Growing up Republican, I have long believed in personal responsibility. In junior high school, when I observed close relatives who struggled with obesity, I vowed to never let myself get out of shape. (“Junior high” is what we called middle school back in the day.) When hip surgery gone wrong dramatically reduced my level of physical activity two and a half years ago, I cut back on what I ate …
Who’s really to blame for the obesity epidemic?
He struggled to hear when people talked to him. He asked the same questions over and over. He fell asleep when really important conversations were going on around him.
But it wasn’t until he missed an emergency call that I knew I had to act.
I spoke to a higher-up about this elderly doctor out of concern for patient …
Reporting an elderly doctor. And suffering from snitch guilt.
Many physicians have become world famous writers, and in Greek mythology, Apollo was the god of both poetry and medicine. I can personally think of many prominent physician writers I have come across in my reading over the years:
There was the 12th-century rabbi Maimonides, Copernicus in the 15th century and the poet John Keats in the 1700s.
In the late 1800s to early 1900s, there were Anton Chekhov, Sir Arthur Conan …
EMRs are robbing physicians of their writing skills
Mrs. Smith is an 81-year-old female. She worked a long time doing very physical work and is now on a fixed income and comes to my office with chronic pain. X-rays show she has degenerative arthritis in her hips, knees and lumbar spine. She has taken Norco twice a day for years and has been able to be very stable on this. She has always been compliant with her medications. …
Don’t let the opioid crisis affect the treatment course for your patients
My job as a standardized patient (SP) at several different medical schools means that I spend a lot of time being interviewed and examined by students at every stage of their education. Occasionally, the interview is of such a nature that the SPs are told to dress in a certain “costume” because it signifies to the student that there is something about our cultural representation that affects our medical care. …
Are cultural sensitivities affecting care?
How important is it for a doctor to want to be a doctor?
At first glance, that question is ludicrous. The path to becoming a practicing physician is so long and tortuous that no one would do it if they didn’t want to. Right? First, there’s the four years of undergraduate education, then four years of medical school, then at least three years of residency. No one has ever suggested that …
Why do doctors who hate being doctors still practice?
October is the epitome of academic conference season. Returning home, suitcase laden, and a belt-hole wider from lost promises of exercise, and plans to “watch what I eat” while on the road, I am ready to get back into my routine. All the same, I come back refreshed by a new flavor to the mundane routine of conference experiences past. At the three conferences that I attended this fall, women …
Women as leaders: reflections from the conference trail
My young daughter will be entering middle school in another year. However, she still likes coloring books. If she watches a scary movie, I have to lay with her in bed until she falls asleep.
She is still just a kid. Should I really be worried about HPV? Is this something you should consider for your daughter?
As an OB/GYN doctor, I know about the HPV virus and have seen so many …
Why your child should get the HPV vaccine
Measuring metrics is a common catch-phrase in health care. The goal of capturing certain data is to improve patient outcomes. But, as doctors, we were taught to treat the patient and not the numbers. While optimizing clinical outcomes is a needed goal with all the complexities in medical treatment currently, the system seems to have gone too far in its quest for targeted numbers.
If, for example, a patient suffers metastatic …
Good doctoring transcends numbers
There’s a common affliction that’s rampant in my practice, but it’s not a gastrointestinal condition. It’s called polypharmacy, and it refers to patients who are receiving a pile of prescription and other medications. I see this daily in the office and in the hospital. It’s common enough to see patients who are receiving 10 or more medications, usually from 3 or 4 medical specialists.
Of course, every doctor feels that he …
Who’s responsible for polypharmacy in the elderly?
A strange thing happened last year in some the nation’s most established hospitals and health systems. Hundreds of millions of dollars in income suddenly disappeared.
This article, part two of a series that began with a look at primary care disruption, examines the economic struggles of inpatient facilities, the even harsher realities in front of them, and why hospitals are likely to aggravate, not address, health care’s rising …
Hospitals are struggling and the future is grim
Diana Feliz Oliva, a 45-year-old transgender woman who grew up outside Fresno, Calif., remembers being bullied when she was younger and feeling confused about her gender identity. She was depressed and fearful about being found out, and she prayed every night for God to take her while she slept.
“I was living in turmoil,” said Oliva, who now works as health program manager in a clinic for transgender people at St. …
Mental health problems in the transgender population
The presidential symposium at this year’s Annual Meeting of the Child Neurology Society of America in early October in Kansas City raised many eyebrows. The first presentation of this symposium focused on burnout rates among neurologists around the country.
Many of my colleagues felt that this was an inappropriate choice, especially with so many trainees and young child neurologists in the audience. Typically, the presidential symposium at a conference of such …
How burnout is plaguing doctors and harming patients
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I first noticed this phenomenon while watching the world news on a weekday after work. It was a commercial for a new diabetes medicine that showed overweight people dancing at a barbecue, cooking and enjoying life. How different this was from my day in the wound clinic, where I saw patient after patient with obesity, diabetes, and nonhealing wounds, as well as other dire medical complications.
So I tucked this image …
The new battleground of prime time media, disease, and death
It’s no doubt that the health care conundrum our nation is facing is fraught with high-risk hypotheses and their unpalatable consequences. Complicating this further is the business-minded nature of many lobbyists and policy-makers influencing our government’s decisions, including President Trump’s. This is particularly timely given the recent executive orders Mr. Trump has unilaterally implemented that both sides of the aisle are concerned about. As a physician with a top priority …
Eliminate the middlemen of private insurance companies
As a corrections physician I frequently heard the question, “How can you take care of those people?” I understood what they were asking, after all, I was caring for people convicted of such crimes as murder, rape and child abuse.
And yet I had very little difficulty providing the same care to inmates that I provided to everyone else. In fact, the corrections environment was generally easier to work in and …
What I learned as a corrections physician
Women who lose part or all of one or both breasts due to breast cancer surgery may choose to have new breasts created with their own tissue — a process that also may or may not involve breast implants. A wide range of reconstruction procedures is available, including a variety of flaps and options to use either implants or what is known as autologous fat transfer.
Each surgery has its own …
Involve plastic surgeons early in breast cancer treatment
Until genuine rights are extended to all patients, the ongoing health-care-reform saga perpetrated by Congress and executive leadership will continue to fail the American people. Many Americans have suffered and died because of a broken health-care-delivery system. One of us lost a 19-year old son due to lack of certain patient rights – specifically the right to evidence-based medicine and the right to a complete discharge plan from his hospital. …
Got real rights? Not when seeking health care.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3 months ago. Family history is significant for his father who developed end-stage kidney disease due to diabetes at age 68 years. He reports no symptoms and takes no …
MKSAP: 45-year-old man with type 2 diabetes mellitus
Flu season is upon us, and with it a chance to test out my persuasion skills on a deeply skeptical public.
Consider this recent patient of mine, a young man in college who came in for an ankle sprain. “While you’re here, why not get a flu shot?” I asked.
He looked at me as if I were a car mechanic offering a few more add-ons to his maintenance exam.
“Oh, I don’t …
This doctor gave flu vaccines to her patients. You won’t believe what happened next.
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