I love running.
I typically run 3-4 miles a day 5 to 6 days per week. It’s only about a half hour of time, and it’s well worth it. I get ‘in the zone’ when I run, and I can tune out the rest of the world and enjoy just being. It feels great physically and mentally each time. It’s helped me immensely to stave off the obesity issues that have …
A psychiatrist on the compulsion behind running and exercise
Part one of the three-part series, Let’s Pay Popular People More!
My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate — he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of …
How basing physician pay on popularity marginalizes some patients
by George H. Northrup, PhD
No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards.
With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties. Psychotherapy tends to draw practitioners who are fascinated by the mysteries of the mind and who find satisfaction helping others in distress. Money has typically been a …
How managed care caused the mental health care crisis
Private practices are organized in a corporate model where the physicians are shareholders, or where one or more physicians own the practice and employ other physicians or providers. Private practices are almost exclusively for-profit. Physician practices are organized into corporations for the tax benefits as well as protecting the owners from liability judgments.
Hospitals can be for-profit, not-for-profit …
Pros and cons of private or hospital owned practice
There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand.
The problem is that the word “sign” has a specific meaning in …
Why pain cannot be a vital sign
Lying on the backboard, a frail little old lady moaned with discomfort.
She had fallen beside her bed in the nursing home and was then tightly bound by straps onto the backboard, a cervical collar pushing her chin up and holding her immobile. A person not familiar with modern medicine might think the ensemble looked like a torture device. Indeed, it can …
Why confused, weak elderly patients are subjected to aggressive care
Medical care in America isn’t doing so well when compared to other developed nations. Historically physicians did not want to take ownership of their patients’ problems. Patients have free will. They can “choose” to be non-adherent. They can choose to not take the medication the doctor prescribes — even if the one prescribed is $70 dollars a month when there is a $4 dollar Read more…
How physicians can take more responsibility in the care of patients
Do we treat diseases or symptoms in psychiatry? While this question might sound philosophical in nature, it’s actually a very practical one in terms of treatment strategies we espouse, medications and other interventions we employ, and, of course, how we pay for mental health care.
It’s also a question that lies at the heart of what psychiatry is all about.
Anyone who has been …
Does psychiatry treat symptoms or diseases?
When anyone brings up the idea of end of life care, you are thrown a political football. Yet, the failure to have these discussions with your loved ones creates an expensive and emotional mess.
I can’t tell you the number of times I’ve been sitting at a table with friends and this issue has surfaced with almost unanimous consent: they all want to …
End of life care requires individual family decisions
by Mariana Perroni, MD
The following post was written on February 27, 2010, while working as a volunteer in a field hospital in Haiti. It was called Love a Child Recovery Center and it was run by us (Albert Einstein Hospital – São Paulo – Brazil), Harvard Medical School and University of Chicago Medical School.
We …
The power of music at a hospital in Haiti
“Code Blue ICU … Code Blue ICU”
I was greeted by the PA system as I walked into the hospital this morning. A shiver ran down my spine as I quickened my pace. The days of running to codes are long gone. But since I have a patient In the ICU I was curious and just a little bit worried.
As I walked through the sliding doors I passed the room full …
How real life medicine is less glamorous than residency
When someone gets sick, what are their options?
They can try to make an urgent appointment that day, but how many of your doctors actually offer that? Most people will have to wait for weeks, if not months, for a regular appointment. Even if you go to a walk-in clinic, the wait will likely be hours, and you’re not sure if clinics can take care of everything, so you head to …
Emergency medicine, we can do better
Recently I wrote a blog about how the American Academy of Pediatrics (AAP) thinks that otherwise healthy children with ear infections should wait a couple of days before starting antibiotics, because many will get better without them.
Now there are two articles in the New England Journal of Medicine (here and here) saying that children with ear infections who are given antibiotics are more likely …
Pediatrics is full of uncertainty, not unlike the practice of parenthood
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The Theresa Brown furor has got me thinking. To be honest, I don’t think the doctor’s apparent offense was really that bad. I remember giving and taking worse.
When I was at medical school and in specialist training, there were senior doctors and nurses of legendary temper and bad disposition. Tiptoeing around them, and working to their satisfaction, however unreasonable, was an accepted part of the job. But the …
A tough disposition is required to endure physician training
by Paul Rousseau, MD
Communication between physicians and patients is critical to quality care and improved outcomes, however, such discussions often seem labored and fraught with anxiety and stress.
Physicians commonly speak too much and listen too little, while patients feel swept up in an unfamiliar and frightening situation with loss of control and little-to-no input into care.
As I have …
Two words that hurt communication between physicians and patients
by Ashwin Patel
As a MD/PhD candidate, I enjoy learning how medicine interfaces with other fields. I found that MDs that have ventured into these fields have the best stories and insights to share.
I recently had the privilege of interviewing Dr. David E. Albert, MD. He’s a physician, a successful inventor with 30+ patents, and a serial entrepreneur. He has sold two of his companies, one to …
5 things I learned from a MD inventor and serial entrepreneur
by Andrew Schutzbank, MD
“He wants to go to Atlantic City for his research time?” must have been the question bouncing around my residency’s Area of Concentration (AOC) Committee.
Not that there is anything wrong with Atlantic City per se, but historically, our residency program generously grants three to six weeks of AOC time to allow residents to explore interests and …
Observations of a primary care innovator in Atlantic City
I have had the pleasure as a medical student to complete my clinical clerkships in the Baltimore area community hospitals, the Johns Hopkins Hospital, and the National Institutes of Health.
I will forever cherish these experiences and lessons as I progress through my career. With an educated and wealthy suburban population and a large disadvantaged urban population; Baltimore is symbolic of the challenges and opportunities the healthcare field faces.
There are different …
Primary care training and international medical graduates
I don’t know what your destiny will be, but one thing I do know: the only ones among you who will be really happy are those who have sought and found how to serve.
– Albert Schweitzer
The middle-aged Tanzanian woman lived many hours away and had traveled to the academic medical center in Moshi. She had now waited all day to see …
6 ENT physicians practicing in Tanzania, a country of 40 million people
I was in practice about five years and was about to do a radical nephrectomy on a patient.
I met with the patient and his son in my office and the son informed me that he and his father were Jehovah’s Witnesses and that he didn’t want his father to receive any blood or blood products before, during, or after surgery. I asked the father if that was his wish and he …
Transfusing a Jehovah’s Witness during surgery
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