Working as a digital nomad physician practicing telemedicine while travelling the world

Physician
February 27, 2020

This is not the career path I set out to practice when I left medical school; in fact, it’s a career path that didn’t even exist. But after making a number of lifestyle choices this is where I find myself today. I am sitting writing this article from the hot, tropical lowlands of Colombia, on the site of Pablo Escobar’s Hacienda where, in a few hours, I will …

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Working as a digital nomad physician practicing telemedicine while travelling the world

How to find your squad in residency

Physician
February 26, 2020

At nearly every stage in our education and training, we find “our people.”  Maybe it’s your table-mate in kindergarten, or the kid with the really cool light-up sneakers in preschool who becomes your best friend.  Maybe it’s your next-door neighbor who you play with after school or a coworker from your first job in high school.  These people become part of our squad — even if their membership is only …

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How to find your squad in residency

The art of diagnosis is like a riddle

Physician
February 26, 2020

“I have a riddle,” Paul says, as the dining room falls silent.

“You’re at the bottom of the stairs. And on the wall, there are three light switches labeled one, two, and three. There’s a room upstairs with three lamps, labeled X, Y, and Z.

You can turn on and off as many switches as you want while you’re downstairs, but you can only go upstairs once. And once you’re upstairs, you …

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The art of diagnosis is like a riddle

Welcome to prior-authorization hell

Physician
February 25, 2020

“What diagnosis do you want to use for those ear drops you sent on Mr. Johnson,” Jenn texted me. “ICD-L21.8 for seborrheic dermatitis?”

Sigh. Welcome to prior-authorization hell.

These are generic ear drops I ordered for presumed fungal infection of the external ear. The cash price for the drops is $15 for a 10-milliliter bottle (I checked before prescribing them). “No,” I responded, “it would be ICD-B36.9 for otomycosis.” (translation: ear fungus)

Jenn …

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Welcome to prior-authorization hell

The best teacher of medicine I ever had

Physician
February 24, 2020

The best teacher of medicine I ever had was during my medical residency. He was a tough, old-school physician, trained at one of the premier institutions in the country, and specialized in pulmonology and intensive care. Before I had even rotated through the ICU, I had seen him around on the medical floors—and must admit I didn’t like him very much at first. He seemed extremely serious, not particularly friendly to any …

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The best teacher of medicine I ever had

What is “good enough” for a surgeon?

Physician
February 23, 2020

A surgery resident from halfway around the world emailed me the other day looking for advice as she was nearing graduation.  She confessed, “I am beginning to question myself if I am good enough … what is ‘good enough’ anyway?”

I had absolutely no idea how to answer the question – what is “good enough” for a surgeon?

First, I tried Google.

“Am … I … Good … Enough”?

2.5 billion hits and some …

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What is “good enough” for a surgeon?

Why I love caring for geriatric patients

Physician
February 22, 2020

As I enter the exam room, I hear, “Don’t get old honey!”

As a physician caring for a large population of geriatric patients in Florida, I hear this approximately five times a day. To this statement, I always reply, “There’s no alternative, though!”  I also try not to get offended by repeatedly being called “honey.” Although I am waiting to someday state; “it’s Doctor Honey.”  Usually, my level is offense is …

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Why I love caring for geriatric patients

How artificial intelligence will affect brain surgery

Physician
February 21, 2020

Brain surgery is getting smarter. The journal Nature Medicine recently published a study that found a new imaging technique that allows pathologists to diagnose brain tumors faster and more accurately than ever before.

The study focused on Invenio Imaging technology’s use of artificial intelligence (AI) in making accurate diagnoses. So, will computers replace doctors? That’s unlikely. Treating the human brain requires a human approach. But AI is …

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How artificial intelligence will affect brain surgery

What to do with the extremely defensive doctor

Physician
February 18, 2020

Let’s talk about the doctor who is excessively defensive.

I divide this kind of communication blocker into two varieties: physician personality and physician mode of practice. The physician with a defensive personality is one who interprets questions from parents as questioning of her medical judgment. Unlike the supremely egotistical doctor, who is often sufficiently secure in her image of herself that she is magnanimous toward parents who ask questions, the overly …

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What to do with the extremely defensive doctor

Why direct primary care is the future

Physician
February 18, 2020

I recently wrote about my new type 1 diabetes diagnosis, the quest for affordable meds and supplies, and the subsequent financial savings found through transparent pricing outside of my insurance plan. I summarized that health care “coverage” is very expensive, whereas medical services may be found much more affordably.

My next step was to establish an ongoing primary care physician relationship.

I contacted one of the large medical …

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Why direct primary care is the future

The Hufflepuff of medicine

Physician
February 16, 2020

Recently, my mother waited for over an hour for what turned out to be a 5-minute visit with her primary care doctor. Her doctor seemed rushed and stressed, her questions perfunctory, the management plan hurried. And then she was gone. “It’s like she didn’t even know I was there,” my mom relayed to me.

This is a physician who is thoughtful, intelligent, and kind, with excellent clinical instincts. After this visit, …

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The Hufflepuff of medicine

Numb: How I survived as a physician

Physician
February 14, 2020

On my final day of work before beginning my self-imposed  burnout sabbatical, a colleague asked, “Why don’t you just get on medication?” I remember thinking, “What am I medicating?  I feel nothing.” I was in the vice grip of burnout, overwhelmed, and physically and emotionally exhausted.  But mostly, I was numb.

But in reality, I have always self-medicated – with work.  As a professional ballet dancer turned doctor, my life has …

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Numb: How I survived as a physician

Heart of a doctor. Mind of a doctor. Soul of a giver.

Physician
February 14, 2020

Calling.

I am awakened by the loud, screeching sound of my pager. I feel my heart race. I look at the clock.

It is 3:07 a.m. It’s cold in the room. I am shivering. I stand up quickly, instinctively. I feel the soreness of my feet for a brief moment, but push that thought aside and look quickly at my pager. It reads, “room 2309, death pronouncement”.

My heart sinks. She is mine—my …

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Heart of a doctor. Mind of a doctor. Soul of a giver.

Why doctors need life skills

Physician
February 11, 2020

Medical school prepares doctors for patient care: perform a history and physical, and based on the findings, consider the next diagnostic tests to order, review all data, and develop a treatment plan. By graduating from medical school, you are skilled to perform those duties with a certain level of competency and confidence.

Success in the next phase of this journey and the rest of your life depends on honing those skills …

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Why doctors need life skills

Medical residents need parental leave

Physician
February 10, 2020

My wife and I had a baby a few months ago. Or, more accurately, she birthed a child while I sat in the corner, contemplating the miracle of reproductive physiology in a vasovagal fugue. In the months leading up to and following that wondrous moment, we found ourselves navigating the labyrinthine complexity of parental leave in graduate medical education.

To start with the positive, we are both residents in the same …

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Medical residents need parental leave

Health care is like lions for lambs

Physician
February 9, 2020

I just watched the movie 1917 at the theatre. Shot in a unique way giving an immersive experience, showing the frontline reality of war through an unforgettable human story, it has to be one of the greatest war movies ever made. I’d encourage everyone to go watch it. I learned a fair bit about the First World while I was in high school in the United Kingdom. Its stories are …

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Health care is like lions for lambs

How you can show patients you are listening

Physician
February 8, 2020

Being a physician is an important role. It’s easy to forget the impact that you have on a patient just by being at their bedside.

It’s huge.

Have you ever been a patient? It’s an incredibly vulnerable experience.

You’re not really sure what’s happening and what is going to happen next.

People are really putting their faith in you to understand their needs and to ease their suffering. It’s a powerful thing to ease …

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How you can show patients you are listening

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