Since the beginning of a new academic year is fast approaching, here’s some heartfelt advice. You might need it, I hope you read it and heed it. If you’re just beginning your medical school journey, the first line is written specifically for you, but the rest of the piece is pertinent for any doctor, at any age and any stage of their careers.
If this is your first day of med …
As you enter medical school: tips from a patient
Match Day is the culmination of a medical student’s education: the day all graduating seniors and non-traditional applicants find out where they will spend the next three to seven years to train in a desired specialty. I fell in love with obstetrics and gynecology (OB/GYN) as it was the perfect way to combine my passion for women’s health with medicine and surgery. I also liked that the patients were relatively …
What’s life like after not matching? A physician’s story.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical history is otherwise unremarkable, …
MKSAP: 25-year-old man with dark-colored urine
I woke up to the sound of a faint “ding” from my bedside table. It was 5:24 a.m. Shaking off my lethargy, I scrambled over to my phone because the ding meant one thing: my first residency interview invitation.
Looking back on that moment, as I responded in the dim light of the morning, I realize that I knew very little about what was to come over the next few months. …
The rewarding and grueling process of residency application
How do we balance freedom and safety for those with dementia, particularly in the risky domains of sex, driving and money?
In 2014, Henry Rayhons, a 78-year-old Iowan, was arrested because he allegedly had sex with his wife.
Wait. What?
The Rayhonses, both previously widowed, met while singing in a church choir. Over time, Mrs. Rayhons developed dementia and went into a nursing home. At one point, a roommate reported hearing …
The fine line between dementia, sex, driving, and money
Recently I was saying goodnight to my oldest son, who is now 14 and about to enter high school. I was standing in his bedroom looking at his midnight blue walls, which are covered in each of the planets. He looked up at me from his Pottery Barn bunk bed and said, “Mom, I need a new bed … and new walls.”
I stared at him, realizing my son was no …
A physician mother and her son
When Amazon, Berkshire Hathaway, and JP Morgan (AmBerGan) announced their health care partnership, Berkshire CEO Warren Buffett declared “the ballooning costs of health care act as a hungry tapeworm on the American economy.” He is right. Our broken system is infested with tapeworms. Tapeworms are parasites; they exploit their hosts, drain resources, and suck the life out of their prey. Unfortunately, Buffet failed to call attention to the tapeworms specifically; …
Can direct primary care save us from the tapeworms of insurance?
In a prior post, I shared my heretofore reluctance to prescribe medications for my hepatitis C (HCV) patients. In summary, after consideration of the risks and benefits of the available options, I could not persuade myself — or my patients — to pull the trigger. These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another …
Why this gastroenterologist decided to treat hepatitis C patients
I usually simplify things here on the blog. Sometimes it is easier to glaze over a part of the story instead of pulling out all the details. Others, the point is clearer when not bogged down by tangentially related details. What’s lost in nuance, however, often adds shades of complexity to the picture. Occasionally another viewpoint is suppressed on purpose. I have frequently referred to the fact that I Read more…
A physician’s first financial advisor
July was an interesting month for artificial intelligence in medicine.
A study from MIT found when human doctors order tests on patients, they factor in something that artificial intelligence is not currently aware of. The authors analyzed charts of about 60,000 ICU patients admitted to Beth Israel Deaconess Medical Center in Boston.
By looking at physician progress notes with positive or negative sentiments in patient records, they derived scores which they correlated …
Artificial intelligence in medicine: not ready for prime time
This was the end-of-the-hallway conversation with an elderly patient after wrapping up a recent office visit, as we walked away from the exam room toward the front desk to schedule her follow-up appointment, and she realized that we were “celebrating” 20 years together.
I met her when she was admitted as an inpatient when I was on service as a junior attending just starting out, and after going home she came …
It’s time for an army of people to help take care of our patients
Since the beginning of the fourth year of medical school, I have lived in six different cities and have been fortunate to call a Michigan apple orchard, an island on the Mississippi River, and a little apartment in the Coolidge Corner neighborhood of Boston home. I come to you as an emergency medicine intern fully immersed in the second month of residency excited about what the future holds as a …
How to separate good medical students from superb ones
I’m not really sure who is at fault, but somewhere along the way, our educational system decided that teaching personal finance is unnecessary. We learn calculus, the rules of dodgeball and even sewing, but financial management is taboo. Then, all of a sudden, we head to undergrad and medical school, and before we know it, we’re in our late 20s or early 30s financially illiterate.
The consequence of this was shown …
It’s time to learn the basics of financial management in medical school
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We’ve all been through difficult times. It may be the death of someone we love or suffering abuse with no one to help. In life, many events fly at us that are hard to manage. Many of us just suffer silently through the pain, not allowing anyone in. And even while we do that, we also know that is not the healthiest response.
Many patients come to me struggling with anxiety …
How to deal with hardships in life
A natural part of life is emotionally growing (hopefully) with experience. If I was to look back at my own journey, when I was in medical school and just graduating, I would say that without doubt, one of the biggest things I would tell my younger self, would be to not take things too personally. This would be particularly true in professional situations.
I look back at how personally I used to …
Physicians can’t take things personally. Here are some tips.
One common question that doctors face in estate planning is whether to establish a trust. This topic gets brought up in the doctors’ lounges, especially after someone gets a pitch from their financial planner. Most doctors who bring up the topic are quite enthusiastic, and cite that doctors need a trust because “we make a lot of money.”
Fair enough.
Medical students and residents probably do not need a trust
I’ll get this …
What physicians need to know about living trusts
I have a theory. There is a simple thing hospitalists can do that can enhance relationships with our patients, and even, I bet, improve patient satisfaction scores. The catch is it is not something you can do for yourself; you can only “pay it forward” for somebody else.
We know patients who trust their physicians are more likely to follow recommendations, and that trust and confidence in physicians …
The simple thing hospitalists can do that can enhance relationships with patients
Death and dying — it is one of the first topics I was taught about in medical school. I was fortunate to attend a medical school that only made us spend half our time falling asleep in lectures. The other half we were in small group sessions, working our way through real patient scenarios, trying to learn to think like a physician.
As part of our first-year curriculum we had to spend time doing …
A physician explains the afterlife to his child
The bedrock requirement to obtain informed consent before patients may be enrolled in research has been eroding. I’ve documented the different ways and different reasons for this several times over the years (“Informed Consent for Babies: When Experts Disagree,” “Informed Consent in Infant Research: Ethical Problems Remain,” “Informed Consent in Comparative Effectiveness Research,” and “The Erosion of Informed Consent in Medical Research”). The latest example is a clinical trial of …
The erosion of informed consent in medical research
Sometimes I wonder if I am wired differently from other doctors, in terms of what I remember on my own and what I need some help with.
The other day I got a “medical call” that simply said, “Mr. Brown called to report his blood pressure is 120/80.”
With more than fifty calls in my inbox and no memory of what the issue was with Mr. Brown’s current blood pressure, I replied: …
The problem with telephone messages in primary care
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