I’ve written a lot lately about caring for our patients, and about caring for our spouses, and those things make me very happy. But now and then, things rub me the wrong way.
I was recently working at TMH, or Tiny Memorial Hospital, my vague name for small facilities since I work at several and wish to preserve their anonymity. While there a patient checked into the ED for a fairly unremarkable …
HIPAA doesn’t apply to rich hospital donors
Though I am two years into my residency, I still experience flashbacks to my time as a medical student on the wards. The adrenaline of arriving at the hospital 2 hours before rounds, scrambling to see my patients, constructing a note that no one would ever look at, and preparing a hastily-constructed presentation to deliver in a half-performance, half-examination outside of our patient’s room.
I remember being the object of a …
A resident’s guide to being a medical student
1. You either over or under-react to everything related to your child’s health. Your kid chokes? You perform the Heimlich and are back to dinner conversation 2 minutes later. Your infant spits up a little more than usual after their introduction to rice cereal? You decide they may have FPIES and stay up all night worried they may require tube feeds. True story.
2. You can’t go to …
10 truths of physician parents
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 53-year-old woman is evaluated for a slowly enlarging, telangiectatic, pearly, ulcerated 1-cm plaque on the left temple. It bleeds periodically when traumatized. Medical history is significant for atrial fibrillation. She takes warfarin daily. She is otherwise in good health.
On physical examination, vital signs are normal. Cardiac examination shows an irregular heart rate but is …
MKSAP: 53-year-old woman with a skin lesion
38 states currently have an apology act. This means that if doctors feel they owe a patient an apology, they may provide one without any ramifications, if future legal actions are taken by the patient/patient’s family.
In 2006, I spent 218 days in the hospital after the healthy birth of my daughter. My chronic autoimmune disease, scleroderma, masked certain signs of preeclampsia, which went undiagnosed. This led to a massive infection …
Medical mistakes happen. It’s what doesn’t follow that is unforgivable.
My name is Dr. Neha Sharma, and I have a confession.
Recently, a patient was transferred to me from New Mexico. He was found in his house, unresponsive. By the time I admitted him, he was connected to a breathing machine, and had a serious lung infection. Over a course of a few days, his condition improved. We were able to remove his breathing tube and successfully treat his infection. However, …
Physicians must admit and recognize their biases
Mental illness has long been associated with shame and stigma. Although progress has been made through the efforts of global celebrities like Stephen Fry and many others to de-stigmatize mental illness — many are still ashamed to admit to it, and the stigma is far from being annihilated.
Nowhere is this stigma more entrenched than within the medical profession itself. A fact that should shock us out of our judgmental slumbers …
We are human beings before we are doctors
“We are witnessing a paradigm change, an unchecked slide into an era in which the scale of global forced displacement as well as the response required is now clearly dwarfing anything seen before.”
– Antonio Guterres, United Nations High Commissioner for Refugees
The global political upheaval caused by the Syrian refugee crisis could potentially mask a critical issue that has all the signs of a catastrophic public health disaster — the health of …
Why you should care about the Syrian refugee health crisis
“‘Normal’ is one of the most powerful words a radiologist can use.”
– Curtis P. Langlotz, professor of radiology, Stanford University
After I used “clinically correlate” thrice in a row in my report, the attending radiologist asked, “How would you feel if the referring clinician said on the requisition for the study ‘correlate with images’? When you ask them to clinically correlate, you’re reminding them to do their job.”
I had been a …
A surprising amount of thought goes into the radiology report
It is February of our last few months of clinical rotations. I am a rising fourth-year medical student at a well-known East Coast institution with a not-so-bad track record, I guess you could say. I scored in the top percentile for the USMLE Step 1, honored my third-year rotations, and have comments from attendings about how I am destined to succeed in this career. One might think that at this point …
A star medical student feels like he made a terrible decision
I walk up to the ICU. Ecstatic.
I just placed a subclavian line, a chest tube, and performed a bronchoscopy on my patient. Intern year is going well, and today is a great day.
For me.
I have been learning so much, been trusted to do even more, and been a part of gratifying experiences. Successes. Life-changing procedures. Things that still make me sit in awe that we can transform the human body, …
Working in the ICU, I now know what hell feels like
I was spending time with friends and family over the holiday when I started to experience various vague symptoms without an obvious etiology. Having been treated for high blood pressure about ten years prior before successfully overcoming the issue with exercise, I immediately recognized the return of the condition. (As an aside, it should be stated that elevated blood pressure typically produces no symptoms at all.)
Stopping by my local pharmacy, …
A doctor who forgot the basics they teach you in medical school
There’s a code among physicians, both in the private and academic setting. It is that, as a physician — unless you are dying, or very close to it — you show up to work. Taking unscheduled time off, for either physical illness or grieving, is not easy as a physician. Doctors experience a huge amount of guilt and pressure, and rather than experience that, most of us will drag ourselves …
It’s time for doctors to stop feeling guilty for taking time off
The affection families express for their dying loved ones can take many forms. Recently, I saw a spry 91-year-old Spanish-speaking gentleman with lung cancer which had consumed the better part of his right lung. He had a large family with many doting daughters. In his neighborhood, he was popular and well respected. He, according his family, had “many girlfriends.” His lung cancer was no doubt a result of a …
Shielding patients from difficult diagnoses undermines their autonomy
A guest column by the American College of Physicians, exclusive to KevinMD.com.
I have a “like-hate” relationship with clinical metrics, performance measurements, and other such things. By now, almost all physicians live with them in the form of insurer “report cards,” PQRS, and “meaningful” use. Some of us have even more exposure to them by participating in …
Let’s fix performance measurement for physicians
A road trip from Georgia to New York was going splendid, dare I say, wonderful — catching up with old friends and family — when it took an unforeseen and slightly less desirable turn: I got admitted with a small bowel obstruction. Thanks to truly excellent care from a community hospital, I am home and now subjected to endless computer questions from my father that has me briefly contemplating readmission …
True confessions of a hospitalized hospitalist
As standardized exam scores increasingly define success for students, teachers and schools, parents worry about the dangers of “teaching to the test” — and of their children being judged by tests with low or unknown validity. We want our children to perform well on tests, of course, yet only if they measure something that students, patients, and teachers believe really matter. We also want the education system to inspire students …
Doctoring to the test: The unintended consequences of performance measures
We’ve got a long way to go before information technology solutions at the frontlines of health care fulfill their enormous potential. The suboptimal, clunky and cumbersome design of most IT systems is responsible for much misery among physicians and nurses on a daily basis. Part of the problem is that hospitals and clinics have rolled out these solutions rapidly and somewhat haphazardly to fulfill meaningful use requirements and gain much-needed …
3 immediate ways health IT can improve
Just as the U.S. health care system is about to make performance measurement a central feature of … well, just about everything doctors do … some prominent and highly influential physicians are asking for a pause and reassessment.
Writing for the New York Times, Dr. Bob Watcher argues that, “Two of our most vital industries, health care, and education, have become increasingly subjected to metrics and measurements. Of course, …
Explaining the physician anxiety behind performance measures
The Zika virus in the news these days reminds us of another microcephaly-causing virus which scourged our world in the not-so-distant past. In the years right before we were born (the late 1960s), the virus rubella routinely swept through the United States and the rest of the world. The airborne germ rubella, just like the Zika virus, caused most people just a mild illness that they usually never even knew that they …
The future of Zika virus? How rubella provides clues.
