There’s a lake in Northern Arizona where I jog. I call it “my” lake. It used to be filled to the brim, a playground for ducks, geese, Monarch butterflies, rabbits, and squirrels. Over the years when I’d jog in the cold mornings, my lake dried away from drought, measured by bathtub rings on the boulders that surrounded it. Today, rust-colored grass …
Why I decided to opt out of Medicare as a provider
Medical students rotate through the clinic I work at. I love it. It brings me back to those days. Sure, it reminds me how old I am, but also reminds me of the incredible impact patients have in directing the course of our career paths.
We all have those memories. Our first delivery. Our first code. The first time we had to …
When a medical student sees you, consider it your lucky day
It is nearly impossible to ignore the need for clear thinking, confident and “in control” leaders. And whether in Congress or in a physician’s office, medical school department or hospital administrative suite, women leaders are notably absent. And while recent research tells us that women aspire to be leaders, the barriers to achieving this nebulous goal are enormous.
So whose fault is it anyway? I say both the women and the …
Can women physicians truly be senior leaders in medicine?
An excerpt from Pet Goats and Pap Smears.
Both my parents are physicians. They are never home much because they work all the time. With no reliable child care, Dad takes me to work. The morgue is my favorite spot. It’s like our secret clubhouse. Nobody ever bothers us there.
Entering the morgue, Dad opens the stainless-steel doors to the cooler and says, “Good morning! Is anyone home?” Then …
Dad took me to work: The morgue was my favorite spot
I visited Safdarjung Hospital in New Delhi recently – an institution with 1,531 beds and 145% occupancy rate. Yes, 145%. You do the math. A lot of bed sharing and asking families to bring in cots. It’s right across the street from the All India Institute of Medical Sciences (AIIMS), the premier public healthcare institution in India. While both AIIMS and Safdarjung are run by the federal government, …
A high volume, efficiency-driven institution that delivers great care
I expect most of us agree that an incarcerated felon experiencing a heart attack should receive medical treatment, even if that treatment comes at taxpayers’ expense. The same probably goes for more preventive measures—blood pressure pills, cancer screening tests and the like. While serving out the sentence for their crimes, prisoners should not be forced to suffer from treatable and preventable illnesses without receiving appropriate medical care. They can pay …
What kind of basic healthcare coverage should we offer to prisoners?
I recently treated two young men, both injured in the same football game. On the way out, one passed the other in the hall, injuries treated and dressed. “See you next game!” they said. They laughed and looked forward to the struggle.
My wife and I have tried to raise our kids that way. To enjoy life, to move through difficulty and injury. They suffer from having a physician father, so …
In the battle of life, a joy that only the ferocious can comprehend
In June of 2006 Mary Ann Ambrogio went to see her gastroenterologist Dr. Frank Troncale in Connecticut for a follow up of her history of liver cirrhosis and associated hepatic encephalopathy.
Reportedly following this visit Mrs. Ambrogio was driving home when she passed out and hit a pedestrian John Jarmie causing “severe and permanent” injuries. The injured pedestrian sued Dr. Troncale claiming malpractice under Connecticut law in that the doctor did …
Why it’s important to place limits on liability by association
During an internal medicine residency, newly hatched doctors are responsible for some of the sickest patients in their teaching hospitals. This is because those patients often don’t have private doctors to attend them and are poor and sometimes self abusive, with the complex problems that go with smoking, drug and alcohol abuse and lack of regular medical care. These patients often present with their diseases late in game, when much …
An end of life discussion is one of the most important to do right
I wake up at 4am feeling nauseous.
I’m not that surprised. My girls have been vomiting all weekend. Not just vomiting, epic vomits. Like the kind where they vomit a lot and you think, “Wow.” Then they vomit again. And then a third time. And now it’s on the couch, the carpet, the TV, basically everywhere in a 50 foot radius. And then just when you think this may never end, …
It’s not fair to anyone for me to be working in this condition
I recently took call on the pediatric ward. Our team was caring for a young patient facing a new diagnosis of a chronic illness. In addition to stabilizing her symptoms, coordinating care with her new specialist, and managing her medications, I also see it as our job to make sure she and her family start to understand what is going on and what this diagnosis means for her.
How does this …
Patient education is often an afterthought
“You look amazing!” It was the first thing out of my mouth upon seeing Sharon.* She is a woman in her mid-seventies, and she has recurrent ovarian cancer.
We had met after she was diagnosed with recurrence, only five months after the end of her “curative” treatment. At the time, we talked about her life—how she had been a nurse before …
Not all cancer survivors have cancer
Hi! My name is Ima Frawde and I am so glad that you have chosen me to be your guide during your climb of Everest.
The fact that you have chosen me indicates that you are well on your way to mastering the most important skill in climbing the mountain: Trust Everest.
And why shouldn’t you trust Everest? The mountain is totally natural; climbing is totally natural; reduced oxygen concentration at higher …
I am so glad that you have chosen me to be your guide
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As new Medicare rules kick in, some 2,200 hospitals nationwide are facing financial penalties for high 30-day readmission rates for myocardial infarction, congestive heart failure and pneumonia. Medicare payments will be lowered by as much as 1%.
Investigators at the Skeptical Scalpel Institute for Evidence-Based Outcomes and Advanced Research (SSIEBOAR, catchy acronym, don’t you think?) have come up with a plan that is certain to lower readmission rates across the board. …
Is it really fair to penalize hospitals for readmissions?
These days, the world is a very scary place.
You go to school. You go to school some more if you can afford it and you feel so inclined. Then, if you’re one of the really crazy ones like me, you go to school some more. Somewhere in that late night caffeine and chili cheese fries induced sophomoronic (no, do not adjust your set) craziness, something starts to click. At least …
Why psychiatry is the right choice for me
The American Cancer Society designated an October weekend “Suits and Sneakers Awareness Weekend” as part of its annual Coaches vs. Cancer program that featured well-dressed basketball coaches wearing “sneakers instead of dress shoes with their usual game attire during weekend games to demonstrate their support for the Society and the fight against cancer.”
The idea is to encourage people to exercise and eat a healthy diet to reduce …
How cancer awareness efforts can backfire
I had an interesting twitter chat the other day with one of my colleagues, a young ER grad studying healthcare policy by the name of Seth Trueger. The Twitter conversation wound up involving about a dozen ER docs and nurses. You can review an edited summary over at Storify.
The point in contention is an interesting one: we know the nation’s ERs are overwhelmed and overcrowded. That’s old news. We also …
The volume of low acuity patients in the ER is not a myth
Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.
Honest fact: The morale of doctors in the real world is low–and sinking lower.
I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”
Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:
Because …
The growing culture of hostile dependency towards doctors
I was driving home from a night shift and the scorching sound of Texas guitars flamed out of my car speakers. The group ZZ Top was old, but the song was new. It went like this, “25 lighters on my dresser, yessir. You know I gotsta get paid.”
Mostly, I was shocked that any members of the band ZZ Top were still alive, …
An unexpected tip after treating a gang member in the ER
The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”
The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.
The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.
Let …
Reasons why doctors overtreat and overtest
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