A breakdown of your pathology report

Conditions and Diseases
September 27, 2018

I’m a pathologist and the main way I communicate to the outside world — to your doctor and ultimately to you, the patient is via the pathology report. But the short missives I send from behind the microscope lack any excitement and can fall short of full communication.

Here’s the usual story:

Skin left scapula, biopsy

Nodular basal cell carcinoma

Negative for perineural invasion

Margin status: Positive

Doesn’t sound real interesting, does it?

How about a more …

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A breakdown of your pathology report

Here’s why you wait in the ER

Physician
September 26, 2018

All have to wait. As is normal with the busy ER, the ambient noises of machines, alarms ringing, painful moaning, and loud drunken outbursts permeate the department. It’s a controlled chaos.

But, a woman’s scream pierced my soul. Her baby eight-month-old boy laid limp in her arms. He’s already pale, lips blue, his chest not rising as it should with breathing — he is not responding at all. We wasted no …

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Here’s why you wait in the ER

Should the Apple Watch monitor your heart?

Health Technology
September 26, 2018

STAT_LogoThe announcement that the next iteration of the Apple Watch can both monitor the wearer’s heart rhythm and, if a suspicious reading emerges, perform an electrocardiogram, could be a boon for users and their doctors. Or it could be a massive headache for the health care system.

The new watch continuously monitors the wearer’s heart rate. It …

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Should the Apple Watch monitor your heart?

Health care has too many moving parts

Health Policy
September 26, 2018

So many moving parts.

Just last week, a patient I’ve cared for over 20 years came to see me, and she was despondent over a number of issues.

First and foremost was that her partner of over 60 years has had progressive dementia, and finally things got so bad that he had to be transferred to a long-term care facility, no longer safely able to be cared for at home despite all …

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Health care has too many moving parts

Why historically black colleges and universities matter

Medical Education
September 26, 2018

Every few months, there happens to be another breathless news story about racism in health care. Mass media seems shocked, progressives angrily tweet, while conservatives claim that somehow it was all President Obama’s fault.

Meanwhile, the four relatively unknown and certainly underappreciated historically black college or university (HBCU) medical schools in the United States (Howard University, Meharry Medical College, Morehouse School of …

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Why historically black colleges and universities matter

The dismantling of informed consent is a disaster

Patient
September 26, 2018

Informed consent is the cornerstone of medical ethics. And every physician must defend this sacred principle from every form of evil that would seek to dismantle, degrade and debase it. If informed consent is the sun, then privacy, confidentiality, dignity, and trust are planets that go around it. For without informed consent, the descent of health care into amorality is inevitable, and the doctor-patient relationship is doomed to ruination, oblivion, …

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The dismantling of informed consent is a disaster

Financial education for doctors 101

Physician Finance
September 26, 2018

An excerpt from the Docs Outside the Box podcast, episode 4: Financial Ed. for Docs 101

Dr. Nii: All right, everyone. Welcome to another episode of “Docs Outside the Box.” We have a treat for you today. Today, we’re going to be interviewing Katie Brewer, CFP, and owner of Your Richest Life. Katie, thank you for joining the show. Can you tell us a little bit about yourself before we go …

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Financial education for doctors 101

A case of instant gratification in primary care

Conditions and Diseases
September 25, 2018

Few things in primary care give patient and doctor mutual and instant gratification.

It’s been a while since I reduced a “nursemaid’s elbow” or a spontaneous shoulder dislocation other than my own, or a finger dislocation, but those all count.

I once wrote about curing deafness in a man with a movement disorder by flushing ear wax more or less on the run as he bobbed around the exam room. That …

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A case of instant gratification in primary care

10 things wealthy doctors won’t tell you

Physician Finance
September 25, 2018

Guess what? You’re surrounded by rich doctors. You probably didn’t even know it. You know why? Because doctors don’t talk about that filthy lucre known as money. So while you’re assuming that all the other doctors in your group, office building, and hospital are in the same position as you, you’re wrong. Some of them are rich. There are ten things they’re not telling you, but which …

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10 things wealthy doctors won’t tell you

The influence of a physician’s father

Physician
September 25, 2018

Because of my father

When you lose a parent during childhood, it effects just about everything you become.  Decisions about life naturally stem from enduring this trauma.  Some try to form families early and replace that which they feel has been lost.  Others spurn close connections and create a wall so firm that no one else can encroach.  An attempt to protect against pain.  Because of my father I …

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The influence of a physician’s father

Encouragement is far from easy

Physician
September 25, 2018

I looked at my life through the lens of an outsider: It looked pretty good. Funding. Presentations. Publications. Great job, and a great family. Check, check, check.

I looked at my life through my own lens, an insider: a mess. Exhaustion. Absent from my closest relationships. Chronically feeling like I was dropping the ball, because I was. Unhealthy. Not enough sleep, or exercise, or joy. Apathy.

This was me, four years ago, …

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Encouragement is far from easy

When should insurance companies be held responsible for medical malpractice?

Physician
September 25, 2018

In July, 2009, the family of Massachusetts teenager Yarushka Rivera went to their local Walgreens to pick up Topomax, an anti-seizure drug that had been keeping her epilepsy in check for years. Rivera had insurance coverage through MassHealth, the state’s Medicaid insurance program for low-income children, and never ran into obstacles obtaining this life-saving medication.

But in July of 2009, she turned 19, and when, shortly after her birthday, her family …

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When should insurance companies be held responsible for medical malpractice?

Female physicians and the fiberglass ceiling

Physician
September 25, 2018

A male physician — one who sits on multiple committees at a large hospital in Dallas — was recently quoted in the Dallas Medical Journal, that female physicians earn less, and they “choose to or they simply don’t want to be rushed.” Adding, “most of the time, their priority is something else … family, social, whatever.”

I should be astounded that a colleague, in 2018, who appears to be about my …

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Female physicians and the fiberglass ceiling

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When a $5,500 decision becomes a $200,000+ loss

Physician Finance
September 24, 2018

How much we micromanage our lives is dependent upon our compulsivity and how many goals that we set in life.  Medicine is a profession that attracts some of the most goal-driven people I have ever met.  There are egos, obsessions, intelligence, and diligence all packaged into one unit.  This is simply overwhelming.  Fortunately, these habits tend to evolve with age.  I’ve seen some of the most incendiary personalities in medicine …

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When a $5,500 decision becomes a $200,000+ loss

Medicine has jumped the shark

Health Policy
September 24, 2018

As I explained to my medical student this morning that I was ordering an ultrasound on a patient first because the insurance company wouldn’t authorize a CT scan without it, it occurred to me that medicine derailed from its true purpose. Shortly later, I found myself again pointing out why I was prescribing a certain medicine rather than the one I wanted because it was not on the formulary of …

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Medicine has jumped the shark

Will artificial intelligence ever replace doctors?

Health Technology
September 24, 2018

Increasingly, we see functions executed by machines that were formerly performed by living breathing human beings. Examples range from the mundane to the preternatural.

  • Order food and drink from an iPad. No server needed.
  • Driverless auto travel. This may lead to a resurgence in prayer.
  • Pilotless air travel. Hard times ahead for the Airline Pilots Association.
  • Making precision tools from 3D printers.
  • Gourmet meals created with a voice-activated command.
  • Theater …

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Will artificial intelligence ever replace doctors?

Real doctoring means mitigating the fear patients have

Physician
September 24, 2018

It’s been said in the world of business that people only buy two things: good feelings and solutions to problems. In medicine, the single most important factor that brings patients through our doors isn’t a “toward” kind of desire, but an “away” one — away from feeling bad.

More specifically, it is pain and fear that most often cause patients to call and ask for an appointment. They hopefully leave with …

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Real doctoring means mitigating the fear patients have

It’s really hard to make money in the stock market

Physician Finance
September 24, 2018

No, I’m not saying that the process of investing in index funds is difficult. In fact, it’s actually quite simple to build a diversified index portfolio, whether your money is invested at Vanguard, Fidelity, Schwab, or Etrade.

What makes investing in the stock market so difficult is tolerating its high volatility. Many investors are unable to stick with the stock market in the long run because of the ups and downs.

But those who stay invested …

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It’s really hard to make money in the stock market

Tips to help you afford medications

Medications
September 24, 2018

A doctor writes prescription, pharmacist fills prescription, insurance covers prescription. Simple, right? But that’s not the way it works anymore.

Some changes are good. Gone are the cryptic abbreviations and illegible handwriting — replaced by computer printed scripts, or better yet scripts magically transmitted via the ether. But along with fewer errors there’s even less transparency on pricing and coverage. Patients, who haven’t been to pharmacy school and couldn’t possibly decode the pages of …

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Tips to help you afford medications

How to make the most of rushed physician visits

Physician
September 23, 2018

Physicians everywhere are having to deal with ever-shrinking time slots with their patients. Every doctor (or nurse) would love to have more time if possible, and it’s probably one the biggest frontline frustrations for any clinician who wants to do a good job. Time to go over the history in more detail, examine the patient thoroughly, and then spend adequate time discussing everything afterwards. Wouldn’t that be nice?

The reality though …

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How to make the most of rushed physician visits

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