“You are too smart to do primary care.”
I have heard this far too many times, directed at me and at others seeking career advice. There are many reasons for the shortage of primary care doctors in the U.S., but at least part of it is this. Smart, capable, successful trainees are discouraged from choosing primary care. It is perceived as a less prestigious pathway than specializing.
The knowledge base of primary …
I met with a young patient recently, a woman who has been done with chemotherapy for lymphoma for close to a year. She was feeling well, and she had no symptoms of cancer, nothing that made her suspicious of a recurrence. After I examined her and reviewed her most recent CT scan and labs, I agreed. No recurrence. I wrote in my note, “NED,” the acronym for no evidence of …
When you ask young medical students why they want to be doctors, you will probably get all sorts of answers. Some may say they like people and want to interact with them and offer them help. Some students will believe this is their calling. Others still may state they are intrigued by the scientific mysteries the human body is filled with. From my experience, not many medical students just starting …
Suppose your malpractice insurance company wants to settle a medical malpractice case against you – even though the case has no merit.
In many cases, insurance policy language may allow the insurance company to do just that.
In the 2011 case of Mohan Papudesu, MD v. Medical Malpractice Joint Underwriting Assn. of Rhode Island, the Rhode Island Supreme Court allowed an insurer to settle a case on behalf of the defendant physician …
Medical residents have fewer labor protections than Chinese factory workers. While labor abuses at Apple’s factories make headlines, few people are as concerned about the lack of protections for doctors and medical students here in the United States. As a resident, I was subject to some of the worst abuses – intentionally misreported time sheets and gender-based discrimination – and after I complained, I was fired, so I sued the …
How can you determine whether you are in a “developed” or a “developing” country? We used to call these latter “un- or underdeveloped” or “3rd world” countries, but those terms are no longer politically acceptable, considering the tinderbox of feelings about this topic.
If one objectively examines all 20 dozen or so of the world’s countries, a geographer would divide them into either north or south of the Equator. And if, …
In January, when my close friend’s lymph node biopsy came back as a rare form of T-cell lymphoma, I scoured the scientific literature. What was his prognosis?He was 56, a little overweight but otherwise healthy. He had helped us move into our home more than a decade ago, and I was like an uncle to his son and daughter.
In the literature I found jagged graphs plunging downward, indicating that my …
People often wonder what causes children to bully. Why is it that some children feel the need to hurt and humiliate other children? What do they really stand to gain from this cruel behavior?
Some studies indicate that some (not all) bullies have naturally aggressive and/or hyperactive personalities from the start. Some. But that doesn’t mean that all “spirited” kids will bully while all “mellow” kids will be perfectly empathic and …
Even though I love my job, I’ve been feeling a little burned out lately. I think it comes from being stretched too thin, which is something I’ve coped with off an on ever since med school.
As the saying goes, there are never enough hours in the day, and sometimes that really gets to me. While my practice is incredibly important, I also place a lot of value on my family. …
I am used to being called a “medical provider” instead of a doctor or a physician these days, but it makes me think about the implications of our choices of words. The word “provider” was first used in non-medical contexts over 500 years ago. It is derived from the Latin providere, which means look ahead, prepare, supply.
“Medical provider” is part of the Newspeak of America’s industrialized medical machine. …
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …
March 29, 2012
Calhoun Lecture Series
Strom Thurmond Institute, Clemson University
Thank you for the invitation to speak tonight. I’m very humbled to stand before you. And what a delight to speak to people who are neither bleeding, intoxicated nor asking for Percocet! And in a setting where no one will burst through the back door on a stretcher!
As you know, I’m an emergency physician …
My patient ran away from the hospital.
This ordinarily is almost common place for a hospital bordering the south side of Chicago. In the last two years at the hospital, I had first grown surprised, and then helpless and finally weary to such mysterious absconding. This time however, it struck a chord.
Long before Mr B ran away, I had an inkling the new diagnosis of HIV would be difficult for him …
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Have you ever said, “I’m going to be perfectly honest with you” or something to that effect? Have you ever had someone tell you that they were going to be perfectly honest with you? Have you ever thought about what statements similar to these really mean? You should.
Trust is an earned commodity and hard to get back once lost. “Doc, I’m going to be perfectly honest with you” means that, …
Impersonal and self-absorbed as Manhattan may be, it’s still embarrassing to cry on West 32nd Street. I looked for a store, any store, and ducked inside. The pace of my steps and angle of my head as I buried myself into a back corner, thumbing through pants twice my size, gave me away. A store clerk walked over and asked if I was okay. I knew I’d have to meet …
A few months ago, I came out with a post on why I love my own doctor. Today I want to celebrate my patients, both past and present. For me, without the experience I have had over the past 14 years, I would not have enjoyed medicine quite as much as I do.
What I like the most about medicine is the ability to interact with people. That’s what clinical medicine is all …
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Full code is the universal default status for patients who haven’t chosen otherwise, but I suspect most physicians believe this policy is wrong. We know in our hearts we’re doing harm when we perform CPR on poor souls at the natural end of their lives, whose bodies can do nothing more than suffer.
Appropriately timed end-of-life discussions are the supposed answer, but for doctors, they are emotionally draining, interpersonally complex, and …
I recently came across two articles in the press concerning doctor-patient relationships and communication. I began to reflect on what makes communication between doctor and patient most successful and many questions surfaced.
In the New York Times, a new study published in Annals of Internal Medicine was referenced. In this study, the way in which doctors communicate non-verbally was examined. Non-verbal communication was often discordant to the message being relayed, particularly …
Being a child in 21st century Mexico utterly differs from any other era. The last decade has been a constant whirlpool for Mexico. Political, cultural and economical changes have shaken the country to its core. Primary care physicians, particularly pediatricians, have a burdensome challenge at hand.
Problems like obesity have quickly emerged in all age groups. Obese children, childhood type 2 diabetes and sedentary lifestyles have invaded Mexican homes. Nutrition related customs …
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(All names and identifying features of characters in this story have been changed.)
Nora, a third year medical student, came to me in moral distress.
Ms. DiFazio, one of the hospitalized patients on her internal medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.
The first year doctor with whom Nora was paired, Dr. White, vented to her:
“These patients come to us seeking our help and then refuse …
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