Walter was far older than his chronological age. A mere thirteen years, he kept company with a much older crew. Doctors, nurses, and CNAs were his constant companions. The other kids on his floor were either too sick to interact, or came and left within a matter of days. But not Walter. His heart was too weak to allow his departure, but too strong to be first in line for …
What physicians experience today is feigned intimacy
My patient was an elderly farmer with severe vascular disease. He had advanced leg artery narrowing, had survived multiple heart attacks, and was admitted to the hospital after a large stroke. He was incredibly cheerful, vibrant, and optimistic. He had a very large, loving family who took turns attending to him, and encouraging him with each small improvement in his leg and arm strength. They knew his neurological exam better …
A life-threatening condition cannot dampen the human spirit
She had been a patient for several years, and I still remember meeting her that first time: Her breast cancer was stage IV at diagnosis, already established in her bones; she was scared; she was in pain. Surgery was taken off the table, and she was referred for medical therapy. We had discussed prognosis, the incurableness of her cancer, …
At the end of life, medicine truly becomes an art
One of the most notable things so many of last year’s biggest health stories have in common is that they envision an increased role for shared decision-making in primary care.
Some patients will want to receive few aggressive interventions at the end of life; others will want more. Some women will be fine with waiting until age 45 or 50 to get their first mammogram; others will still want to start at …
Shared decision-making in primary care: How can we make that happen?
Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago. Are they right?
First, let me say that in some instances they may be correct. It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon. The hospital is not always right …
Discharged too early? The decision is more complicated than you think.
The customer is always right, or so the saying goes.
If you have ever worked in retail, you may have been frustrated by buyers who ransack neatly folded tables of sweaters and leave them strewn about like tornado wreckage. If you are in the food industry, you may be annoyed by a diner who complains his soup is too cold even as you see steam rising off the bowl.
It can sometimes …
This is why patients cannot be customers
When I was a new attending, an older man came to see me as a new patient. He had not seen a doctor in over thirty years and was experiencing worsening chest pain that first occurred when he walked upstairs but had progressed to pain at rest. An electrocardiogram in the office showed signs of ischemia, and I advised him that I wanted to call an ambulance to take him …
These are the moments why we practice medicine
“Donald passed away.”
We had been sitting in the chiefs’ office with a few of the attendings who had all had Donald (name changed to protect privacy) on their service at one time or another. Everybody exhaled a collective sigh, soaking in the sting of the knowledge of Don’s death; then, within a few seconds, everybody had smiles on their faces. The smiles were born out of a personal experience with him in …
A patient is remembered. He lived life the way he wanted.
Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right.
We enter medicine as inspired, intelligent, compassionate humanitarians. Soon we’re cynical and exhausted. How did all these totally amazing and high-functioning people get so f’d up so fast? Attention medical students and doctors: It’s not your fault.
Burnout is physical and mental collapse caused by overwork.
So why …
Physicians aren’t burned out. They’re abused.
Would my white lab coat be better put to use when I carve the Christmas roast than when seeing patients?
After all, we know that these coats can be covered with pathogens, including drug-resistant ones, which may be transmitted to patients. They are cleaned infrequently: In a survey of physicians, nearly 58 percent said they laundered their white coats monthly or never. Less than 3 percent washed them daily …
Why it’s time for doctors to ditch their white coats
There are times, as a healer, I feel helpless. These are not just the moments when cancer consumes. I understand that the dread disease has yet been conquered, and there is still terrible loss. This not when I refer a patient elsewhere; I know my limits. Rather, these are the times when I am trapped, ignored, and the result is needless suffering.
In his classic, often quoted, 1942 short story, Runaround, …
Doctors are not in control. Perhaps this is our greatest challenge.
Today so many physicians are not able to see pharmaceutical representatives (PRs). However, PRs do serve as a great resource and finding a way to make their visits more efficient and focused is an objective we all need to strive for.
I recall requesting an interview with Lou Holtz, then the head coach at Notre Dame, and was told by his secretary the date and time that the interview would take …
A surefire way to see pharmaceutical reps in a timely fashion
This New Year is the appropriate time to make a resolution: the occasion to link advance care planning with a spiritual legacy. People all have deep-seated values and determinations of what they are willing to pay for, live for and die for, but few actually document these for caregivers or posterity.
Beginning in 2016, Medicare will begin to reimburse physicians for end-of-life counseling. However, throwing taxpayer dollars at no-win situations is …
It’s time to make a spiritual legacy for 2016
ADVERTISEMENT
I have a dream job.
I make my own hours, working three 12-hour shifts on Tuesday, Wednesday, and Thursday. I’m off Friday through Monday, and I don’t take any call. I take as much vacation as my budget will allow, and if I wake up with the flu, I call off from work without the usual feeling of guilt and anxiety.
It wasn’t always this way. Like all new doctors recently out …
How partnering with urgent care created a dream primary care job
I’ve noticed as I get older, life seems to travel full circle no matter your path or destination. I find myself trying to teach my son Grant things that my father attempted to teach me not so long ago. “Don’t do that, you’ll fall and hurt yourself.” Or, “Try it this way and the process will be much easier.” There is that brief moment of acknowledgment often followed by scraped …
Physicians: Listen to voices of the past. And learn.
“Don’t forget to bring that stool card back in, OK?”
As he walked out of the room, carrying his portable oxygen, he turned back, with the nasal cannula in his nose, and replied, “I’ll get it back to you soon. I’d hate to have colon cancer.”
At this point, I’d hate for him to have a positive occult blood card. I could really care less about colon cancer. Colon cancer isn’t going …
I’m not worried about colon cancer. I’m worried about the potential colonoscopy.
Up to a third of resident physicians suffer from clinical depression or its symptoms. This was the finding of a large review of 54 studies involving 17,560 resident physicians, published in JAMA recently. In some of the studies reviewed, up to 40 percent of resident physicians reported depressive symptoms. The study found these physicians were 4.5 times more likely to suffer from depressive symptoms following beginning …
The key to preventing depression in residents? Value young physicians.
It is important that I make two disclaimers:
A physician goes on paternity leave. Here are 6 things he learned.
After months of negotiations, the Conference of Parties 21 (COP21) adopted a historic and unprecedented climate change agreement in Paris recently. The Paris Agreement reflects nearly universal recognition among parties that climate change demands an urgent, coordinated response. This agreement includes cutting greenhouse gas emissions to curtail the average global temperature rise to “well below 2ºC above pre-industrial levels and to pursue efforts to limit the temperature …
We owe it to our patients to lead and support climate change action
What do you do when you love your job, but it’s killing you?
That’s an easy question if it’s asked by someone else. It’s a hard question when you’re asking it of yourself. As a physician, I give advice to people all the time — other people. If you have diabetes, control your diet. If you are obese, then lose weight and exercise. If you have COPD, then you better not …
This surgeon loves her job. But it’s killing her.
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