I’m getting to the point where I think it might be time to stop or at least decelerate the pace of my writing on medicine. When I retired from medical practice almost a year ago there were a lot of pent up experiences that I felt a need write about. But now I have already written about almost everything that I wanted to and, as I am no longer a practicing physician, …
Can writing about medicine change medicine for the better?
In July 1991, I was beginning my first year of medical school in Rochester, New York. I was filled with excitement and anxiety on beginning a journey in medicine as I started on the road to becoming a doctor.
At that time, Rochester was in the national spotlight because of the actions of one of our faculty members, Timothy Quill. …
What does a good death mean to you?
Cynicism appears to have replaced idealism as America’s defining characteristic. So many of us just don’t trust the government, scientists, the clergy, journalists, business CEOs, labor unions, lawyers, or just about anyone for that matter, to say or do the right thing.
Two years ago, the National Journal reported that as a consequence of the Great Recession, “Americans are losing faith …
The public’s lack of trust in science is alarming
I’ve waited to address this sensitive topic until after the midterm elections, when political slogans such as the phony “war on women” and trumped-up threats to religious liberty were discarded like so many campaign posters. It was curious to see the American Congress of Obstetricians and Gynecologists (ACOG) and Planned Parenthood attacking Republican Senate candidates for supporting over-the-counter birth control pills without a prescription — a position that, if …
OTC birth control pills: Let’s replace politics with science
I didn’t think much of it at the time.
Most physicians can trace back and recall their first patient. For some, it is a clinical encounter the third or fourth year of medical school. The more creative may point to their cadaver during first year anatomy and nod knowingly. My first patient was a mouse. Or shall I say a group of them?
My freshman year of college, I volunteered in …
You always remember your first patient
Open a new browser tab and check your favorite weather forecast website or app. Right now.
How many days in the future does it go? Seven? Maybe even 10? Look at the current forecast for the 7th day out from today. Do you trust it to accurately predict the weather for that day? Why? Or why not?
Have you ever wondered why they can’t …
What chaos theory has to do with family medicine
One of the top students at one of the nation’s largest medical schools, Ishan Gohil has made an unusual — and to many of his colleagues — inexplicable decision. Instead of seeking to train in one of medicine’s most highly specialized and competitive fields, he says, “I elected to pursue a career in family medicine.” Many view his choice of primary …
Primary care fits some medical students. Here’s one.
Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any …
Run your emergency department like a restaurant
Part 3 of a series. Read part 1 and part 2.
The aspect of malpractice suits that lawyers seem congenitally unable to understand is how devastating it is. “Ho hum,” says a lawyer who read my first two posts in this series. “Get out the violins.” It’s as if, because I make my living operating on …
Patients are doubly screwed by the malpractice system
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Care coordination seems to be the rage these days. It is mentioned in most discussions of new delivery and payment models such as the patient-centered medical home (PCMH) and accountable care organizations. The concept is not a new one; primary care physicians have been coordinating care …
Need better care coordination? There’s a toolkit for that.
Most of the doctors I know went into medicine because they really truly wanted to help people. But medicine, long honored as a calling as well as a profession, is facing some tough new challenges. Many doctors are disillusioned or simply burnt out. Others have accepted their fates as interchangeable provider units.
The name of the game today is efficiency — i.e., …
Patients: Accept your fate as a hamburger
What is a pickup basketball game? It involves players of varying skill levels forming a team on the fly and hoping to win the game. Often the players have some or no familiarity with each other or their skill levels. What is the analogy to surgery? Often, surgeons walk into an operating room and have to form teams with unfamiliar or unknown personnel, and teams may not be consistent. However, …
Perioperative team training: Can we learn from basketball?
I remember the day like it was yesterday. I was 10 years old, dressed in kid pajamas with sleep still in my eyes. I walked upstairs with a sense of purpose. “I can’t take it anymore,” I told my parents. At that point it had been a year since we found the surgeon who was finally able to offer the chance …
When is it right to share our personal struggles with patients?
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The alarm clock’s blast brings hours of work, running from task to task, always pushing toward the next turn. In moments of failure, the waves of complexity and anxiety batter and you question each stroke. Then you fly downhill, easy breeze in your face, as success urges you on. After the finish, the parking lot empties, the lights go out, and …
Oncologists have one of the lowest burnout rates. Why?
At the national conference of the American Academy of Pediatrics (AAP), I got to hear Hillary Clinton talk about the AAP’s partnership with her Too Small to Fail campaign. It made me happy — and sad.
The partnership is a great idea. It’s all about improving early childhood literacy, which is way more crucial than most people realize. It’s not just about an income gap when we talk …
The reading gap: Too small to fail or too big to care?
This article adapted from a lecture presented by Pamela Wible, MD, at the 2014 American Academy of Family Physicians Scientific Assembly in Washington DC.
Why did you go to medical school?
I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I’m unhappy with the direction …
Physician suicide 101: Secrets, lies and solutions
Anesthesiology used to be a job that was attractive for people who don’t like patients very much. The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done. Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the …
Anesthesiologists have to start to truly care for patients
I remember when I first started in oncology; I had joined the faculty at Brown three years after fellowship and was seeing a patient* with newly diagnosed breast cancer. She was in her 40s, an advertising executive, married, with two small kids. The diagnosis was unexpected (as it usually is), with a lump found while showering. She had come …
When patients seek a second opinion: It’s not about you
Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals …
It’s time to tell fast medicine to slow down
I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference — she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through.
I have a different thought.
Although every experience …
When you can’t share experience: The power of listening
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