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.
Most of us are skeptical that insurance companies are devoted to our health. Answer the following question: Do you think your insurance company is more interested in your health or in controlling costs?
Pretty tough, huh?
There is a tension between medical quality and medical costs. If we had a system that offered perfect quality, it would be unaffordable. If we imposed rigid cost controls, then medical quality would be compromised. Where …
Why can’t we control outrageous health care costs?
As an oncologist, I have witnessed patients go home and heard later how they died there, surrounded by family and friends. I have seen others die in a hospital room, comforted by the care of the inpatient team even as they depart this earth. These are the ones that stick with me and what I think about when …
Not all patients share the same views on end of life
In November of my intern year, I had trouble finding the sun. It was dark when I woke up for work, and it was dark when I headed back home. I’d picked up the service on the cancer ward from an intern named Bob, and he left me six handwritten pages on the subject of Jim Franklin.
This was the deal: Jim Franklin, thirty-seven years old, was in the cancer ward …
A difficult patient helps a doctor see the light. Literally.
Medicine has become increasingly stressful for all levels of health care providers. Every year, nearly 400 physicians commit suicide, and in a study published in the Journal of Academic Medicine, researchers found that almost 10 percent of final year medical students and first-year residents (called interns) reported having suicidal thoughts. Previous studies from the National Institutes of Health found that physicians were twice as likely to …
How can doctors avoid burnout?
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
I don’t want to dramatize the death of a nineteen-month-old girl who passed away this summer from wounds secondary to child abuse. I just want to document that it happened. That in late August, as I was signing out my patients to the resident taking over for me in the ED, an infant was wheeled in who was found by EMS in asystole with a body temperature below 90 degrees Fahrenheit. …
Acts of violence against children have 2 victims
When I started medical school, my classmates and I attended a special ceremony where we stood in front of our friends, family, and professors and recited some modern version of the Hippocratic Oath. For years afterward, I only remembered the “do no harm” bit, which is a lazy approximation of the actual words. I recently reread the oath, and even though I’d completely forgotten, it also said this: “I will …
Practicing medicine in the Trump era
It was Albert Einstein’s “biggest blunder.”
Using his general theory of relativity, Einstein devised a formula that predicted the universe was expanding. This was an unfathomable idea, though. How could the universe expand with all the gravitational forces pulling the heavenly bodies together.
In Einstein’s time, the universe was thought to be stationary. A universe that was anything but stagnant was an inconceivable idea since celestial matter would spin out of control, …
Should medicine have a cosmological constant?
I was about 13 years old. I heard that she had cancer and I went to the hospital to visit her. Her name was Sister Pat, and she was my former principal and my favorite teacher from elementary school. I don’t think she had reached her fortieth birthday. I was too young and uninformed to ask about any of the details. However what stuck with me and I remember so …
The treatment to give people more time
The medical assistant swabbed my nose and my throat multiple times. Pricked my finger too. Then, the phlebotomist (or vampire?) drew bottles and bottles of my blood. Along with the physical discomfort, there was emotional discomfort too. What would the test results show? If they were all negative, would I be satisfied without having an answer?
Being a patient can be extremely vulnerable. Not only do you often divulge to a …
My experience as a patient has made me a better physician. Here’s how.
I spent the evening of the 2016 presidential election and the morning after on an emotional rollercoaster. It began high and then descended into shock, disbelief and grave concern about the future of our country. Now that we have selected a candidate who intends to take the country in a radically different direction, and I worry about the consequences of reversing the Affordable Care Act, reversing economic assistance programs, and …
We must cross the political divide for the sake of our patients
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As an internist and geriatrician, I deal with elderly patients all the time. We always end up talking about end-of-life issues:
“Should I be resuscitated if my heart stops and I stop breathing?”
“Do I want a feeding tube or gastrostomy tube if I stop eating and require nutrition?”
“Should I be kept alive on machines and for how long if there is no reasonable hope of recovery?”
“When should we refuse tests for …
End-of-life decisions aren’t any easier for a doctor
Madame Laurent came to my office one day last year with bloodshot eyes and a two-day headache. She’s well known in our clinic – kind to all the staff and always smiling even when she’s in pain. Despite a stroke a few years ago, she is mentally sharp, often able to read what I want to say before I can say it – an impressive feat considering that she only …
A patient’s hypertension and the war on science
For a century, the white coat has been the symbol of the medical doctor. Today, the vast majority of medical schools in the U.S. begin with a white coat ceremony. There, the fledgling, future doctors stand together and recite a modified version of the Hippocratic Oath before being called up one-by-one to receive the white coats that they will wear throughout the upcoming trials and adventures of medical school. The …
What does a doctor’s white coat really mean?
You will probably never meet me in person. Your name will be on the bill my insurance receives from the hospital. Your signature will be on the line after the end of the report as you mumble report after report into the system. You will never know my story. I am my organs to you; organs will anomalies that you have to squint and sometimes lean back to look for. You …
Please dear doctor, give me my results. My life is on hold.
Physician burnout has received a lot of well-deserved attention lately. Characterized by emotional exhaustion and professional frustration, it’s tied to an array of adverse consequences, from physician suicide to poor patient outcomes. Organizations are waking up to the need to measure its prevalence and ameliorate its impact.
There seems to be two broad schools of thought about the causes — and by extension, the fixes — of physician burnout.
The first focuses …
What’s at the root of physician burnout?
I hugged them longer than any 10- or 11-year-old wants to be hugged by their mom, and tried not to cry tears of gratitude that they were in my arms. The last kid their age I saw was the one I had resuscitated and admitted to the PICU just hours before, and it took my breath away to think about that happening to my sons. I had to make one …
Why this emergency physician is thankful this holiday season
On November 1973, I had an epiphany. My first week on my internal medicine clerkship, I realized that I had found my specialty: internal medicine.
Prior to medical school, I had worked with emotionally disturbed children in an inpatient hospital. I really enjoyed the experience, and learned a great deal. During my first two miserable years in medical school (I disliked how they taught the basic sciences and even more how …
Why this physician chose internal medicine
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