A lone figure stood at the entrance to bed 14, intensive care unit 2, floor 15-North. Though it was 2:30 a.m., he stood with rapt attention. He looked out over the hallway, eyes scanning. He looked like a gargoyle brooding over his castle, protecting it.
He looked unlike anyone I’d ever seen in an ICU. He was a slightly pudgy yet wholly muscular 5′ 10” or so, with a few days …
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Recently, I’ve been thinking about how physicians express condolences. This weekend, I attended calling hours to visit with the family of a recently deceased patient. As I drove back from the funeral home, I tried to recall when I started to attend my …
A part of patient care that I was not taught in medical school
I have never wanted to be the medical advice columnist. “Dear Dr. Leap: My feet sweat all the time. I’ve tried everything! What should I do?” Nope, I’m not your guy. Nor do I want to opine on study after study about statin drugs for cholesterol or discuss whether women should take estrogen. There are physicians who love those questions! And I think they’re fantastic. But I’m an emergency medicine …
Cheaper health care isn’t hard
I am a practicing hospitalist physician in Dayton, Ohio. Dayton has emerged in the last year as the city with the highest per capita death rate from opioid overdoses. When we measure the number of deaths here we talk about how many there are per day, not per week or month. We have been inundated with heroin and other products laced with fentanyl or carfentanil. Every other drug, including marijuana, …
What it’s like to be a doctor in the heroin capitol of the U.S.
My husband, the anesthesiologist, came home one evening, he was solemn, affected, not himself. His patient died in the recovery room. It was sudden and unexpected for my husband. Despite the team’s swift efforts and perfectly executed code, the patient died anyway. It’s relevant to note that his patient was an almost 90-year-old man with significant congestive heart failure, probably chronic kidney disease, and complete occlusion of one of his …
5 ways to make dealing with death easier
Some days, it is about crossing paths with others that bring a smile to your face. Here is one such individual.
Sitting in my office was my new patient and her husband. She was a just-pregnant Brazilian woman wearing a warm smile; he was an older, overweight, unkempt American who sat uncomfortably in the chair. I imagined he had never been to a gynecologist’s office and was perhaps unsure what to …
The inspiring growth of a doctor-patient relationship
1973, as we prepare to start our clinical rotations, the chief medical residents taught us the new concept of SOAP notes.
Larry Weed developed the concepts of the problem-oriented medical record and notes that included subjective, objective, assessment and plans for each problem. We wrote our notes each day using his system.
I have wondered in many conversations what he would think of the unreadable computer printout notes of …
Remembering Larry Weed, founder of the SOAP note
Senator John McCain recently had surgery to “remove a blood clot above his left eye” according to a CNN report. CNN, fortunately, didn’t have a chance to wade into their familiar territory of fake news because they had a practicing neurosurgeon, and CNN Chief Medical Correspondent, Dr. Sanjay Gupta on hand to discuss Senator McCain’s surgery.
Despite the cheery description, “minimally invasive craniotomy,” this was brain surgery, opening the skull …
Does Senator McCain’s blood clot explain his recent behavior?
I had never met the man, but from a brief reading of the notes in his medical record, I knew that this was not going to be easy. Thirty years old with stage III kidney cancer, the notes showed a long history of missed appointments and late arrivals. I had been asked to talk to him about sperm banking and so …
Treating the patients we cannot reach
There have been recent discussions in the lay media about a growing trend of litigation cases focused not on the “right to live,” but rather on the “right to die.” These cases have involved patients who received aggressive treatment, despite having documentation of their wishes not to receive such aggressive treatment. Although unsettling, it is not surprising that this issue has arisen, given the national conversations about the exorbitant cost …
Important considerations in how we use advanced care planning documentation
Recently, I attended a conference where a recognized expert in physician burnout was a keynote speaker. As I sat through this lecture on physician burnout, it struck me that we may be approaching burnout in an entirely wrong way. We either look at it from a disease standpoint along the lines of PTSD or depression. Alternatively, we view it as Read more…
Physician burnout is the inevitable result of a failed medical education system
As a new doctor, I’ve learned that the best patient care happens as often outside of the hospital as inside. While we treat sick people and get them tuned up, each patient’s opportunity to get better and stay better often depends on their access to resources beyond clinical walls.
One of those resources, I’m learning, could be mobile technology. I’ve …
How a text message saved this patient’s life
Travel is one of our passions. Spending time in unique places, trying new foods, and meeting different people is enjoyable and exciting. We are also passionate about our jobs as otolaryngologists.
Humanitarian trips allow us to combine both of these loves.
During these trips, I have repaired cleft lips/palates, removed cancers, reconstructed facial disfigurations and improved breathing and swallowing. Few things are more gratifying than being able to provide life-changing operations without …
Want to go on a surgical humanitarian trip? Here are 12 things to think about.
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There are many different theories out there about the direction that health care should go, and what we need to be doing in the future.
Passions run high, and peoples’ opinions vary wildly. It’s frequently difficult to find agreement on anything. There is, however, one universal truth I’ve found about the everyday practice of medicine, and what constitutes great medical care for any individual in any health care system. Having worked …
Good communication is at the core of all good medical care. Here are 3 examples.
How applicable are the lessons we learn in the hospital to other areas of our personal and professional lives? Over the past eight years in the emergency department, I have learned most about people. These lessons have been crucial to my success in the ER and as a father to my teenage children.
These are my top 5 insights:
1. Clear communication is key and overly clear communication is even better. It …
Working in the ED has made me a better parent
On a recent visit to DC, I found myself feeling inspired; regardless of your politics, it’s almost impossible not to. At each monument, museum, memorial, and government building, I stood in awe of the boldness, faith, hope, and determination of our founding fathers and their unwavering belief in the future success of their American experiment. So many of these sites are inscribed with famous quotes from leaders who inspired generation …
Finding the right words for my patients’ hard questions
As physicians, we are regarded as intelligent. Are we, as a community, as emotionally intelligent as we could be? The answer is no. Let’s face it. We are trained from the time we are medical students to disconnect and suppress our emotion, and we are taught to appear stoic and strong. Showing emotion in front of patients is discouraged, even in a situation that would be deemed acceptable by most. …
Doctors are smart but not emotionally intelligent
Since I was a little girl, I have been called a lot of things. Sensitive. Funny. Strong-willed. Outgoing. Take-charge. Friendly. Bossy. Focused. And my favorite — domineering.
I’ve always been a direct person. I’m an extrovert, which means I walk into a room and I am energized by the people around me. I am also a positive person; I assume you are my friend until you prove otherwise. On most days …
Go ahead and call me bossy. Bossy saves lives.
Be honest. What’s the first thing you think of when you hear the words “plastic surgery?” Breast implants? Nose jobs? Or maybe you’ll think about one of the numerous television programs out there that have featured the discipline: “Nip/Tuck?” “Botched?” “Grey’s Anatomy?”
If so, you aren’t alone. Plastic surgery as a discipline is poorly understood by many, including primary care physicians, nurses, medical students and the public. Plastic surgeons perform many …
The real reason we think plastic surgery is just boob jobs and tummy tucks
My wife and I married in our mid-thirties. Over the next five years, we had three sons. When our boys were young, we had no real desire to go anywhere or do anything unless it involved our family. Traveling and entertainment were a low priority unless it involved a Disney character, the Power Rangers and the like. My serious passions such as hunting and fishing were put on hold until …
Don’t be one of those sports parents
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