In medical school, you learn very quickly that you can’t know everything. By the end of your first-year anatomy course, you’ll probably give up on learning the names of every part of the body, let alone the intricacies of how they function. As physicians, we must grow comfortable with our limitations. We seek help from our colleagues and try not to let our egos get in the way of patient …
What is the proper way for physicians to be leaders?
Recently I attended the funeral of a prominent gastroenterologist in my community whom I knew socially as the father of my son’s friend. It was an untimely and rapid death due to pancreatic cancer. He left behind a young wife and four children, two of whom are in college. I would see him periodically at school functions; he would sneak into an event at the last minute and often struggle …
This doctor was remembered for his devotion to patients. Was it enough?
For many people in medical training, one period of time that they look forward to is the elective period. Most of the time, these periods are available for people to explore potential career opportunities, whether it is a certain subspecialty or a research opportunity. Usually, people are not on call and weekends are free, luxuries that are often sparse during the rigors of medical training. Most of the time, one …
How violating trust during residency undermines patient care
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Dad had taken a turn for the worse, but my family was not ready to give up on him and consider end-of-life care. Nevertheless, choices had to be made. Would Dad be allowed to pass while in assisted living or have his life prolonged in a skilled-nursing facility? What kind of a doctor am I? When perceiving that a patient is dying, what type of physician neglects to intervene and …
Physicians are society’s scapegoats
A couple of years ago, “epic fail” was the phrase my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself it was a harsh but accurate assessment of my performance. And I was certainly motivated to practice on my own so that the next time, things would be different.
That same phrase came to mind as I …
The collective failure of the HPV vaccine is ours
In early 2014 I decided to use the six state licenses I had obtained as a locum tenens physician to start practicing telemedicine. Since then I have worked with several telemedicine platforms. I use telemedicine to keep up my outpatient skills. I have found that telemedicine companies differ dramatically in their overall ease of use for the provider.
Here are my top 7 tips for deciding which telemedicine company to work …
7 tips for doctors to be successful in telemedicine
Many stories have been shared by physicians detailing their experiences during their years as house officers. I trained at an inner city hospital in the early 1970s, and my story was unique.
Hospital J was built in the early part of the twentieth century. The structure was nine stories tall, with the ICU, the only air conditioned floor, located at the top. The elevators had not been automated and were still …
This hospital was put out of its misery. Deservedly so.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is evaluated because of fatigue. He also notes constipation and cold intolerance. Medical history is significant for tonsillar squamous cell carcinoma treated with radiation 3 years ago. There is no family history of thyroid disorders.
On physical examination, the skin is dry. Mild periorbital edema is present. The thyroid is of …
MKSAP: 54-year-old man with fatigue
“I solemnly pledge to consecrate my life to the service of humanity.” Standing with my medical school colleagues, we continue: “I will respect and hold the secrets that are confided in me. I will exercise moral integrity.”
I easily agree. But then, “The health of my patient will be my first consideration.” I’m 40 weeks pregnant, with swollen feet and raging heartburn. My baby kicks wildly. With certainty, I know that …
Living the oath requires physicians to set boundaries
As a physician who is planning an early retirement, and is writing about the topic often, I find that retirement is frequently on my mind. It’s not difficult to articulate my desire for an early retirement. I crave the freedom and time with my family. I look forward to restful nights free from the threat of the loathsome pager. Another round of MOC is not for me, and I’m ready …
When this doctor retires early, here are 4 things he’ll miss
The news media is hooked on the opioid prescription drug abuse story. Every day, it seems, I read a new announcement:
What I learned about prescription drug abuse from San Diego
“It’s an 8,” I heard him say from behind the curtain as I walked into the room.
The nurse’s aide dutifully recorded the number while the automated blood pressure cuff searched for his pulse, and the plastic clip on the tip of his index finger measured his oxygen saturation.
“What does an 8 mean?” I asked.
“Oxycodone!” he chirped cheerfully, without a moment’s hesitation. “An 8 means oxycodone. Five milligrams!”
“Ah, but you’re wrong,” …
How pain scores escalated the opioid crisis
I slipped and fell. My hip fractured, surgery would make it better. But it didn’t. My body was too weak to fight. I couldn’t cough and deep breathe; I stayed in bed. I had nausea and vomiting. I couldn’t breathe. I became weaker and weaker, until my family noticed. The medics rushed me into the ER. My blood pressure was 62/34. For how long? The ER nurses and doctors tried …
Sometimes when I’m working at the hospital overnight, I go for walks. Every now and then, things calm down in the operating room, and you can get some time to relax. Life moves at such a break-neck pace, especially within the world of hospitals, that taking a moment to reflect, is beneficial.
Walking around a hospital at night is very different than during the day. During the day, it feels like …
The hospital’s homeless at night
I handed her the humungous gardening shears and watched as she snapped through each rib providing access to the silent heart of our cadaver. Abruptly, the fire alarm rang out cutting short the most physically taxing day of our yearlong anatomy lab course. Once we had evacuated, firemen streamed into the building, and I wondered if my lab-mates were also thinking about the horrific scene these men would encounter as …
The donors were our first patients
Once upon a time, not that long ago, there was man who lived an uncomplicated life. One morning he awoke and did not feel well. He could not really describe his malaise, but he definitely was not his usual self. Nothing particularly noteworthy had happened to him except that his dog had recently died of old age. William, a scruffy little terrier, was 17 years old, and the man knew …
The story of a man who did not feel well
Sooner or later, you will need the ER. I don’t care how healthy you are, how much you hate going to the hospital for care, how much you distrust doctors or modern medicine, how rich you are, or how deep in the woods you live, the odds are almost 100 percent that in your lifetime you will end up in the ER.
You may get lucky, and find …
Sooner or later, you will need the ER. Will it be there?
The first time I wore a white coat was during the white coat ceremony in medical school. It was a beautiful day in New York City. Scores of young, bright-eyed medical students and their proud family members were all congregated in a ballroom, which shared its building with a bowling alley, in the heart of Harlem.
It was particularly warm inside the building, and we were being served hot coffee while …
Doctors don’t have to wear a white coat to look professional
Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do.
Why do doctors over order? These same people thought a …
The question doctors should ask before ordering a test
On May 11, 2016, we lost another bright, young soul to suicide. Sean Petro was in his third year at the USC Keck School of Medicine and is the third tragedy at his school in the last two years.
On April 23, 2015, we lost Kevin Dietl to suicide just weeks before he was to graduate medical school. Kevin’s parents were so excited to attend their son’s graduation. Instead, they attended …
Sign this petition to prevent medical student and resident suicides
