I had taken care of her for years. We had faced a new diagnosis, the toxicities of adjuvant treatment, the promises of having no evidence of disease (NED as my friend, Molly, refers to it), only to have it shattered with the first recurrence. Over the next three years, she had undergone treatment — chemotherapy, a trial of endocrine therapy, …
The public perception of oncologists: Is it really true?
A friend of mine has been living well with lung cancer for five years — working, running several miles a day, traveling, doing good stuff with his family, and generally enjoying the pleasures of everyday life. He knows the cancer will eventually kill him, but has been making the most of every remaining minute.
Then, a month ago, things suddenly turned dramatically south. Severe shortness of breath, constant coughing, sleeplessness, fatigue, …
How to talk to a patient with terminal cancer? Not like this.
Team-based care is one of today’s buzzwords without real substance, because unless the payment systems change, only the physician members of the team can bill for their work.
Few people seem to be concerned with the simple but essential question of how physicians spend their time and how medical offices are paid. As a primary care physician who doesn’t do any major procedures, and who in 2014 is essentially paid fee …
Team-based care needs to be more than a buzzword
As a physician, I enjoy listening to non-physicians tell me how to motivate doctors. I don’t mean this in a totally snarky way (well, maybe just a little). These conversations often highlight the chasm that exists between physicians and administration.
What’s the most common motivator people throw out there? Money. Certainly everyone wants to make more money, I don’t refute that. What I take issue with is the notion that the …
Money is a poor way to motivate doctors
This post by Paul Levy got me thinking about informed consent, and a case I saw recently got me to take a little time and write about an issue frequently ignored in medical school.
A bit of background for non-medical readers. Informed consent is a term in medicine for when doctors get the agreement of the patient to do something to said patient. For example, before a patient is cut …
Informed consent: Can patients ever truly be informed?
“Plank? Is that a board?” asked my patient. I had been encouraging her to start doing exercises to strengthen her core in order to stabilize and support her back. My hope was that over time, these exercises would lessen the need for pain medicine. There are times for words and there are times for action. So I got down on the …
Motivate patients to exercise more and eat less
I received my new thinner bigger iPhone. Within a few days, news reports highlighted how new iPhone 6 owners accidentally bent the latest Apple iteration of the modern smartphone. A blogger bent an iPhone 6 Plus with his bare hands. This story, the subsequent fallout, and response has learnings for doctors and health care on the challenges facing the vaccination “debate.”
The best launch in iPhone history with roughly 10 million smartphones shipped …
What the iPhone 6 bendgate can teach us about vaccines
There he sat, hunched over with rugged, muscular arms stretched across his abdomen, his weary eyes stealing hopeful glances from behind an otherwise steely facade. Mr. J was a 53-year-old Latino agricultural laborer with a history of H. pylori who presented at our student-run free clinic with persistent abdominal pain, unchanged from his multiple previous visits. As I learned more about Mr. J and his story, I realized that treating …
How the costs of care impacted H. pylori treatment
I was finishing tying my shoes as I got dressed to take my lovely wife out to dinner for our 41st wedding anniversary. It was 7:30 p.m. after a hectic day at work and we had a wonderful dinner planned at a local restaurant.
The telephone rang with the caller ID identifying a call on my office work line.
“Hello this is the emergency department, please hold on for Dr. S.” …
Physicians don’t take the time to communicate with their colleagues
The ALS wave has finished sweeping the nation, resulting in a flood of over $100 million raised to fight a devastating disease which is actually quite rare. Now that gallons of ice water have drenched American’s bikinis and trunks, we should be asking ourselves two questions. First, does everyone really understand more about the disease now that the challenge is over? Second, and more importantly, what lessons can we learn …
Apply the lessons learned from the ice bucket challenge
Should we be worried about Ebola? That’s the question on the minds of many Americans given the first documented case on U.S. soil. And now there is a second possible case, someone having contact with Thomas Duncan, the first U.S. case of Ebola.
Thomas Frieden, director of the Centers for Disease Control and Prevention reassures us, “I have no doubt that we’ll stop this in its tracks in the U.S.” President Obama also told …
Ebola: Is it time for travel restrictions?
The unexpected death of Joan Rivers at 81 years of age occurred during a routine outpatient procedure at an accredited doctor-owned surgery center. Although there are few confirmed reports of what actually occurred, what we do know is that media-fed information can resonate amongst the general public — and our patients. Concerns have been raised about the outpatient setting, patient selection, and types of surgeries that are performed.
As a result, the responsibility …
Examining the safety of outpatient surgery centers
Dr. Danielle Ofri has an important piece in the New York Times: “The Physical Exam as Refuge.” As an outpatient physician, she makes the case that the physical examination provides a special time for the physician to focus entirely on the patient. Is examination time the refuge for the harried physician, and the opportunity to engage the patient in extended conversation about their condition?
While I did outpatient medicine for …
The physical exam is still useful. Here’s how.
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There are now so many rules and regulations in medicine that it is difficult for doctors to express any individuality. Like the burgers at McDonald’s that are constructed in such a way that they taste the same regardless of your locale, doctors are expected to behave similarly when confronted with similar circumstances. Or at least that is how the proponents of algorithmic medicine see it.
In addition, electronic health record systems create uniformity by enforcing …
Is there any room for individuality in medicine?
We’re born into our bodies, and we take that for granted.
Our first job is to take a breath, something we’ll hopefully do many millions of times and never think about. That first breath changes everything: Our blood starts to flow through our heart and lungs in a different way and for the first time we taste a new world.
Before we’re born, all our needs are met via an artery and …
There’s a part of us that’s unafflictable
Faxes!
Who still uses faxes? The medical industry does. Here is a picture from just today: 27 faxes received and about 20 sent, and that is only counting after noon. Some days are worse, with up to 40 faxes to handle in our small medical practice.
On the left are the 27 faxes received: We use e-faxing, so they arrive as pdfs. On …
Who still uses faxes? The medical industry does.
Pretty much on a weekly basis I come across an article about how awful life is as a practicing physician. Articles focus on how unhappy physicians are with their jobs, with their hours, with their pay or with health care reform.
After almost a decade of practice, the fact is that I like my job.
Is it perfect? Absolutely not: quite far from it, in fact. There are certainly many times when …
There is something very special about being a physician
The New York Times has reported on a woman who wanted to deliver vaginally and claims she was forced to have a repeat C-section (her third C-section) against her will. I can’t comment on the veracity of her claims, however a forced C-section is never, ever acceptable. It doesn’t mater if the fetus has an agonal rhythm (is visibly dying on the monitor), as an OB your role is …
VBAC is the love child of medical malpractice lawyers
As a family doctor, I had the privilege of sitting down at the hospital recently with Mr. M, a longstanding patient of mine, and his family. Mr. M is a college-educated engineer, struggling near the end of his life with end-stage kidney disease, dialysis, severe congestive heart failure and crippling COPD. And he was pretty down about it.
In the hospital, a critical care physician, a pulmonologist, a nephrologist, and a cardiologist …
A family physician misses hospital rounds
The dark underbelly of health care is becoming all too visible now.
Fresh faces in neatly pressed white coats are in the halls. Eager. Enthusiastic. Clearly very bright. All hoping for a moment, an experience, an encounter that makes all their hard work worth it. Surely they’ll have one, but not before the thousands of keyboard clicks, the mandatory lectures, rounds and lots of lengthy, lonely call nights.
He was a doctor …
Doctors have to learn to play the game of numbers
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