I do some of my best thinking while exercising.
A few years ago, I was swimming laps in the still-dark early morning.
Swimming is one of my favorite activities. But in a pool, it gets boring staring at the bottom, so my mind often wanders off to tackle difficult problems.
That morning, like many of you, I was wrestling with the question of how to turn my passion into a successful side gig …
How this physician started his consulting business
For the past four years, this is James Beck’s routine: After a morning spent guzzling $5 vodka, he stumbles into a Dunkin’ Donuts parking lot, lying on the cement with his dusty oversized coat splayed open to reveal a cachectic chest. A concerned patron (cigarette and coffee in hand) will call 911 and, in accordance with protocol, an ambulance will deliver him to our emergency room.
Upon his arrival, we unpredictably …
In tragedy, practicing medicine both an honor and a privilege
As a psychiatrist, I’ve spent almost two decades caring for patients who have survived sexual trauma, be it childhood sexual abuse, rape or repeated and threatening forms of sexual harassment.
I’ve witnessed how when the assailant was known to the victim, especially someone from whom they expected comradery or even just professionalism, it can be devastating. The fact that the assailant came from within a trusted circle often delivers the toughest …
What #MeToo must learn from the science of sexual harassment
In my second year of residency, I was on the hematology/oncology service where we were taking care of a pleasant lady in her 80s who was admitted with pancreatic cancer. It was apparent that the disease had spread rapidly, and when we discussed her at rounds, we knew that she likely had a few months to live, at best. We also knew, however, that there were life-extending treatment options we …
A physician sees end-of-life care through a religious lens
After being prescribed opioids for just one day, individuals can face significant challenges with addiction, with six percent continuing to use opioids a year later, according to the Centers for Disease Control and Prevention (CDC). The likelihood of long-term use increases sharply after five days of use.
While much of the discussion around the opioid epidemic has centered on the challenges of opioid use and recovery, to get …
You’ve prescribed an opioid: Now what? 5 key strategies to prevent addiction
What if each doctor who interacts with medical students and residents acknowledges that they are a diverse group with their own inherent strengths and weaknesses?
Some residents will have mastered the knowledge within the pages of the textbook and can easily recite it during attending rounds. Others will have a natural bedside manner, making patients feel comfortable so that the admission history and physical exams are more complete. Others will be …
What if we treated physicians in training the way we want to be treated?
It is 3:30 p.m. on a Wednesday, and I am bringing my last patient out of the operating room. Everyone is in great spirits: a smooth case and an early finish at our surgical center. The patient has already awakened, stretching his arms, and clearly comfortable.
“Everything went alright, doc?”
I smile, knowing that I will be repeating what I am about to say a few more times as the anesthesia wears …
A doctor to a patient: Please call me when you get home
Across the United States at least forty people die each day from overdosing on opioids like Vicodin, codeine, heroin, and oxycontin. Seven percent of drivers who died in car crashes last year were found to have prescription opioids in their systems — seven times more than in 1995.
Considering these alarming rates of overdosing and DUIs, this is serious business. Authorities view it in their traditional way: the problem is drugs. …
There’s no easy way out of the opioid epidemic
In a recent issue of the Annals of Internal Medicine, Terwiesch and colleagues propose “reimagining provider visits as the new tertiary care.” Initially, their arguments seem sound, even reasonable. Then, they conclude with this:
The conceptual change is to see every engagement with a clinician not as something to be celebrated but as a kind of failure — an inability to accommodate patient needs by any of …
“Where is Saipan?” I typed into Google to search for this little U.S. territory island in the Western Pacific when I was told about a need for an OB/GYN in 2016.
Next, I inquired to the private physician looking to expand his practice, “Do you really have a significant volume to support another doctor?” My vision of island medicine was that there were a smaller number of births due to a …
A physician’s life as an FBI informant
I keep reading about how physician’s rightful bitching and moaning is peaking at an all-time high. It’s time they do so before the bow breaks, and let me tell you — we’re almost there. The worst problem that persists is “the enemy within ourselves.” This voice of doubt keeps us from the next logical step: stop what we’re doing, revolt and disable a broken runaway system lest we all soon …
Physicians have had it. What do we do now?
I did not need help. I could do it myself. I never asked, and anyone who worked with me quickly understood they did not need to offer.
This was my modus operandi. It was how I unconsciously organized my life, no more aware than riding a bike or tying my shoes. It happened in the background — utterly unknown to me for many, many years.
I could see “side effects” of this …
A physician goes from stressed to zen
After a complicated stay in the hospital, my patient was finally ready to be discharged. After all he had been through, I was excited to tell him the good news.
“You will be leaving this afternoon,” I said, heartened by the smile I saw spreading across his face. He thanked me, and then said something that made me cringe.
“Finally! I thought you guys were going to keep sticking me with needles …
Are all of those morning labs really necessary?
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A few days ago, my Gmail app flashed an email across the screen of my phone. By mistake, I swiped in the wrong direction, and it opened up an invitation from a medical survey company. When I had first signed up with this company almost a decade ago, rates were much better (and admittedly, when you are making a resident salary, you don’t have a lot of pride in your …
The devaluation of physicians’ time must end
As women in the medical workforce increase, women physicians are faced with the unique position of training the hardest they ever had in their lifetime cutting into precious childbearing years. Many women physicians seek time off or engage in part-time jobs to address the dilemma of fulfilling the obligations of their careers while enjoying the tender years of their babies. Others pursue non-clinical routes such as medical chart reviews or …
How to get back into the medical workforce if you’re a mom
When I started treating opioid dependence, I began with high expectations. I was frustrated with what had become a mindless, ineffectual exercise in providing medication for chronic pain. I saw too many patients “circling the drain” on opioids. Most admitted they still had chronic pain despite their high consumption of opioids. Many patients needed their medication just to feel normal and avoid withdrawal. Others wished they could stop taking opioids …
What’s our goal with opioid treatment?
As I walked in the room, I noticed it immediately: Norman was worse. The recurrent invasive cancer in his neck was impairing the drainage of fluid from his face making it difficult for him to turn his head, and it had progressed overnight. Despite his alarming appearance, he seemed calm.
There were no more cancer-specific treatment options: the surgeons had declined to operate again; he had received maximum dose radiation; and …
You don’t know what your patient’s end-of-life wishes are
A guest column by the American College of Physicians, exclusive to KevinMD.com.
I recently saw a 35-year-old patient of mine who came into clinic requesting brain imaging. Although she had no specific symptoms, she had a friend who was diagnosed with a brain tumor several months ago and is concerned about the possibility that she …
The challenge of the worried well
During our lifetimes, the role of physician has been shrinking, from healer to technician.
You’ve probably seen the famous painting, Doctor and the Doll, done by Norman Rockwell in 1929. It depicts an old country doc listening with his stethoscope to the heart of a doll held up to him by a worried little girl. Today there’s no time for such play, and no pay for it, either.
The gradual transformation of …
Turning doctors into technicians is a mistake
The ancient Greeks were one of the first groups of philosophers to recognize and describe the complexity of love. Eros: an intense, passionate form of love. Philia: a deep friendship or affection. Philautia: love for one’s self. Agape: an unconditional love for humanity.
These same complexities in love forms described by the Greeks play an important role in how we treat our patients in medicine.
Eros allows us to have the passion …
Don’t let burnout impact our ability to provide selfless love
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