for life; education is life itself.”
– John Dewey
I stood there in awe as I watched the trauma team leap into action as the patient was rolled into the trauma bay. “Crush injury,” they said. Vitals were terribly unstable, and the patient was decompensating quickly. The corner of the room shielded me somewhat from the organized chaos that ensued and also gave me a great vantage point …
How will you educate future doctors?
My parents were married at the College of Physicians.
They picked a location that was not tied to either of their family’s religions but still sated a ceremonial need. A justice of the peace filled the role of a rabbi or priest, and they got married under the only doctrine they both held sacred: the Hippocratic Oath.
I never knew that this was an unconventional wedding location. I used to watch their …
My future as both a mother and a physician
I remember when I started nursing school about a decade ago, that there was a near militant attitude describing the nursing shortage. School administrators, politicians, and journalists hopped on this easy bandwagon and talking point. Research and polls of dubious quality rode the tidal wave of popular opinion. Unsurprisingly, their genesis in an echo chamber yielded predictably confirmatory responses. As graduation time was fast approaching, the class began to job …
The nursing shortage: then and now
An excerpt from The Pharmacist is a Whore: How Pharmacists Lost Control of Their Profession and Why You Should Care.
The day patients became customers was a black day for us all. Don’t get me wrong, pharmacy has always been a service profession, and we take that …
How pharmacists lost control of their profession and why you should care
As you sit here in the office, waiting for this visit to be over, I wonder if you would let me share just a few things with you. Despite your impeccable eyeshadow, your impressive GPA, and the smile you flash so readily, I sense that there are things left unsaid. I am curious if there is more to your story that you wish could be told. But I know that …
You are more than an eating disorder
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I sat in seat 23F next to the window, took out my leftover dinner from my backpack, and furiously started eating. A few minutes later, a man wearing an Astros baseball cap sat next to me with a puzzled look.
“You sure look hungry.”
“I am, can’t beat fried noodles with chicken. My name’s T.J. Pleasure to meet you.”
“My name’s Mike, Mike Jordan.”
“Are you related to the Michael Jordan?”
“Ha ha! I sure …
Dealing with prejudice as a cancer patient
The stories are disturbing. A pregnant emergency physician assaulted in a hallway. A patient leaping from the bed, wielding medical equipment as a weapon against the care team. A security guard intervening in a tense waiting room confrontation late at night. Most people find the violence hard to fathom, but for emergency physicians, these threats are part of life on the job every day.
A new poll by the American College …
Violence in the emergency department puts patients and physicians at risk
When I talk to medical practices about hierarchical condition category (HCC) and risk-adjusted diagnosis coding, I receive a lot of questions that point to the existence of persistent urban legends!
Let’s separate fact from fiction.
Urban legend #1: CPT fee-for-service coding will be a distant memory when we switch from volume to value
Not anytime soon. Medicare’s newer payment models starting with Medicare Shared Savings Programs (MSSP) and Accountable Care Organizations (ACOs) are …
5 urban legends about risk-adjusted diagnosis coding
I spent my first two years of medical school collecting stories. I journaled about my thoughts in the anatomy lab. I wrote about what it was like to learn how to interview and examine patients, about the immense honor and privilege I felt just being able to don a white coat with a stethoscope around my neck. I wrote about the patients that touched my heart – the patient with …
One of the biggest lessons medical school can teach you
“There’s no heartbeat.”
Three words no one ever wants to hear.
Three words no one ever wants to deliver.
And yet, as a community of physicians, we deliver those crushing words on a daily basis. None of us would ever take the task of bearing this piece of news lightly, but for me, it was not until I was on the receiving end of them that I truly grasped how profoundly a physician …
Humanity in medicine is in crisis
I cannot get behind fat acceptance, or better stated in medical lingo as “normalizing obesity.” As a physician and as someone who has been obese or morbidly obese my adult life, I know first hand what it’s like to hate my body and feel ashamed of it. I still do this very moment as I type this, that’s something I have to work on.
Funny thing is, I am much more …
Don’t sign off on fat acceptance. Don’t normalize obesity.
The California Department of Justice mandate to consult CURES (Controlled Substance Utilization Review and Evaluation) prior to prescribing, ordering, administering, or furnishing a Schedule II, II or IV controlled substance becomes effective on October 2, 2018.
The law states that CURES must be consulted the first time a patient is prescribed, ordered or administered a Schedule II, III or IV controlled substance. CURES must be consulted every four months thereafter if the …
CURES is not a fix for the opioid crisis
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