My elderly and infirm parents live 15 minutes south of my home in an assisted living facility. They moved there after it became apparent that they could not manage their affairs in their own home, have some degree of independence and socialization with friends and receive the care and supervision they needed to stay out of the hospital. Their cognitive impairment …
A doctor for the elderly: What to look for
A grandfather-father-husband-salesman-cook-gardener-hiker-gentleman, adored by many, is struck down by cancer. His disease is particularly horrible, spreading quickly though his body causing damage not only to bone and organ, but to sinew and nerve. He suffers terrible pain for weeks, relieved poorly with inadequate doses of inferior medications, thrashing in misery witnessed by his kin, always at the bedside, ages seven to seventy. Finally, uncomfortable and agitated until the end, he …
A poorly managed end of life experience can transform families
We know that physicians (and their pens/keyboards) are some of the main drivers in health care spending. But which ones are the biggest offenders?
A recent study from the nonprofit RAND Corporation asked this question and found that newer doctors tend to run up higher health care bills for their patients than their more seasoned colleagues. The study, published in Health Affairs earlier this month, looked at insurance …
The age differential in medical care
If you ask for a spoon in my house, you may expect to be directed towards a drawer of neatly nestled stacks of stainless.
Instead, you will likely find this a tangled mess of silver and plastic in no apparent order.
I used to be bothered by a such a disorganized silverware drawer, but that was years ago. I have let go of …
Ask your toddler to do the chores
My veterinarian answers my phone calls. The other day I called her office to ask for a renewal of the pain medication for my little dog Jack. He has been blind and deaf for over a year, but now his rear end is going and he is falling a lot and having a hard time getting up. When I asked for …
Doctors should return phone calls because it is the right thing to do
A war is brewing in the House of Medicine. It’s a war of philosophy based on how we physicians approach our patients–the people who come to us to be cared for and to be cared about. The people who come as patients to the physician as healer, a healer who also has a wealth of scientific knowledge which can be used to stamp out disease and bring long, healthy lives …
A war in the House of Medicine: Can women physicians help?
“There’s no passion to be found playing small, in settling for a life that is less than the one you are capable of living.”
-Nelson Mandela
Amidst the chaos of our noisy world, it’s hard to know where to begin a new career as a healthcare professional who’s about to inherit an American disaster called healthcare. And it’s likely that in a few …
My advice to a new generation of doctors
I can always count on Mr. Wonderful to come up with a timely subject for my blog. Today’s quotable is, “Dear G-d, I have a problem. My problem is me!”
Some days it feels like I spend half my time trying to convince patients that they need to change their ways in order to get healthy. I often spend the other half of my time treating the effects of their bad …
I have a problem and my problem is me
As a primary care doctor, my days are busy. Seeing patient after patient, I try to provide the most patient-centric, evidence based care that I can. But if I read anything about healthcare reform, it will tell me that 80-85% of the patients I see can be seen by a nurse practitioner or a physician’s assistant. So why did I train for an extra 3-4 years as a doctor, incur …
Primary care doctors may no longer be needed
One of medicine’s ethical traditions is to relieve suffering whenever possible. I believe in this, and try to treat all of my patients as I myself would want to be treated under similar circumstances.
My dilemma is, even after practicing medicine for over 30 years, the definition of a “suffering patient” has become a moving target.
On the one hand, I hear arguments primarily from governmental agencies that presume to “advocate for …
The insanity of pain management in the ER
When you set out on an unfamiliar journey, you will need a map to get to your desired destination. You may pass landmarks, but not know exactly where you are unless you are able to identify these landmarks on your map. The same is true for the journey of life, and specifically, the path at the end of life.
You may know …
At the end of life, never underestimate the power of a map
You try to hide it.
You leave the scrubs in the locker-room, the shop-talk at the staff dining hall and the on-call phone consults outside in the cold, away from the highly-anticipated dinner date or holiday party.
But regardless how much effort you put into leaving your career where it belongs, it is so obvious that you work in a hospital.
And here are …
3 clear signs that you work in a hospital
In this article I will show you a push button shortcut you can use to quickly create more work-life balance, no matter how busy your practice and your life feels at the moment.
When it comes to creating balance between your medical career and your life, there is a simple rule in play. The strongest structure wins. When we are talking about …
Improve your work life balance: A schedule hack for doctors
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She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly …
What doctors can learn from working at Starbucks
Dear Patient(s),
Thank you for educating me.
Thank you for letting me shine bright lights into your eyes and place Q-tips up your nose. Thank you for not shooting me a dirty look when I ask you to lift up your pendulous breast so I can listen to your heart. Thank you for letting me ogle at your protuberant belly—whether it contains a baby, a liver tumor, or liters of fluid inside. …
Dear patients: Thank you for teaching me
Four years ago, as I was making rounds on the oncology floor, one of my patients with leukemia asked, out of the blue, “Hey, Doc, who you gonna vote for?” He had an Obama T-shirt by his bedside.
Chuckling politely, I asked him why he wanted to know. “I’m curious, Doc,” he said. “It tells me your worldview.” He said that if we agreed on who should be the next president, …
The problem with discussing politics in the exam room
This blog is about freedom and personal responsibility. I have opined that cigarette smokers should not be permitted to transfer total responsibility for the consequences of their choices to the tobacco companies, even if this industry has committed legal and ethical improprieties. I do not support the politically correct beverage ban in New York City, sure to spread elsewhere, where the …
The folly of breasts and politics
Suppose 20 children and 6 adults died at a school in a very short time period. And suppose there were clusters of similar deaths, many of young healthy people, around the country: at a movie theater, a shopping mall, a high school, a house of worship. Would you expect the Center for Disease Control to get involved in trying to figure out why these people died and how to prevent …
Did any doctor ask Nancy Lanza about guns?
As a doctor, I have never really believed in any type of significant mind-body connection. Of course stress is related to depression or even heart disease. But I never really thought that we as humans were capable of controlling our bodies responses to disease. I don’t think I’ll ever believe that it is possible to heal yourself from a serious disease like cancer from thoughts.
But recently, I have had a …
Patients who pass quickly once they have given up on life
The AP alert flashed over my phone, its words chilling — gun shooter — elementary school-Connecticut — then the report: 27 killed, 20 of them young children. Killed by a young adult not old enough to legally buy a drink, but able to get his hands on a fearsome amount of firepower, and old enough to have developed a hatred of others that nobody will ever comprehend.
Struggling with this since, I …
How technology can exacerbate mental health problems
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