I remember, when I was a kid, that my grandmother would spend time at our breakfast table reading the newspaper. Not cover to cover, mind you — she seemed to always focus her attention on the obituaries. Sometimes she would look up and tell anyone sitting around her about the death of someone near her age …
Let’s stop calling cancer a war
An excerpt from The Devil You Know.
“Dr. McGill!”
I look up and see seventy-one-year-old Herman Katz hurrying across the waiting room with outstretched arms. Herman Katz is the bane of my existence. During my short stint at the VA, I have had him in my examining room …
I promise you. It’s definitely not cancer.
After another long shift of patients with colds, bug bites, ankle sprains and sore throats I eagerly looked through the wine selection at the local grocery store. It was my wedding anniversary and nearing 9 p.m. at the beginning of a holiday weekend. While at the checkout line, an elderly woman in front of me thanked me for my service. At that moment, I realized that I was wearing my …
This is what it’s like to be a military physician
The medicine model has changed since our predecessors practiced medicine in the days of Dr. William Osler. These days, medicine is a commercialized industry. The hospital makes this clear by prioritizing charting and patient satisfaction over patient care. Also, patients are accountable for making it feel this way. Some patients want to dictate their care completely, like making an order at Burger King. Physicians are encouraged to please patients, because …
Imagining a world where Amazon runs hospitals
As Southern states entertain legislation granting nurse practitioners independent practice rights, there are some finer details which deserve careful deliberation. While nurse practitioners are intelligent, capable, and contribute much to our healthcare system, they are not physicians and lack the same training and knowledge base. They should not identify themselves as “doctors” despite having a doctor of nursing practice (DNP) degree. It is misleading to patients, as most do not …
MD vs. DNP: 20,000 hours make a difference
Independent physician groups and solo physicians have been the historic bedrock of medical practice. While it is true that there is intense pressure on the single-physician group, and this market is shrinking, independent physicians are here to stay. Some single practice physician groups may merge with larger groups, some physicians will break off from the large contract groups, but there is no plan on them becoming extinct.
Independent physician groups have …
5 myths about emergency physician groups
I was recently on an off-service rotation and one morning as I entered a patient’s room that had been admitted to our service, I overheard the patient quickly tell the person they were talking to on the phone, “Hey, can I call you back? My nurse just walked in to talk with me.”
For a moment I was confused and actually turned around to look for his nurse behind me. Alas, …
Overpowering the glass ceiling will take more than outnumbering men in the field
I scream in frustration as the flickering screen creates another required check box. Silently of course. I am on the hospital ward, and broadcasting the doctor’s frustration will not help patients or nurses. “Who created this tool?” I wonder for the thousandth time. Why don’t doctors make their own tools?
Contemporary philosopher Daniel Dennett ponders thinking tools. “Like all artisans, a blacksmith needs tools, but — …
Doctors, we need to start making our own tools
Mr. O was my new patient but had been known to our practice for several years. He was 74 years old. He had been complaining of “dizziness” for some time. He came in for his visit accompanied by his home health aide. He was born in the Dominican Republic, and he spoke Spanish with limited English proficiency. I scanned his former notes and saw that his aide typically provided translation. …
Care for patients with limited English proficiency begins with medical interpretation
It happens to us all. I was frustrated with one of my patients about two years ago, angered because she did not want to help herself. She kept requesting help for her mental disorder, and when the help was given, she would literally run away. She would start then stop taking a medication that even she had to admit did help her. Medication was just not for her she would …
Patience for patients: Good things come to doctors who wait
Medical school applications can raise big hairy questions about the long-term potential and trajectory of your relationship as well as the question of whether you get a say in where the applicant applies and attends medical school. For some, the timing of these questions arises in synchrony with the relationship’s natural progression that is at a time when you and your partner are beginning to discuss your long-term prospects. Other …
How can relationships survive medical school applications?
When I was in television, I was friends with the late Gene Siskel (the film critic’s syndicated show would shoot in our Chicago CBS studio). Siskel would drop by my office to talk and get free medical advice.
Siskel was, you might say, frugal. I remember when I was in contract negotiations with CBS, my bosses couldn’t praise me enough — but the money wasn’t there. When I told Siskel about …
Advice for PCPs from Gene Siskel
The young woman in my clinic, whom I’ll call Nicole, was 8 months pregnant with her third child. It should have been a joyous time — but she was in a county jail. Nicole was awaiting trial for a misdemeanor, and while a judge had set bail, she couldn’t afford to pay it.
I’m a public health researcher and physician in the Los Angeles County Jails, the largest jail system in …
Bail reform matters. A physician explains why.
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Sixty is the number of patients left on our schedules at the end of the day on Monday this week, people who never showed up, what we call no-show appointments. This number does not include those patients who did reach our practice to reschedule (these are counted separately), but simply those who never made it in for their scheduled appointments.
While we are a very busy practice, and this is not …
No shows at your practice. And how to fix it.
It started with nightmares. I would wake up frightened, covered in sweat and searching my empty room for an intruder. It progressed. I started setting traps on my doors to see if anyone was coming into my apartment when I wasn’t there. I didn’t open my blinds often. And when I did, I ensured no one would be able to see inside. I meticulously planned movements outside my apartment — …
Why don’t doctors talk about mental health?
“Do no harm.”
This is a key phrase in the Hippocratic Oath; one that I announced with conviction at my medical school graduation. I swear to do no harm. What would Hippocrates, the Father of Modern Medicine, think about the concept of harm reduction?
Canada has a drug problem. We are one of the world’s largest per-capita opioid consumers. The country is facing what has become known in the media as the …
Doing no harm to addicts might be doing a lot of harm
Burned out cardiac surgeon seeks opportunities or empathy,” one message reads. “I feel stuck,” another confides. A third says simply, “I don’t want to be a doctor anymore!”
The posts come in from across the globe, each generating its own thread of commiseration and advice. “I just wanted to reach out and let you know I feel your pain,” a doctor-turned-MBA replies to one surgeon. “Your story is so similar to …
Here’s the place where burned out physicians go
I sometimes joke that hospitalists are the medicine version of the mullet haircut; you know, all business in “the front” (i.e., the patient care area) and all party in “the back” (i.e., the work room). In “the back,” the usual scenario is to complain and moan about our frequent flyers, our drug seekers, our many unsaveable patients, the incredible situations (“He put a nail where?”), with good-natured but somewhat bitter …
5 ways to make a connection with previously unreachable patients
Monday morning and no place to go. After 35 years of practicing medicine and GI, including a year of eager anticipation, the day had arrived when there were no patients in my schedule. Nor would there be tomorrow. Nor the next day.
I was happily accustomed to a scheduled life. For me it had been decades of awakening early, working out, assembling a breakfast to inhale in the car, kissing the …
A retired physician asks: Am I still a doctor?
Jimmy spent 10 years on the street chasing oxys and heroin. He lost his family and friends after lying and stealing. He lost his truck when the bank repossessed it. He lost his four-year-old son to the Department of Child Protective services. His life was like a country song.
Now a member of our suboxone group, Jimmy has two years of sobriety under his belt, he is enrolled at the local …
Treating addiction: Rewriting patients’ country songs
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