As a cardiac anesthesiologist, there are times I care for patients who are faced with a tough decision: to take their chance on a very high-risk surgery, or let nature take its course. It is in these times I feel most humble and most human, as I may be the last one to hear the last words they speak.
Recently I was at a social event and introducing myself to some …
7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel.
“He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, …
It’s 3 a.m., and I wake with a jolt. My heart is pounding out of my chest. I stumble out of bed to take a beta blocker hoping it’s enough to quiet my heart so I can doze off again. I sleep fitfully the next three hours, experiencing weird dreams and terrifying nightmares.
At 6 a.m., I take my Valium. Nauseated, I lie in bed for 30 minutes, so I keep …
A friend of mine recently underwent a total knee replacement. Although he did well and was pain-free, he did say that he felt he was on an assembly line. I asked him what he meant. As he was talking, I flashed back 30 years, back to a time when by today’s standards I would be considered a “good old country orthopedist.”
Thirty years ago, I moved to a small community to …
So stated one of our children in their autobiography assignment for school. I kept reading, curious what would come next.
“My dad usually stays home and cleans up, and takes care of the pets.”
I thought for a moment. “That’s very good, honey, but do you think you could write something else about Dad?” I suggested. “He does other stuff too, add some more nice things.”
“OK, how about … ‘And he takes …
I have been working with psychiatric patients for the better part of 30 years. During this time, I have worked in psychiatric emergency rooms, prison wards, substance abuse treatment centers and inpatient psychiatric units. I have been proud of the fact that, despite working in some dangerous areas, I have never been harmed by a patient. I have been threatened, swung at — but never injured. Once a patient decided …
Five years ago today I was at a memorial. Another suicide. Our third doctor in 18 months.
Everyone kept whispering, “Why?”
I was determined to find out.
So I started counting dead doctors. I left the service with a list of 10. Now I have 547.
Immediately, I began writing and speaking about suicide. So many distressed doctors (and med students) wrote and phoned …
“She doesn’t look like a person with an addiction problem to me,” replied the physician to the psychiatrist, referring to a patient who was admitted to the hospital for confusion. She was found at home amidst an array of bottles containing various controlled substances, and a toxicology screen positive for cannabis. She was in a higher socioeconomic bracket having retired from a professional job. The psychiatrist explained that addiction crosses …
It’s something that’s not taught anywhere near enough as it should be in medical school, but every practicing physician quickly realizes that communication is everything in health care. It’s the foundation of the doctor-patient relationship, and what patients will judge you on. Sure, doctors are among the busiest professionals out there. We do an incredibly hectic job. But it’s so imperative to remember the importance of that interaction with your …
I am going to discuss something that is really important for women. It’s going to get a lot of criticism, and it’s OK. I can take it.
Your clothing.
That’s right. I am here to tell you that what you wear, and how you dress, matters.
Why? Because how you feel in your clothes affects the way you walk, talk, smile, interact, and well, lead.
Don’t mistake what I am saying. I am not going …
A couple of weeks ago I visited Canada. It was my first visit in a very long time. We were in Ontario, spending most of the time in the Toronto area, and also getting to visit the majestic Niagara Falls for the day. I’ve heard so much over the years about the differences between neighbors USA and Canada, and in even just a few days there, agreed that there are …
“A condition counts as a disease independently of whether there is safe and effective treatment.”
– Journal of Medicine & Philosophy, August 2017
What is a disease anyway? Mrs. Jones is 90 years old and frequently experiences episodes of chest pain. She has numerous partially blocked coronary arteries, and her physician has told her to come to the emergency room because she might be having a “heart attack.” …
A guest column by the American College of Physicians, exclusive to KevinMD.com.
For this column, my 61st for the American College of Physicians (ACP), I thought it would be interesting to look back at the first 60 and review the trends and topics that inspired me to write 800 to 900 words every month. Rather …
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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with …
Every now and then, when some people learn what kind of work I do, they say, “You’re doing God’s work. Thank you.”
They mean well, so I accept the compliment, though I also tack on, “I also like what I do. It’s meaningful work for me.”
So many of the people I see, whether in my current job or in my past jobs working in other underserved communities, have a lot going …
So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of …
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November brings fall weather, raking leaves and one of my favorite holidays. No, not Thanksgiving, it is Veteran’s Day. Veteran’s Day is a day reserved to celebrate members of the U.S. armed forces for their service. Thank you, veterans. Veterans are found in all segments of our society. Some are retired, some have started second careers, and some are struggling with health issues as a result of their service. They …
An excerpt from The Flame Broiled Doctor: From Boyhood to Burnout in Medicine.
“So what did my bloodwork show, Doctor?” asked Liz. Liz was friendly and polite, but a textbook example of the Worried Well … healthy but neurotic patients I didn’t need to see as often as …
As physicians, we are conditioned to put ourselves last. This long-standing tendency likely began way before we hit medical school. But certainly, our training reinforces it. Think about it: the personality type that goes into medicine is typically a caretaker. And while medical school reinforces this personality pitfall, It doesn’t end there. Residency brings a whole other dimension of self-neglect. We think, “If I can just get out of residency …
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Medicine is a calling. And almost all of us went into this profession for altruistic reasons. Unfortunately, it’s no secret that the health care landscape has changed dramatically over the last couple of decades, and practicing medicine is undoubtedly getting more difficult for most doctors.
Fortunately, I’ve found myself in a better place than most. But after hearing feedback from physicians at various stages of their career, there are a number …
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