Bleeding is upsetting. At least, that’s what I’ve been told. I mean, I have noticed that many people have visceral reactions to the sight of bleeding, or even just blood. People who pursue a career in surgery generally do not have this kind of reaction, and I find it interesting that it can distress some individuals while others are not at all bothered by it.
This might lead you to assume …
It ain’t bleeding until you can hear it bleeding
At the wake, when the kids kept running around, disturbing the disturbed, their mother, or maybe their aunt, or maybe their neighbor, shooed them to the basement. Adult quiet and proper mourning returned. However, I noticed that Mary, eight years old, or so, stayed upstairs. For a while, I watched her, carrying food, clearing plates, even answering the front door. A petite, hard working, hostess. I wondered why.
“Mary,” I said, …
Grandma was tired. So she told me goodbye.
As a primary care provider practicing in the safety net, I work with incredibly diverse patients with chronic illness. My patients have a wide range of beliefs and preferences about how to best manage their health. I believe their varied perspectives, if more widely shared, could meaningfully improve health care.
I also do research on health information technology, and in that sphere I have listened to talks and spoken with many …
From e-patients to all patients
I had two experiences recently that reminded me that many doctors and nurses remain resistant to measuring and improving how patients experience the care we provide. One was a face-to-face discussion with a senior physician. The other was reading an article by a nurse. Both the doctor and the nurse denounced the growing focus on the patient experience by citing the threat to the quality of care, and I believe …
In support of measuring patient satisfaction
LabCorp, one of the largest outpatient lab providers in the USA, is soon going to let you skip the tedium of a doctor’s visit to get lab work done. Want some tests? Come on down!
I’ve got mixed feelings about this. While there are some tests that seem reasonable for people to do on their own — pregnancy and HIV tests come …
Order your own lab tests. What could go wrong?
We received the report of the 2015 Dietary Guidelines Advisory Committee some weeks ago. Some months from now, that science-based report, politics, and a whole lot of pestering will come together, and we will get the actual Dietary Guidelines for Americans 2015.
That’s how it works, which I presume most people in this country at least already know. We have Marion Nestle to thank for first shining …
The dietary guidelines are for which Americans, exactly?
I became a doctor because I was excited by the idea of helping people every day. Following a lifelong fascination with science, I found myself in medical school, surrounded by bright classmates. We bonded over late night study sessions at the library and kegs of beer after each exam. As all medical students do, we memorized the 640 skeletal muscles that …
Invaluable lessons about what a “good death” might look like
As an internist, working in the emergency room feels at times like the dark underbelly of medicine. The frenetic pace, the need to make decisions within highly uncertain conditions, and reliance on technology all cut against the grain of the internists credo of “being a doctor’s doctor.” If internists are biased in how they arrive at diagnoses, emergency medicine doctors face such bias on an exponential scale. Clinical decision-making is …
Confronting cognitive bias in the ER
Scalability is the end goal of nearly every tech start-up, systems innovation, and teenager you-tubing their cat — it’s going viral, business-style. And traditionally, it’s been seen as a marker of relevance and success. Growth is good, right?
But in health care systems transformation, do we lose something meaningful when we measure the value of our work by its national impact?
Take Iora Health, a new health …
Health care transformation is local: The problem with scaling Iora Health
“It’s good to see you brother!”
I had never met this man, but I knew exactly what he was talking about. With a large smile on his face and a look of pride, he extended his arm to give me a handshake. “There aren’t too many of us doing what you do. I’m glad we got some representation in here.” I am a black man in the medical field. When I …
Where the brothers at? Why aren’t they in medicine?
When a terminally ill but mentally competent patient wishes to die, should a physician be allowed to bring about such wish? The California legislature is considering that question, and physicians will soon be asked to weigh in on it. Until recently, so-called “physician-assisted dying” (PAD) garnered little support among doctors. Currently, however, enthusiasm in its favor is growing. What are the reasons given to justify this emerging practice? Do they …
Physician-assisted dying: Has the pendulum swung too far?
Recently there has been a great deal of controversy surrounding the American Board of Internal Medicine (ABIM), and its board certification requirements. Currently, the board require physicians to take an exam and recertify every ten years in a process termed MOC, or maintenance of certification. The process is time-consuming and costly, and many physicians claim it does not improve their day-to-day practice. Doctors have become more vocal in their grievances …
Why board certification is important to this physician
One night while on call, I was sitting in a loud downtown restaurant when I received a phone call from the hospital. I didn’t think I would be able to hear the call, and so I scurried around to find a place to speak. The bathroom appeared straight ahead, so I rushed into the first empty stall, locked the door and took the phone call. After wrapping up with the …
Primary care: Easing trepidation is a full-time job
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To his credit, Mark Cuban, engaged on Twitter in response to my post.
Mark, I’m sorry I had to leave Twitter abruptly. My wife threatened to kill me and then divorce me — in that order — if I didn’t get off Twitter instantly and get the groceries.
However, I caught the tail end of the Tweets. I’ll do my best to respond.
1. “Why is this contingency …
A radiologist vs. Marc Cuban: 6 answers to his questions
Do you know the difference between a surgeon and God? God doesn’t think he’s a surgeon.
Everyone who goes into the study of surgery has ideas about what they’re going to be. I would imagine that each individual has different expectations of what the future holds, though few find their future at all resembles those expectations.
I recall when I started my surgery …
A surgeon who wasn’t God in the OR after all
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
As a physician, you never quite get used to being paged in the middle of the night. The shrill tones emitted via a radio frequency device that seems squarely stuck in the 1980s are almost always …
A physician anesthesiologist reports in from Afghanistan
Dear drunk driver,
Tonight, I am tired.
Tired from lack of sleep, tired from the long hours, and tired from bearing witness to your destruction.
Tonight, you caused an accident while under the influence of alcohol. And you are badly injured, requiring emergency surgery. Your liver is hard, cirrhotic, and unforgiving. Although I can get you through this first surgery, I know you will …
Dear drunk driver: From your trauma surgeon
“It must be nice.”
Without a doubt, this is my least favorite colloquialism in the English language. Though not explicitly stated in the phrase, I have always felt that it implied luck and/or privilege rather than plain old hard work. I have a problem with that because very few things in this precious world are easily obtained, whether it is a fit …
It must be nice to be a doctor. Except when it isn’t.
Going into my final few months of residency, I am somewhat puzzled, knowing that so many of my colleagues are signing contracts with hospital-owned outpatient practices, going into subspecialist fellowship training, or having plans to work as a hospitalist. As someone who plans to go into solo private practice, I feel like an outlier.
Yes, I know what you might be thinking. Who goes into solo practice these days when hospitals …
Is starting a private practice a dying art?
Medicine is plagued by a form of prejudice called “specialism.” (Yes, I just made up that word, but it fits.) In medical school we were united; we were all in the same boat; we were a team making our way through the gauntlet together. And then it came time to choose a specialty.
A satirical article by “Lord Lockwell” circulated on social …
This isn’t Game of Thrones. Physicians need to help each other.
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