My husband likes to say, “No good deed goes unpunished.”
I don’t always agree, but sometimes you just can’t argue that concept. One of my favorite patients, a forty nine year old woman who I treated for head and neck cancer a year ago is a good case in point. Head and neck cancer is on the rise, and is linked, like cervical cancer, to infection with human papilloma virus which …
Beware of hidden agendas in cancer support groups
As healthcare providers we are focused on life. We are committed to healing. We measure success by lives saved. Unfortunately, many diseases remain incurable. Some diagnoses do carry with them a death sentence in spite of the best that modern medicine has to offer. Even in theses extremely devastating cases, We can still make a huge difference in the lives of our patients in the way in which we help …
A duty to guide patients through the process of death
“We’re doing everything we can,” I said as I put my hand on the sobbing woman’s shoulder. “We’re going to keep trying for about 10 more minutes, but I don’t know if we’re going to be successful with this.”
These are the moments that are truly difficult in my job. Telling people their loved ones have passed away, or preparing them for what seems inevitable.
“You can do it!” the woman said …
Should family members be present when performing CPR?
I’m lucky to practice in a national regional anesthesiology center, a hospital with five dedicated nerve block suites, each with the latest in ultrasound equipment, nurses trained in conscious sedation, regional anesthesiology colleagues and infrastructure to support regional practitioners. It seems like there is so much we can do for patients, but really, there is only so much a physician can do. We need a little help from the patient …
Is the era of patient centered care decidedly anti-physician?
The cavernous hospital amphitheater in Tel Aviv, normally used to screen videos and new surgical procedures, was illuminated only by tea candles floating in decorative dishes of water on a recent Wednesday in January. Hundreds of doctors, nurses and other medical personnel filled the seats, as usual. But we had not come to learn the latest life-saving technique.
Dr. Ofira Ben-Tal, one of Israel’s leading hematologists, had lost her battle with …
Are physicians more afraid of death than the general population?
I have been married and practicing medicine for 32 years and during that time I have learned lessons that equally apply. First, listen carefully; both wives and patients need to be heard. Second, prepare and think before you speak; as the saying goes “put brain in gear before operating mouth.” Finally, perhaps the hardest lesson of all is, when necessary, be 100% inconclusive.
Any man or woman, who has been in …
Marriage and medicine: Both are not exact sciences
Those of you who have followed our blog for the past few years probably know that one of my favorite topics in infection prevention is the role of clothing in transmission of pathogens. But I’m also fascinated by the sociologic aspects of clothing in medicine, which is usually framed around questions of professionalism (for example, is a doctor in a white coat more “professional” than a doctor …
Doctors: It’s ok to shed the white coat and tie
I recently presented Yale Surgical Grand Rounds focused on “Cost and Quality in Cancer Care.” Amidst the talks in Washington regarding our unsustainable health care spending, and provisions of the Affordable Care Act rapidly taking hold, it seemed appropriate to start to critically evaluate how we spend our health care dollar and the value we receive in return. The data are …
It’s our duty as physicians to avoid needless tests
Al Franken, the humorist-turned-senator, once published a book that was titled “Oh, the Things I Know!” Indeed, by the time we reach parenthood, it is truly amazing what we keep up there in that attic of a brain.
Here is a brief selection of things about the practice of medicine that I have had to discover for myself or never quite figured out, including clinical pearls, aphorisms, dictums, platitudes, mysteries and …
Clinical pearls that you don’t learn during medical training
My office consultation for the 50 year-old woman was her complaint of chest pain. I could not help but glance at her insurance and it was for Medicare. I have always been fascinated with what types of disability people have which qualifies them for Medicare and SSD, (Social Security Disability), before the usual age of 65. To say that I have observed bizarre and inequitable awards would be a gross …
Why I’m skeptical of the growing number of disability beneficiaries
I believe the role that God plays in our lives is often magnified during times of great suffering. How we perceive that role is a question of faith, often strong and steadfast in some, especially my patients, but sometimes unreliable and inconvenient to others, like myself, on a journey of understanding and acceptance.
During the terminal stages of my grandmother’s colon cancer, I recall her saying, “Je pense que le Bon …
A frequent witness to the power of faith
There are many ways to write about health, medicine, and health care. And there are many people – patients, caregivers, policymakers, pundits, thought leaders, and health professionals – in a position to do so.
Fortunately, the world also offers a similar and growing diversity of places in which to publish this sort of work.
My focus today is more, well, literary.
I know the word “literary” often …
Where can doctors publish literary writing?
Wrong site surgery is never acceptable. A surgeon ought never to find himself in a situation where he has to inform the family that he just operated on the wrong body part. It is embarrassing, unprofessional, and an egregious violation of the patient/physician covenant.
That being said, we have allowed this issue to be defined entirely in terms of “systems management”. And hence the …
How diminishing returns may render the surgical timeout ineffective
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I am a physician who writes and I think that more of my colleagues should do so. Not because, we are such skilled wordsmiths or understand plot and characterization. We don’t. But, we confront the human condition every day. We see pain and struggle and fear and rebirth. We have much to share.
Beyond my own profession, I think everyone should write, because everyone has something important to say and to …
Why more physicians should write
I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they are being “burdened” with hundreds of extra cases every year that they must handle. And if other doctors don’t sign off on the cause of death, sometimes it takes two …
Why coroners should fill out death certificates
Every once in a while a news item becomes so big that a threshold is reached. Thinking people must weigh in.
When the US Supreme Court hears two cases involving the rights and treatment of individuals who are lesbian, gay, bisexual or transgender, there is a lot at stake. Our country faces a really important test.
It’s not so much about the specific legal issues, though they are not insignificant. Much more …
I just finished reading Neil Gaiman’s fascinating novel, Gods of America. I first learned about his work by watching the movie Stardust, then reading the novel.
One of the themes of Gods of America is that the deities of the old world came to America in the hearts of their followers, but over time lose their followers and thus their power. A war is arranged between the …
We worship at the feet of pain and pills
I enthusiastically shared the news of the American Academy of Pediatrics (AAP)’s same-sex marriage endorsement with my medical school classmates yesterday. I even publicly posted the AAP’s article – the sole public posting on my private Facebook page – because to me, the strong endorsement of equal rights by an organization of 60,000 pediatricians seemed enormously important for my colleagues and for our world.
I was disheartened to read the viral …
Let us signal that we accept and support same-sex marriage
Before patients can become savvy consumers of healthcare, they need information about their healthcare choices. Too often, such information is nearly impossible to get, especially when it requires doctors to give patients useful statistics about things like treatment side effects.
Since publishing Critical Decisions this fall, I have received a number of emails from readers who have recognized their own medical histories in the pages of my book. I received …
Just sign here: That isn’t real informed consent
Recently, my family and the hospital care team have been guided by my father’s healthcare proxy to avoid painful, invasive, or aggressive care at time when his multiple medical issues have combined to make his health decline irreversible.
The healthcare proxy was extremely clear and enabled us to finalize the do not resuscitate and do not intubate orders. We agreed to stop monitoring and stop all medications except …
Comfort care goes beyond DNR orders
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