A recent issue of the Journal of the American Medical Association (JAMA) reads like an expose. Well, at least three of the research articles do. So exciting! I don’t want medicine — my field — to be ethically unsavory, but it is sometimes. It makes me proud to see that it polices itself and that such information is published in a high profile journal.
The first article is …
Why should we worry about conflict of interest?
My colleague, Dr. L.T. Kim, was off this week and I covered for him.
On Friday afternoon, I dealt with two of his patients and learned — or relearned — two important lessons.
I saw a man with thoracolumbar back pain. He had fallen off a ladder a few years earlier and suffered from recurring bouts of back pain — sometimes with tingling in both legs. He had been to the emergency …
I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn’t going to let it be that easy. I repeated myself and paused again. This time a few tentative answers flutter up to the podium.
Hospice? Comfort care? End of life? Giving up?
Now this is something I could work with. I cleared my throat and smile broadly.
Palliative care is a philosophy.
I can’t help but …
Palliative care is a team sport
The boom in telemedicine is here, and understandably so. The “consumer” is in control now, and they sure don’t want to be “patient” anymore. When Americans want care, they want it cheap, and they want it now. Telemedicine has grown to accommodate 7 million annual patient encounters, up from 350,000 five years ago. What savvy health care administrator doesn’t see numbers like that and get dollar signs in …
Telemedicine encounters inherently sacrifice quality
I was raised in a family that hates taxes. Not hates taxes as in, “Gosh, it’s too bad such a high percentage of my paycheck goes to the government.” More like: “How dare the government steal my hard-earned money and give it to undeserving moochers?” (Is there such a thing as a deserving moocher? Sorry, I digress.)
The origins of this anti-tax sentiment are deeply ideological, steeped in a frothy mix …
Who hates taxes? The answer isn’t what you think.
In this podcast, I share insights from a doc who barely survived his suicide attempt plus simple ways to prevent the next suicide. Listen in. You may save a life.
Dear Pamela,
I’ve never been so happy to fail at something in my life. Four weeks ago today I died. Cardiopulmonary arrest in jail. Why was I in jail? My wife alerted …
Doctor revived after suicide tells all
I know of only two people who, upon starting medical school, knew that they wanted to become psychiatrists. (How did they know what they wanted to do eight years before they did it?) They both achieved their professional goals: One created a community clinic for people with severe psychiatric illnesses. The other became an addiction psychiatrist and now oversees an entire substance use disorder program for a health care organization.
I …
Why it’s important to know yourself
This week, a resident asked, “What do you say to suicidal physicians?”
1. I don’t say anything. I listen without judgment. Our culture doesn’t support physicians asking for help — or revealing their suffering. As a result, physicians fear sharing suicidal thoughts with friends and family because we’re the ones that others rely on for help. Physicians fear speaking to their program directors or employers because of professional retaliation and loss of …
3 things to say to a suicidal physician
When I was a third-year medical student, I was a victim of sexual harassment.
I had a patient (I no longer remember his name, so let’s call him Mr. X) who was in his eighties and I had to do a rectal exam on him. I had been on the team taking care of Mr. X for a while, and I was fine doing the rectal exam and checking for blood …
A victim of sexual harassment as a medical student
We do many things in medicine to patients that are either not helpful or have the potential to harm. If you take the long view of medical history, this should not be surprising. After all less than a century ago, physicians were still giving toxic mercury compounds to people in the form of calomel. And a century before that, physicians were bleeding people because they thought that was a good …
Let’s stop therapies that hurt kids
I was very saddened to learn this past week of another physician who died by suicide. This, the untimely death of a young and brilliant mother of two, is a horrifying tragedy.
I do not write this to pretend I know anything about this recent tragedy. I write this as a sort of case report on myself. I was an at risk physician at one point.
I’ll start where the problems most …
What a burned out physician looks like will surprise you
Gather round kids! Let Grandpa Doctor Leap tell you a few things about the old days of doctoring in the emergency room:
Back in the good old days, medicine was what we liked to call “fun.” Not because it was fun to see people get sick or hurt or die, but because we were supposed to do our best and people didn’t wring their hands all the time about rules and …
Once upon a time, being a doctor was great. Not anymore.
Knowledge is power. Increasingly, patients are demanding and receiving access to levers in the medical machine that would have been unthinkable a generation ago. The informed consent process, which I support, can overwhelm ordinary patients and families with conflicting and bewildering options.
Television and the airwaves routinely advertise prescription drugs directly to the public. Consider the strategy of direct-to-consumer drug marketing when millions of dollars are spent advertising a drug that …
Should patients order their own lab tests?
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Politicians and policymakers are discussing what parts of the Affordable Care Act to change and what to keep. While most of us have little control over those discussions, there is one health care topic that we can control: what we talk about with our doctor.
The Institute of Medicine (IOM) released the landmark publication Crossing the Quality Chasm 15 years ago. The report proposed six aims for …
The most important thing you’re not discussing with your doctor
On a busy day in the office, a patient was added to my schedule for “bleeding, early pregnancy.” She was one of my partner’s patients, but he was not in the office that day. We talked for a minute, then I examined her and did an ultrasound. As I expected, she was in the process of a miscarriage. Unfortunately, I, who wasn’t her regular doctor, had to give her this …
Patients are unique with individual needs. That is the art of medicine.
G1P0 or Gravida 1, Para 0. Well, turns out that’s me. It’s very common in the medical field to use this phrase to describe women who have been pregnant but do not have any living children. This could have been due to miscarriage or worse yet, intrauterine fetal demise at later staged pregnancies. Or it could be due to an elective termination. For me, it was the latter.
I had never …
Why it’s important to protect Roe vs. Wade at the state level
U.S. physicians continue to struggle to maintain morale levels, adapt to changing delivery and payment models, and provide patients with reasonable access to care. This finding from our biennial physician survey reverberated amongst the members of the Physicians Foundation. But what amazed us the most were the over 10,000 physicians who took the additional time to provide written comment on the concerns they felt most passionate about. That act alone demonstrates …
Why the physician workforce needs to be rejuvenated
The U.S. rings the bell on health care spending, and some point fingers at patients themselves.
But why do patients choose the paths they choose? Just about every shift, I and my coworkers shake our heads, and wonder what may be driving our patients’ decisions. Parents who haven’t yet tried a drop of acetaminophen bring kids in at 2 a.m. with fevers. Patients show up with nose bleeds that …
How much are patients to blame for ER overuse?
Most of the lawsuits I deal with have more than one named defendant. For example, the plaintiff (typically a deceased patient’s next of kin) might sue a hospital, a nursing home, and the attending physician at each facility. Sometimes they go a bit further and may even include the administrator, the director of nursing, and individual HCPs, such as the wound care nurse or the registered dietitian nutritionist.
When a lawsuit …
The blame game: It’s not alright to blame the patient
2016 closed around a continued effort to “salvage” the medical profession’s reputation, but the notion that it’s broken continues to be counterproductive.
The brightest students, for example, question the long journey and delayed gratification being a physician entails. They do the math and continue to engage in other professions that are medical but not specifically Medical Doctorate degrees or Doctor of Osteopathic degrees. These same students conclude there is no longer …
4 reasons why being a doctor is worth it
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