This post is based on a “friend of a friend” situation. Important details have been changed to protect anonymity, but not the basic realities I want to discuss.
A 49-year old man was diagnosed with a rare form of lung cancer about a year and a half ago. This sad situation is compounded by the fact that he was in a stable marriage with a wife and two children, ages 10 …
We must tell sad medical stories too
How can a doctor resist an essay entitled, “The Sickness Unto Death?” Kierkegaard, the darkest of the bleak existentialists, begins by asking, “Is despair an excellence or a defect?” Can despair be an excellence?
It is December in Oregon, the rain comes down in sheets, with only a few hours daily of half-light. Kierkegaard’s winters in 1840 Denmark must have felt a lot like this, so I press on.
“In despairing over …
The double meaning of despair in the hospital
As my co-workers and I peered out the window of the Planned Parenthood in Philadelphia, we saw over 200 protestors chanting the name of a man who had killed 2 people and injured several others at reproductive health centers the day before. They kept coming closer and padlocked the entrance gate so that we were trapped. We worried they might have weapons. The stand-off lasted for three terrifying hours. As …
Planned Parenthood and my decision to go to medical school
Chronic kidney failure is a serious disease. When progression to end-stage renal disease (ESRD) occurs, dialysis is required to sustain life.
It is shocking, then, that in the United States, it is estimated that over 1,000 patients annually are involuntarily discharged from their dialysis clinics. Further, they are often “blackballed” from other local clinics. The consequences for such patients, predominately African-American, are dire. A patient may be unable to find a …
Involuntary discharge from dialysis: A health care practice like no other
U.S. life expectancy declined in 2015 for the first time in more than two decades, according to a National Center for Health Statistics study released last week. The decline of 0.1 percent was ever so slight ― life expectancy at birth was 78.8 years in 2015, compared to 78.9 years in 2014. However, this reversal of a long-time upward trend makes these results significant.
While many researchers are scratching …
Do primary care physicians increase life expectancy?
An excerpt from Malpractice: A Neurosurgeon Reveals How Our Health-Care System Puts Patients at Risk.
It is not possible to live life in a way that every choice and decision awaits a definitive, double–blind study with a statistically significant …
Rule #1 of emergency room diagnostics
How in the heck would three nurses and I ever orchestrate ECMO in the middle of the night in my community ED? I pondered this over tuna tartare while listening to ivory tower docs discuss cutting-edge modalities like they were part of treatment algorithms everywhere. The conversation turned to REBOA, and I wondered how many academicians had ever manned a single-coverage ED.
Ivory tower medicine and my world, where there is …
Don’t engage in fishbowl emergency medicine
In medicine, our motto is first do no harm. Words matter. Choose them wisely. Here are 7 words that shame, blame, and injure people who need our help.
1. Don’t say COMMITTED suicide. Committed implies a crime. Committed rape, burglary, murder. Suicide is not a crime; it’s a medical condition that has been taboo for too long. Let’s come out of the dark …
Stop saying these 7 shaming words in medicine. Right now.
About a year ago, Yusuke Tsugawa — then a doctoral student in the Harvard health policy PhD program — and I were discussing the evidence around the quality of care delivered by female and male doctors. The data suggested that women practice medicine a little differently than men do. It appeared that practice patterns of female physicians were a little more evidence-based, sticking more closely to Read more…
The difference between male and female physicians. Here’s what it means.
A response to “This resident works 100+ hours per week, but is still a poorly trained surgeon.”
I am truly sorry your experience in a urology residency thus far has been far below your expectations. I am finishing residency in June, and I know how hard it is. There are sleepless nights, thankless tasks, and residency feels like a learning process that crawls forward in inches rather than feet. …
Not all residency programs are bad. Here’s what to do if yours is.
Medicine is a paradox. To save, we cut with sharp knives. We ignore pain so that it will light the path to diagnosis. We give toxins to destroy toxic disease. We scold our neighbors when they neglect their health, even as we work ourselves to exhaustion, eat too much and evade exercise. We comfort the families of our patients while ignoring our own.
There is one contradiction, which, by its very …
Should doctors’ personal judgments affect their patients?
A friend of mine recently had a very sore throat. She knew how to manage her symptoms — lozenges, warm tea and the like. But she was worried she might have strep and would, therefore, need antibiotics. That should be a simple question to answer with a quick trip to the primary care clinic. Except that her primary care physician was booked, and if she wanted an unscheduled appointment with …
Going to a walk-in clinic? 6 essential things you must know before you visit
As health care increasingly propels itself into the world of corporations and big business, it may seem like the practice of medicine has entered an irreversible new era. Gone are the days of good old Dr. Wilson in his solo private practice around the corner, loved and respected by all his patients and the community. Nowadays, it’s all about mega multi-specialty groups, health care mergers and hostile corporate takeovers.
Being someone …
Corporate health care is doomed. Here’s why.
Dear Husband, MD
I see you. I hear you cough all night, knowing your flu vaccine has failed and you have it. I hear you wheeze with your post-flu pneumonia. I feel you shiver in the bed beside me while you sleep for 5 hours before you get back up and start getting ready for the next “shift.”
I put quotations around “shift” because we both know you will not work 8 …
A letter to her physician husband
Sleep deprivation and medical errors are not the only issues that arise from long shifts. Aside from being dangerous, working 28 hours straight can teach new doctors that their health and even their life is not a priority. With extremely high rates of depression and suicide in this field, increasing work hours is not the step we should be taking. When I was interviewed by Public …
A different consequence of 28-hour shifts
An excerpt from Physician—Time to Invest in Yourself: Work-Life Balance, the Needs of the Patient, and Medical-Legal Risk Management.
What is an essentialist? What is an essentialist lifestyle? Essentialism focuses on identifying the important signals in life and eliminating the noise. The noises are the distractions that add no value to your life and frequently monopolize time and meaning. When you assume the role of an essentialist you will discover that you …
Essentialism for health care professionals
Sir William Osler wasn’t exactly wrong when he said, “Listen to your patient, he is telling you the diagnosis.” But he didn’t mean it literally. His patients did not offer up esoteric and complete medical diagnoses on a silver platter. They left him clues in plain language that he listened to carefully in order to make the correct diagnosis.
He penned his words in an era when medical information was scarce …
Listen to your patient’s story: It’s their diagnosis
Someday, we may miss the quaint idea of going to see your doctor for your medical concerns.
I realize taking your children to see their doc is a pain. So is taking your car into the mechanic, waiting for the cable guy or going out for groceries. There are other things you’d rather be doing with your time. Can a quick phone call substitute for a doctor visit?
At least one huge …
Telemedicine: What could go wrong? A lot.
It was recently pointed out that one of my partners had made an error in a patient’s electronic hospital chart. Did I want to correct the mistake? Curious, I looked at the computer screen. There in 12-point-black-on-white Cambria was the culprit documentation. The words were:
“Our therapy goal is palliative. Prognosis is good.”
Now, this was clearly not what the author had intended. In common practice when someone is so sick that …
Is there a difference between a good and bad prognosis? It depends.
I had a familiar conversation the other day with yet another female medical student.
“I really loved surgery!” she said, “but I was concerned about the lifestyle, so I decided on ______.”
Lifestyle — it turns out — almost always seems to be code for having a family.
Maybe it’s just the kind of students who seek me out. I have yet to encounter someone concerned that a surgical career will hamper their …
Please tell me what a “mommy-friendly” medical career is
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