One of the most valuable jobs I held following fellowship was working as a full-time deputy editor at UpToDate. My “territory” was breast, gynecologic, and genitourinary oncology, and I helped launch cancer survivorship and palliative care. I learned to really and critically read the literature, and how I could summarize it quickly so that my …
Why physicians should acknowledge the validity of second opinions
“Compassion fatigue” is a phrase thrown around easily when talking about the health care professions. It is often spoken in the same breath as “burnout” and “turnover” while discussing the crisis of a diminishing workforce and increasing demand in health care.
The phrase brings to mind the burnt-out nurse who doesn’t have the emotional energy to care anymore. I can see her: deep frown lines, flat facial expression, dimmed eyes.
The light …
Nurses are sick of being treated like hotel workers
Wiley Boynton is dead. I first heard the news when Katie, a colleague, called me on my cell phone. Wiley had been taken to the hospital with a knife wound.
I asked her right away: “Self-inflicted?”
“I think so,” she said.
A self-inflicted knife wound might be possible, I figure with someone like Wiley, considering the violent world he came out of. I know quite a lot about him.
Wiley is around 40 years …
Could this patient have been saved?
We knew that the most powerful way to provide substance abuse treatment is in a group setting. Group members can offer support to each other and call out each other’s self-deceptions and public excuses, oftentimes more effectively than the clinicians. They share stories and insights, car rides, and job leads, and they form a community that stays connected between sessions.
Participants with more experience and life skills may say things in …
The most powerful way to provide substance abuse treatment is in a group setting
High blood pressure is the silent killer. It puts people at risk for heart attacks, strokes, vascular disease, kidney failure. It is basically really bad to have longstanding, undertreated high blood pressure.
But it is also harmful to be told you have high blood pressure when you don’t, and to be treated for high blood pressure when that treatment won’t benefit you. So when your doctor diagnoses you with high blood …
How do you know if you have hypertension and need medication?
If you work a desk job, you’re familiar with the aching back pain, stiff shoulders, and all-around discomfort that hits after you’ve been sitting for an extended period of time.
Not only is it painful, but research shows that sitting for hours at a time can be harmful to your body and even increase your risk for a number of health concerns, including cardiovascular disease and obesity.
How doctors can get fit while they sit
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 45-year-old man is evaluated for anorexia, dizziness, and weakness. He was discharged from the hospital 5 days ago after transsphenoidal pituitary surgery for a pituitary macroadenoma abutting the optic chiasm. His postoperative course was uneventful, and his postoperative hormone evaluation was normal; he did not require …
MKSAP: 45-year-old man with anorexia, dizziness, and weakness
I’ve just discharged a kid with a cough, and there are no patients waiting to be seen. “I’ll be back,” I tell the nurse, as I slip away to the hospital kitchen and unlock the door. I steal two frozen grilled cheese sandwiches from the freezer and throw them into the microwave. Minutes later, I’m in the call room.
I take a couple of bites and can already feel acid rising …
Beyond red flags: Beware of black butterfly warnings
Anita is 37 with blonde, wild, disheveled hair. She is overweight, has bad teeth, wears too much make-up, and is severely depressed — sometimes psychotic. She tells me she often hears voices. And she constantly complains that the medicine she gets from our clinic (and she gets a lot), does not take the edge off her feelings.
She has severe anger and is in an anger-management group at our offices. Each …
Preceding traumas lead to current ones
I, along with some others, take Presidents Day as an opportunity to celebrate the lives and contributions of all U.S. presidents. Amid the praise, however, perhaps I alone feel compelled to describe their skeletal maladies. I have gleaned the following information from several websites and books that carefully detail the reported injuries, diseases, bad habits, and addictions experienced by U.S. chief executives throughout their lives, starting with George Washington’s …
An orthopedic surgeon analyzes presidents’ skeletal maladies
Prostate cancer is the second most common type of cancer diagnosed in men in the U.S. According to statistics gathered by the American Cancer Society, approximately 191,930 new cases of prostate cancer will be diagnosed in this country in 2020, with one in nine men at risk of being diagnosed with this cancer during his lifetime. While advanced or aggressive disease can lead to death from prostate cancer, most men …
How to manage the side effects of prostate cancer treatment
The patient was well over 6 feet tall and looked like he had recently lost weight. When he took off his winter coat and hung it over the back of the chair, I could see his scapulae like wings under his sweater. He folded himself into the chair and carefully crossed his legs. He sighed softly as he arranged his …
The one word that carries so much weight in the cancer experience
James is a tall, lanky Caucasian man, well into his 40s. He has brown curly hair and is not a bad looking fellow except for the vacant look in his large brown eyes. He is a pacer, which is a manifestation of his illness, and a consumer of excessive amounts of water.
You have to talk right at James to be understood. I try to make eye contact. Sometimes he doesn’t …
Can a unique boarding home save my patient?
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 23-year-old woman is evaluated for 2 weeks of painful lumps on her legs. The lumps persist for several days and make it difficult for her to go to work as a waitress. She is a college student in Ohio where she has lived her whole life. …
MKSAP: 23-year-old woman with 2 weeks of painful lumps on her legs
Professional burnout is widely identified using the Maslach Burnout Inventory, which defines it along psychological lines: emotional exhaustion, a feeling of depersonalization and cynicism, and a low sense of personal accomplishment.
Accordingly, the phenomenon of physician burnout is often framed as a personal problem to be solved by means of self-care. While this approach is undoubtedly helpful, it doesn’t sufficiently address the structural factors that contribute to burnout in the first …
What Karl Marx can teach doctors about burnout
I admitted an elderly woman to the hospital recently. The previous week, she had presented to the emergency department (ED) with chest pain and shortness of breath. For some unknown reason, a urinalysis was obtained and was found to be abnormal. The patient left the hospital with a prescription for cephalexin, in addition to unexplained chest pain and shortness of breath. The patient presented to the hospital this time with, …
Please stop the over-diagnosis of UTIs
She was new to this ICU. She was young, smart, funny, and considered one of the “cool” nurses.
Before we could really get to know her, she exposed her wonderful, fantastic, perfect life all over social media.
Their perfect two-story brick house, their two little, perfect angel daughters — the perfect life in the perfect town.
But what was most important was her perfect, handsome husband. He was bound to be a self-employed …
This nurse was hiding the truth behind social media
Doctors dispense medical advice. That’s what we do. Folks come to our office with various medical issues. We talk to them. We poke around some of their body parts. Then, we exercise our medical judgment. We might order a CT scan. We might prescribe stuff. We might simply reassure them and send them on their way.
This is a typical day in the life of a health care provider, formerly known …
Don’t ask me about your husband’s flatulence if he’s not my patient. Bring him in instead.
During the winter months, it’s common for many families to spend more time indoors due to colder weather and fewer daylight hours.
Unfortunately, children may also end up spending an increased amount of time using electronics to entertain or divert themselves from the dreaded childhood condition commonly known as “boredom.” As parents and caregivers, we must be aware of the time our children are committing to digital media and regularly monitor …
A pediatrician’s 5 ways to curb kid’s digital media consumption
An excerpt from Fallible: A Memoir of a Young Physician’s Struggle with Mental Illness.
Jason had an entire group of voices in his head that he called “the committee.” They talked nearly constantly, sometimes in a flat roar but often escalating to shouting. He described it as …
How your mind can turn against you
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