So the American Health Care Act was rejected. And I want to scream! Not because it failed, but instead because of the way the whole thing was handled. While both parties will argue that they were trying to do what is best for the American public, I disagree. As a physician, what I see are two forces who are more intent on winning a battle than in helping the public. …
Why politics and patients don’t mix
At first, you’ll question reality. You will hear your own words, but they’ll sound foreign — apart from you. The ground will still reassuringly push back against your toes when you walk out of the room, but you will wonder if they are your feet. Like in a movie, you will negotiate the world convincingly. Yet, you are an actor playing a part. It is not the real you.
Be assured …
What do you feel when someone dies?
My entire childhood I wanted to become a doctor. When asked by adults what I wanted to be when I grew up, it was always the same answer. Never did I consider being a fireman or policeman or professional athlete. It was always the same answer: doctor. You see, my father was a small-town, general practice doctor who was somewhat of a legend in town because of his unfailing dedication …
Medicine comes in second for me
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“Help!” I yelled out of our open apartment door.
I was seven years old, and my family had recently emigrated from Egypt to the U.S. We’d been feeling elated that week because, after months of interviews, my father had matched into a pediatric residency.
That morning, he’d awoke feeling nauseated. My mother and sister went to buy some soothing food. I noticed that he’d vomited in the bathroom; now he was feeling …
My prayers and my medical practice
The American Congress of Obstetrics and Gynecology (ACOG) estimates that the U.S. will have between 6,000 and 8,800 fewer OB/GYNs than needed by the year 2020. Additionally, there is a possible shortage of 22,000 by the year 2050.
What is being done about this problem? Well, there are currently efforts to attempt to increase the number of residency positions. There is also talk of having nurse midwives take a greater role. While those are valid …
Who will be delivering babies in the United States in coming years?
I am a pediatric resident working, like many residents, in a clinic that sees many of the most vulnerable children in our area. We see many refugees and immigrants coming through our clinic, including many from the countries named in President Trump’s immigration ban.
These refugee children often suffer from afflictions we rarely see amongst our usual patient population: severe vitamin and nutritional deficiencies, intestinal parasites, malaria. They are often thin …
Our responsibility to refugee children
Unparalleled reductions in cholesterol levels are now possible with a new class of cholesterol medicine, a PCSK9 antibody, reported in one of the large national cardiology meetings recently. But this latest example of high-tech cholesterol treatment comes with a staggering price-tag, $14,000 a year for the new genetically engineered injectable. As a preventive cardiologist, I began to wonder if this is the best way to spend our money.
A few caveats …
How much health can you buy for $14,000?
Down in Baltimore for a meeting, long days full of plenary sessions and workshops, awards ceremonies and poster sessions. Recycled hotel air, bad coffee, great camaraderie.
Lots of new ideas, lots of new ways of looking at things, lots of reinventing the wheel, lots of hope for change. Lots of sessions about how to improve the environment for learners, how to engage medical students, how to build a curriculum, how to …
Fighting burnout: No is the wrong answer. It is not acceptable.
A confluence of events has occurred in the United States that could help to save the lives of many patients as well as the lives and careers of many physicians. The solution is to apply the use of micropractices to address the current opioid addiction crisis. A micropractice is a small medical practice that is run efficiently to keep overhead low and put the patient first. The patient is given …
How micropractices can help the opioid crisis
The hold music on the telephone cut off abruptly as the doctor I was trying to reach picked up the line. “Yes?” she said curtly.
“Hi, this is Erin Barnes,” I said. “I’m calling from Temple University Hospital in regard to one of your patients. She was admitted last week with anemia. We were initially concerned …
This physician fights burnout by having a binder of successes
A patient comes into the ER complaining about throbbing migraines after falling off her bicycle; thus, the physician quickly orders an X-ray, complete blood count, and asks the nurse to schedule the patient for an MRI of the head and neck in case both those tests come back inconclusive. As an ER scribe, I saw many conditions where the physician would quickly do a physical exam, and then use a …
Recognize the importance of the physical exam in the history of medicine
There’s a clear culprit in the rising drug overdose death count in Massachusetts — the synthetic opioid fentanyl. More powerful and more deadly than heroin, fentanyl has sparked a new set of survival rules among people who abuse opioids.
About 75 percent of the state’s men and women who died after an unintentional overdose last year had fentanyl in their system, up from 57 percent in 2015. It’s a pattern cities …
Surviving opioids in the fentanyl era
As the civil war in Syria shows no signs of de-escalating, worrisome evidence points towards the deployment of chemical warfare with banned agents recently, resulting in almost a hundred deaths with more than a quarter of them children. Chlorine and Sarin gas are primarily being implicated. Here are ten facts to know about Sarin gas and how it works.
1. Historically, Sarin was used for bioterrorism by members of Aum Shinrikyo, …
Bioterrorism: 10 facts about sarin gas
Recently, Utah Republican Jason Chaffetz made comments concerning health care reform that illustrates just how out of touch Congress is with modern medicine. In a press conference addressing the ongoing debate over Obamacare repeal, he stated that Americans should make a choice between purchasing health insurance and an iPhone — in the Congressman’s own words “rather than getting that new iPhone that they …
Congressman Chaffetz: iPhones are the future of medicine
In striking contrast to the happenings in the U.S. Congress, Kate Middleton, future queen of England, spoke these words at London’s Royal College of Obstetricians and Gynecologists on the occasion of a launch of educational films dealing with maternal mental health:
Nothing can really prepare you for you the sheer overwhelming experience of what it means to become a mother, It is full of complex emotions …
Maybe mothers saved the Affordable Care Act
An excerpt from The Financially Intelligent Physician: What They Didn’t Teach You in Medical School.
Every practice should have a dashboard of financial and performance metrics that the physician leader studies on a regular basis. A good dashboard should include the financial analysis tools that are most important to the organization. Pick which ones you want …
This is what every medical practice should have
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 79-year-old man is evaluated for a 3-month history of right hip pain. He points to the center of his right buttock when asked to identify the location of the pain. He has no radicular symptoms. He reports no focal trauma but believes his symptoms began after he stepped off a curb that …
MKSAP: 79-year-old man with right hip pain
“Am I going to die?”
There was a mixture of fear and pain in my patient’s eyes. He was a second grader but had already survived three major heart surgeries. Now he had pneumonia and was struggling to breathe. We were about to intubate him.
“You’re a strong guy,” I whispered to him as his mother held his hand and sobbed. “We’ll get you through this.”
He died two days later.
I drove home …
I once made a promise to a young boy with half a heart. I could not keep it.
Health care reform as it is typically discussed in America is dead for now. By “as it is typically discussed,” I mean broad “big picture” health care reform, which deals primarily with how we organize payments: government vs. free market, multi-payer vs. single payer, profit-based vs. not-for-profit. The Democrats tried. Obamacare’s shortcomings stem largely from the fact that neither President Obama nor the larger Democratic Party had the political power …
Health reform is dead. So what can we do now?
Why are the costs of prescription drugs so high? While I have prescribed thousands of them, I can’t offer an intelligent answer to this inquiry. Of course, all the players in this game — the pharmaceutical companies, pharmacy benefit managers, insurance companies, consumer activists and the government — offer their own bromides, where does the truth lie?
While I don’t fully understand it, and I don’t know how to fix it, …
Drugs shouldn’t be this expensive
