Is it time to rethink how we determine the capacity of our patients who are addicted to drugs? I recently began debating this question after I took care of a young woman with endocarditis. She had a long history of IV drug abuse that had led to the development of endocarditis. She had been admitted one week earlier and was being prepared for surgery, but she left against medical advice …
We watched as the new viral outbreak happened in a remote place in China, wondering if this would be a quick flameout or if Mother Nature would again exert her majesty on us mortals.
My associate, Madilyn, and I watched with more interest, knowing that her sister was in South Korea teaching English. She was due to return in late February, …
Recently the Wall Street Journal reported on how many young people are now seeking “accommodations” at work for their anxiety, PTSD, depression, and other mental conditions.
The article provoked a lively discussion split largely on age lines. While older people accuse Gen Z members of being “emotional hemophiliacs,” Gen Z members often say they have real, palpable “mental illnesses” and need extra time to complete their …
An excerpt from Tough Decisions In Care Of Elderly Loved Ones (A guide for caregivers).
Empathy is more than just loving an elderly loved one. It is more than simply making the decision we may feel is best for our loved one. Empathy is different …
Most Canadians are familiar with nursing homes or long-term care facilities that provide 24-hour care to seniors who are no longer able to care for themselves independently – but we don’t spend a lot of time thinking about them. Given our rapidly aging population, and the likelihood that someone we love, or maybe even ourselves, will be living there one day, maybe we should.
What might surprise …
A case study seemed to confirm the presence of asymptomatic transmission within China, where a woman was afebrile with no chest CT abnormalities or laboratory abnormalities. She did not develop the virus, while five of her relatives did.
An earlier report out of Germany found a woman traveling to Germany from China with …
I remember lying in my bed after my second delivery in severe pain. With my first delivery, I had already endured a C-section. Four years later, I wanted to experience a “natural” delivery. I opted for a vaginal delivery after C-section (VBAC).
The VBAC quickly turned into an emergency where the maternal-fetal medicine (MFM) physician gave me two options: Get this baby out now or emergent C-section.
My mind flashed back to …
In my very first job as a doctor — working in a London hospital in the 1980s. I always took a ridiculously detailed past medical history for every patient I saw. I started to notice how many elderly women had had septicemia, a life-threatening infection in which enormous amounts of bacteria enter the bloodstream.
The neighborhood surrounding the hospital had once been the worst slum in London. And it didn’t take …
By the time I turned 40, I had gained and lost 40 pounds at least ten times. It started with the “freshman fifteen” plus another twenty-five in college. In medical school, I was introduced to sweetened coffee beverages, and I snacked on pretzels and candy to stay awake while studying. I got through overnight call during residency by using my meal tickets to buy chocolate-covered ice cream bars. And once …
There is good news and bad news in the world of women’s health.
The good news is that women do not need annual Pap smears. The bad news is that, upon hearing the good news, many women incorrectly assume they no longer need annual pelvic exams, either.
Historically, Pap smears were performed annually, and during the same time as pelvic exams, so it is understandable why women would conflate the two. But …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a 6-month history of loose stools, bloating, and a 3.2-kg (7-lb) weight loss. Her medical history is otherwise unremarkable. Her brother has type 1 diabetes mellitus, and her mother has autoimmune thyroid disease. She reports no other symptoms and takes no …
Every day, children are cared for in clinics and hospitals. And every day, some of them are unhappy about it; some of them deeply unhappy about it.
The contemporary practice of nursing and medical care includes health care providers having to touch their patients. This may include an abdominal exam, listening to their lungs with a stethoscope, or even slightly invasive maneuvers, such as having to put an otoscope into their …
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“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 …
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 …
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 …
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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 …
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, …
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 …
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What seems like a tidal wave of pages washes over you. Drowning in a torrential sea of order clarification, bowel regimens, and vital sign deviations — you struggle to stay afloat. Medical school did not prepare you for this. Patients and nurses are calling you, “doctor,” you wish to return to that minimal responsibility role as a medical student.
Welcome to your first on-call weekend.
These first few days, weeks, and months …
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