A wise friend who had completed residency told me prior to my starting training that the key to having fun was “never sit down when you get home from work.”
Three years out of fellowship and practicing as a psychiatrist in Brooklyn, the words still resonate today. The residents and medical students that rotate with me marvel at the stories of my full time acting career as a resident performing in …
Work-life balance begins in residency
The telephone message arrived in my EMR’s inbox. A patient’s daughter had called and wanted to ask some questions about her mother. Her mother, Louise (name changed), had died about two weeks before.
I hesitated before calling her, recalling her mother’s cancer course.
Louise had been diagnosed with cancer at a relatively young age, in her late 40s. She received curative chemotherapy …
I am so sorry I didn’t make this different for you
Question: What do you do when presented with abnormal lab results?
Answer: Ask lots of questions.
The nursing home just sent over a urinalysis on a patient of Dr. Carlyle. I am covering his practice for a few days. The test showed that an 82-year-old woman had 3+ white blood cells in her urine. “NKDA” was written in the margin, indicating she had no allergies.
I sighed internally and called the nursing home. …
Context is crucial when deciding what to do with abnormal test results
There’s a lot of talk about quality metrics, pay for performance, value-based care and penalties for poor outcomes.
In this regard, it’s useful to ask a basic question. What is quality? Or an even simpler question, who is the better physician?
Let’s consider two fictional radiologists: Dr. Singh and Dr. Jha.
Dr. Singh is a fast reader. Her turnaround time for reports averages 15 minutes. Her reports are brief with a paucity of …
Who is the better radiologist? Hint, it’s not that easy.
OpenNotes is “a national initiative working to give patients access to the visit notes written by their doctors, nurses, or other clinicians.” According to their website, three million patients now have such access, generally online. Participating institutions include the MD Anderson Cancer Center in Texas, Beth Israel Deaconess in Boston, Penn State Hershey Medical Group, Kaiser Permanente Northwest, and several others.
Patients with a premium account in the My HealtheVet program at the VA have access to outpatient primary …
Progress notes are a poor tool for doctor-patient collaboration
“Doc, can I ask you one more thing?”
These words are classic symptoms for those patients suffering from the “one more thing” syndrome. We’ve all been there. The visit has ended, your hand is on the doorknob, and you’re about to leave the room. Precisely at that moment, your patient stops you and says he has one more thing to discuss.
You think to yourself, “No! I almost made it out of …
One more thing syndrome: 4 tips for doctors to stay on time
Somewhere late morning, after rounding on my first day of internship, I received a call from my sister.
“She wants to kill herself. What do I do?”
We had been through this before with our mother, fifteen years ago, the week I moved out of her house. She ended up in the psychiatric unit as we packed our bags to move in with our grandmother. This time, fifteen years later, things were …
Medicine has allowed me to intellectualize my mother’s illness
Yearly checkups for school-aged and older kids can be a great opportunity to help your child stay healthy. Don’t skimp by relying on a cheapo sports physical at a local drug store. They cannot offer the kinds of important things your own doctor’s office can do for your child at a yearly well check.
We’ll review old issues and problems. Still getting …
Your children deserve more than a minute at a clinic
A dozen set of eyes stared upwards. The nurses ate their pizza and glanced back and forth between me and the dry erase board that I had recently filled with incomprehensible scrawl. I had given this lecture many times and said the words over and over again. And yet the response was always surprising.
“Why do you think physicians get angry and …
Why do physicians behave badly? Maybe because they’re scared.
I am a solo, independent family physician and my practice is not a silo. It is not a cold, stagnant, immobile, potentially dangerous storage facility where data to be used by insurance companies and statisticians is held until it is finally purged. No, my office is a visually and emotionally comforting, innovative, healing environment where information is shared and confidence is enhanced. It is an oasis.
My practice is embedded in …
My oasis of care is being threatened
There’s at least one hidden reason the health care system is failing people who just want some face time with a doctor: too many dedicated physicians are not just overwhelmed, but burned out.
According to a 2012 JAMA Internal Medicine Mayo Clinic study, 46% of all U.S. physicians are emotionally exhausted, feel cynical about work or have lost their sense of personal accomplishment …
Americans think that most physicians have it made. They’re wrong.
I knew immediately it was a problem. It was not just that Faith’s cancer had spread with innumerable masses in her liver, golf ball-like tumors in her lungs, punched out holes in her bones. It was not that the chemo, third round and toxic, had failed. Those were awful things. Rather it was her response as I began to tell her. As soon as I said, “I looked at the …
Giving terrible news to those we love
Florida politicians will not change pediatrician resolve to advocate for and protect children. There’s no question that a gag order cannot halt a passionate child advocate. I’d call the recent Florida ruling a dull tool taken to a very sharp crowd. Consider this post an open letter to Florida politicians.
I live as far away from Florida as any continental American (you do the math) yet Florida politics affect pediatricians and …
A gag order cannot halt a passionate child advocate
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An excerpt from The Demise of Medicine.
As with the Aesop fable, familiarity breeds contempt. The role and responsibilities of the physician are being slowly eroded by the media, the legal profession, and even other allied health professions. The tools we hone and more importantly the thought processes physicians develop to diagnose and treat are different than the tools nurses or any other …
Unify the standard to practice primary care
Inevitably, there will come a time in our medical journeys where we will have to have a difficult conversation with a family about the passing of a loved one. Sometimes, it will be an expected event after a patient has dealt with a long illness at an advanced age; other times, it will be an unexpected event in a person who looked healthy a short time before. These events can …
Honoring families in times of grief
Medical errors are estimated to be the third leading cause of death in America’s hospitals. Though some of these errors are beyond physician control, many are the direct result of physician action and inaction. I spend a lot of time thinking about how to reduce these errors and I (like many of my peers) lose sleep over the mistakes I witness.
When you ask patients what quality is most important in a …
What is the most important trait in a doctor?
To improve patient care, doctors rely on research and published information.
According to an American Medical News report, professional journals are still the most popular source of up-to-date medical information among doctors.
These medical publications inform physicians on new drugs and treatments, and they contain peer-reviewed studies that both physicians and patients assume are scientifically accurate.
But all too often, research findings aren’t as scientific as they should be. And some are flat-out biased.
Research studies …
Curbing bias in medical research
I am a great supporter of mental health research but worry that it has lost its sense of proportion and is chasing the wrong priorities.
The really glamorous stuff consumes almost all of the enormous NIMH budget and now has behind it the huge addition of a $650-million private donation aimed at solving the genetics of mental illness.
Neuroscience is an extremely easy sell to Congress and rich philanthropists because it promises …
A cruel paradox when it comes to mental disorders
I have never experienced a military boot camp. I have however completed a rather intense three-year residency in internal medicine followed by another grueling, three-year fellowship in pulmonary and critical care medicine. I like to think that my experiences were not unlike those of military training.
As a matter of fact, being on the medical wards at the county hospital was referred to as being, “in the trenches.” It was true. …
The difference between medical practice and medical training
In a recent verdict a jury in Massachusetts awarded $16.7 million in damages to the daughter of a Bostonian lady who died from lung cancer at 47, for a missed cancer on a chest x-ray.
The verdict reminds one of the words of John Bradford, the heretic, who was burnt at the stakes. “There but for the grace of God go I.”
Many radiologists will sympathize with both the patient who …
The $16.7 million x-ray: Possible beats probable in court
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