Six months ago I posted a story about a demented 94-year-old patient who’d fractured her hip. She’d lost more than thirty pounds in the preceding months and had already had a collarbone fracture from a previous fall.
Her son wanted her to be made comfort care only, and avoid a trip to the operating room since she was likely within …
What I’ve learned from calling out my orthopedic colleagues
The ED is a hectic place.
Sore throats. Heart attacks. Dog bites. Broken bones. Strokes. Major trauma. If you work in an ED, you see it all. And then some.
Is it any wonder then, with the potential for literally thousands of medical and surgical problems to stumble through the doors of an ED, that hospitals and the bodies that accredit them demand strict, regimented, standard, reproducible emergency assessments …
Psychiatric patients don’t fit the usual medical mold in the ED
Sexual health, though fundamentally important to every human being, is rarely discussed between patients and their healthcare providers. It’s an important conversation and one that requires doctors and patients to venture into less-than-comfortable territory.
Who exactly should treat sexual health issues? Many assume that this should be the territory of a gynecologist for women or a urologist for men.
But because we see our patients more frequently than any other doctors, general …
Sexual health issues should be normalized in the exam room
It’s painful enough to lose a patient. But I found it even more painful to try to console a family whom I’d never met.
Depending on your point of view, the limited patient contact afforded the anesthesiologist is a disappointment or a perk of the specialty. Anesthesiologists are steadily branching out into other areas of perioperative care where lengthier patient/family contact is necessitated but the preop encounter with the anesthesiologist is …
Consoling a family whom I’d never met
This, apparently, is a map of my mind. It’s a little shocking to find out that my mind looks like a sea creature, a bug, or perhaps a vegetable. Actually, “Rob’s mind” and “vegetable” are often used in the same sentence.
Someone suggested to me that I may benefit from mind mapping. I don’t know how to describe it, but I think spatially; …
Pulling me away from the seductive simplicity of cookbook medicine
Let’s get one thing clear from the start: I love nurses. My grandmother was a nurse’s aide. My aunt is a nurse. My mother is a nurse. Nurses have been by my side for the most frightening and important experiences in my life (in the hospital and out). However, I’m not a nurse. I’m a doctor. And when someone calls me …
Thanks for the compliment, but I’m not a nurse
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Over the past several years, I have had the honor of representing the American College of Physicians at scientific conferences and professional society meetings. In addition to hearing about the latest advances in internal medicine at these events, I learn what is on the minds of physicians in …
ACP: Physicians around the world face similar non-clinical issues
I couldn’t really blame the social worker. He was just doing his job. The skilled nursing facility (SNF) connected to the hospital was full of flailing patients. So he thought he would ask for a palliative care consult (after getting an okay from the primary team). It was his third request of the day. He spoke slowly as he tried to untangle the twisted path the patient had taken.
“Dr. X …
Palliative care has become the last bastion of health care sanity
When I visited Allan in the hospital yesterday, I told him to get up and stroll the hall. However, when I checked in on him this afternoon, the nurses informed me that he refused to get up, even to the chair. When I asked why, Allan told me he could not walk. I was concerned, but when I examined him, I found his vital signs were fine, he had no …
Numbers fail to answer that one vital question
Do you find yourself spending too much time on things that have nothing to do with seeing patients, and then getting home later than you would like?
Do you notice that for every 15 minutes you spend with a patient you spend way more than that messing around in the EMR and being distracted by things like prescription refills, test results and a hundred other forms of two bit clerical work …
Use batch processing and stop working like a dog
Sometimes you just get lucky. When I was pregnant with my first child, during my radiation oncology residency, we had a guy living in the apartment over our garage, which we liked to refer to as “the carriage house.” He was a dog trainer by trade, and in his spare time he played softball in a local adult league. When we told him he had to move out, because we …
Childcare during medical training: Sometimes you just get lucky
An excerpt from What Doctors Feel: How Emotions Affect the Practice of Medicine. Excerpted with permission by Beacon Press.
The stat cardiac-arrest page came through on my beeper at exactly the same moment as the hospital-wide PA system announced, “Code 411, cardiac arrest, MICU.” The operator chanted the mantra over and over with studied deliberativeness, as though there …
Fear is a primal emotion in medicine
An 85-year-old woman with moderate Alzheimer’s disease who enjoys walking in her nursing home’s garden with her walker has fallen and broken her hip. An advance directive signed by the patient states a preference for “comfort measures only,” and specifically states that she does not want to be transferred to the hospital. The physician believes that surgery would provide long-term pain relief and the chance to maintain some mobility.
What do …
When can you override an advance directive?
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NuVal began as, and remains, a dream of mine — a dream about helping everyone find and choose better foods, and in the process, putting pressure on the food industry to offer better foods in the first place. They’ll stop selling what we stop buying, after all.
This was a dream born initially of frustration. I have been caring for patients for over 20 years, and placing an emphasis on the …
A dream to help everyone find and choose better foods
As someone who has been a parent for 22 years, I know firsthand just how hard driving kids around can be. When they are little they cry, as they get older they ask a million questions and fight with their siblings, and when they get older there’s the whole issue of the radio, not to mention the chaos of friends in the car. But a study recently released suggests that when …
It’s time for parents to stop distracted driving
I’m not sure I’ve ever been great at being still. As a kid, I joined one activity after another. Not because my parents told me I should. I just liked it. Staying busy. But, I could concentrate. Quiet the mind. I’d sit and read for hours on end or close my eyes and listen to a cassette tape from beginning to end.
Even through busy high school and college years, a …
Finding mindfulness in unexpected places
Perhaps it’s because I love the practice of medicine so much. Or maybe it’s because doctors (and teachers) have always been my heroes.
I’m trying to sort out why I feel so offended by Paul McHugh’s editorial in the Wall Street Journal. His sensational and paternalistic view of physician-assisted suicide can be summed up in one word—shameful.
It is true, thankfully so, that in the United States offensive speech is protected. And …
Americans too often lose autonomy at the end of their life
You drive down a busy expressway amidst thousands of other vehicles and a billboard jumps out at you. In the font of confidence, it reads, “The first step in fighting cancer should be a second opinion.”
The billboard informs you of the location of the nearest Cancer Treatment Center of America (CTCA), “only” about 130 miles from the billboard.
When …
Second opinions: A chance to listen and teach
Being a part time hospitalist, I am frequently on overnight call in the hospital, spending the night admitting sick patients from the emergency room, or dealing with any calamities that happen on the medical floors. I would have to say the that the most dreaded events are: “Code blue” (this means a hospitalized patient in cardiac or respiratory arrest waiting to be resuscitated), followed closely by a nurse calling with: …
The spiritual bond between two souls
For the first time in my career I asked myself that question. Over the years, I’ve had more than my share of difficult cases. I’ve had patients with life threatening conditions whom I wished I could offer more than to just shake my head and speak empty words of encouragement. They stare back at me and I see their eyes full of hope. How many times have been forced to …
What should a surgeon do with an impossible case?
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