My daughter and I were talking the other day and saying we would like to ask a doctor what his thoughts are about all these ‘natural’ remedies that are available. Recently a friend made the remark, ‘I do everything I can to avoid a doctor.’ I lean more toward the medical system and the knowledge they have acquired over the years rather than relying on these home remedies. What are …
Some “natural” remedies aren’t natural
A fairly recent article in the Journal of Pediatrics is both intriguing and sobering. It is intriguing because it lays bare something we don’t talk much about or teach our students. It is sobering because it describes the potential harm that can come from it — harm I have personally witnessed. The issue is overdiagnosis, and it’s related to our relentless quest to explain everything.
“Overdiagnosis” is the term the authors …
Overdiagnosis harms kids. Here’s how to avoid it.
Why would a well-respected, venerable health care organization adopt a soft and squishy approach — tracking disrespect and other forms of emotional harm — to monitor its performance?
In 2007, Beth Israel Deaconess Medical Center (BIDMC), a 672-bed health system affiliated with Harvard Medical School, adopted the audacious aim of eliminating all preventable harm by January 1, 2012. According to Kenneth Sands, MD, chief quality officer of BIDMC, the organization has …
Place emotional harms on par with physical ones
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We have two ears and one mouth so we can listen twice as much as we speak,” said Epictetus. It’s clear that the Greek philosopher wasn’t a physician in 21st century America. If you watch doctors — and many researchers do — they speak more than listen.
Studies have shown that doctors interrupt or redirect patients within the …
A positive visit with a patient with chronic pain
In these strange days of unsure future health care policies, shrinking budgets, and significant belt-tightening, as we look for ways to improve access for our patients, we need to reevaluate how we to get them into care, making sure we see them in a timely and efficient manner.
We have always said that in this topsy-turvy time, in the crazy state of health care, what we really need is more primary …
Primary care today is like squeezing blood from a stone
The news was bad. Mimi, a woman in her early 80s, had been undergoing treatment for lymphoma. Her husband was being treated for bladder cancer. Recently, she developed chest pain, and a biopsy showed that she had developed a secondary tumor of the pleura, the space around one of her lungs. Her oncology team’s mission was to share this bad news.
Mimi’s case was far from unique. Each year in the …
Can a dying patient be a healthy person?
A recent issue of the Journal of the American Medical Association (JAMA) reads like an expose. Well, at least three of the research articles do. So exciting! I don’t want medicine — my field — to be ethically unsavory, but it is sometimes. It makes me proud to see that it polices itself and that such information is published in a high profile journal.
The first article is …
Why should we worry about conflict of interest?
My colleague, Dr. L.T. Kim, was off this week and I covered for him.
On Friday afternoon, I dealt with two of his patients and learned — or relearned — two important lessons.
I saw a man with thoracolumbar back pain. He had fallen off a ladder a few years earlier and suffered from recurring bouts of back pain — sometimes with tingling in both legs. He had been to the emergency …
I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn’t going to let it be that easy. I repeated myself and paused again. This time a few tentative answers flutter up to the podium.
Hospice? Comfort care? End of life? Giving up?
Now this is something I could work with. I cleared my throat and smile broadly.
Palliative care is a philosophy.
I can’t help but …
Palliative care is a team sport
The boom in telemedicine is here, and understandably so. The “consumer” is in control now, and they sure don’t want to be “patient” anymore. When Americans want care, they want it cheap, and they want it now. Telemedicine has grown to accommodate 7 million annual patient encounters, up from 350,000 five years ago. What savvy health care administrator doesn’t see numbers like that and get dollar signs in …
Telemedicine encounters inherently sacrifice quality
It’s Match Day. Standing with my medical school class in the lobby of our medical education center, there is a palpable energy. It had been a long journey. After reluctantly leaving CA for NY I had finally completed four grueling years. The entire time I was laser focused on doing well enough to make it back to California. The four years came and went in a flash, and without hesitation, …
The untold story of Match Day emotion
I was raised in a family that hates taxes. Not hates taxes as in, “Gosh, it’s too bad such a high percentage of my paycheck goes to the government.” More like: “How dare the government steal my hard-earned money and give it to undeserving moochers?” (Is there such a thing as a deserving moocher? Sorry, I digress.)
The origins of this anti-tax sentiment are deeply ideological, steeped in a frothy mix …
Who hates taxes? The answer isn’t what you think.
Did you know that several Caribbean medical schools provide postgraduate premed courses so students can complete their science requirements? At least one school’s nearly year-long premed curriculum includes 8 hours per day of classroom work, rudimentary general chemistry and organic labs, and a physics lab with 40-year-old equipment. The fee is more than $30,000 cash, no loans. That’s a lot to pay for courses that are not accredited and credits …
Caribbean medical schools: It’s not all palm trees and sunsets
In this podcast, I share insights from a doc who barely survived his suicide attempt plus simple ways to prevent the next suicide. Listen in. You may save a life.
Dear Pamela,
I’ve never been so happy to fail at something in my life. Four weeks ago today I died. Cardiopulmonary arrest in jail. Why was I in jail? My wife alerted …
Doctor revived after suicide tells all
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old woman is evaluated in the emergency department for several hours of altered mental status. She is from out-of-state and is visiting with relatives. One of her young relatives was recently ill with gastrointestinal symptoms. The patient developed anorexia 3 days ago and vomiting 2 days ago. She has been unable to …
MKSAP: 74-year-old woman with altered mental status
I know of only two people who, upon starting medical school, knew that they wanted to become psychiatrists. (How did they know what they wanted to do eight years before they did it?) They both achieved their professional goals: One created a community clinic for people with severe psychiatric illnesses. The other became an addiction psychiatrist and now oversees an entire substance use disorder program for a health care organization.
I …
Why it’s important to know yourself
Health care costs are out-of-control, and many patients can no longer afford medical treatment. The system is broken, but no real fixes are visible on the horizon. Sure, politicians debate the road health care should take and act like they are very concerned about the health of Americans. Truthfully, however, they are driven by political agendas corporate influence. Little discussion is given to what it would take to fix the …
Politicians can’t fix our health care system
This week, a resident asked, “What do you say to suicidal physicians?”
1. I don’t say anything. I listen without judgment. Our culture doesn’t support physicians asking for help — or revealing their suffering. As a result, physicians fear sharing suicidal thoughts with friends and family because we’re the ones that others rely on for help. Physicians fear speaking to their program directors or employers because of professional retaliation and loss of …
3 things to say to a suicidal physician
When I was a third-year medical student, I was a victim of sexual harassment.
I had a patient (I no longer remember his name, so let’s call him Mr. X) who was in his eighties and I had to do a rectal exam on him. I had been on the team taking care of Mr. X for a while, and I was fine doing the rectal exam and checking for blood …
A victim of sexual harassment as a medical student
We do many things in medicine to patients that are either not helpful or have the potential to harm. If you take the long view of medical history, this should not be surprising. After all less than a century ago, physicians were still giving toxic mercury compounds to people in the form of calomel. And a century before that, physicians were bleeding people because they thought that was a good …
Let’s stop therapies that hurt kids
