As a fourth-year medical student in a sub-internship in internal medicine, I have something that no doctor in America has. I have as much time as I want to spend with my patients. Don’t get me wrong, I am still a student. I’m still paying hospitals to let me be there, and I only have a maximum of four patients per day, but I inevitably end up spending more time …
When will we start taking mental health seriously?
I do a strange thing as a physician almost daily. I go to alcoholics and have them promise me they’ll go home and continue drinking. Then I release them back into the wild to do just that.
I’m an emergency physician at an urban hospital, and I see alcoholics every single shift, brought in by the ambulance “found down” — that is, found passed out in public places or belligerent on …
Our health care system makes physicians hypocrites by enabling addiction
In his post, “The geriatrician shortage: The problem isn’t what you think,” I completely agree that the current gap in health care professionals’ skills to care well for our aging population is exceedingly complex, reaching well beyond lack of medical school training or funding. Funding for graduate medical education needs to be transformed to match the workforce needs of the nation, with special …
Why older adults need geriatricians
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I spent a couple of hours today discussing a topic that has become increasingly important in the world in which we live, and which would have completely mystified an earlier generation of physicians. The subject was attribution. Simply put, how should one decide which patients “belong” to which doctors? On a more technical level, what algorithms should be employed to connect patients, or episodes of care for those patients, or …
Who’s in charge of the patient? It’s a question increasingly difficult to answer.
Any Stanford student knows all too well that the immense campus, with its seemingly eternal sunshine and endless rows of palm trees, can make it difficult to want to get outside and experience the real world. When it comes to medical education, this creates a very real concern: Is it possible to experience the full diversity of our health care system when you are living in the so-called “Stanford bubble” …
What medicine is really like isn’t seen in some medical schools
“How far did you go in school?”
This is a question that I ask every new patient as a matter of course.
Granted, I have gotten some very odd answers, including hearing from a very successful businessman who only finished the seventh grade, or a very psychotic person who has a double master’s degree. Not implausible, but certainly not expected or the mainstream answer from the majority of my patients.
Now, leaving the …
The question about education that this doctor asks every new patient
It’s no secret that I have a special place in my electronically-regulated heart for evidence. There’s a good reason for that. Our primary job as physicians is to avoid harming our patients, but it’s followed closely by our calling to help them in some way. The problem is that, until we test our theories, we don’t really know which treatments will help our patients (or which ones might harm them), …
A physician’s personal experience with evidence-based medicine
The American Cancer Society (ACS), an advocacy organization that has fairly recently (and very positively) taken a more appropriate, evidence-based approach to cancer screening, recently revised its mammography recommendations. While it still recommends more mammograms than the U.S. Preventive Services Task Force (which doesn’t recommend starting until age 50, and then screening only every other year), it has raised the starting age from 40 …
The problem of expert fallacy in cancer screening guidelines
She came to the urgent care center with a sprained ankle. The primary care provider gave her excellent care, expertly applying evidence-based evaluation guidelines to her situation, and, thereby, avoiding unnecessary x-rays. By all measures, the provider’s care was excellent, but the interaction still ended up reducing his salary. You see, that patient’s only medical interaction that year was for this ankle sprain, and the provider was therefore held accountable …
The joy has been sucked out of medicine. Here’s why.
When a wife suddenly comes in for her husband’s appointment, I usually worry a little; when a husband shows up for his wife’s visit, I sometimes worry a lot.
I have come to expect that when I enter an exam room, and a male patient has his wife with him in the room, she is there to make sure I hear some part of his symptom history that he has never …
What worries me about husbands and wives in the exam room
“Gunshot wound to chest, pulseless, 20 minute ETA.”
When that’s the EMS report, it gets your attention. Despite the wonderful theatrics of modern medical shows, and the best efforts of real-world, sweat-drenched paramedics, those of us who have done this long enough can translate that report. For the layperson it means: “Dead.”
I saw that last week. And the week before I saw another tragic, unexpected death in a man not much …
What physicians call burnout, others call PTSD
I have two refrigerators.
The full size, expensive version, sits in the usual location in the kitchen. The small black one rests idly in the basement. Excluding this morning, of course, when I dragged it up the steps and begrudgingly coaxed it back into action. Let me explain.
Six months ago my old refrigerator started acting up. Somewhere around year five, it’s motors groaned, its coolers moaned, and all the sudden the …
For the most part, doctors get it right. Remember that.
Recently, I have discussed networks (Internet and electricity), but I would be remiss if I didn’t spend a few moments on the networks that are most likely to rob us of personal choice and increase costs: Health care networks.
Wait, didn’t President Obama promise us that the new health care law would preserve choice for us? Didn’t he promise us lower costs? Well, in spite of much good …
Health care networks: A mistake we will pay for
Last year, there was a rash of ill-researched articles in the press claiming a connection between the HPV vaccine and POTS (postural orthostatic hypotension syndrome) and CRPS (chronic regional pain syndrome). Toronto Star, The Independent, Daily Mail I’m looking at you.
These articles read like propaganda for anti-HPV vaccine groups. They all followed such a similar format that I wondered if they …
The HPV vaccine is safe. Now will that stop shoddy reporting?
My patient’s son stood vigil outside her hospital room day and night. His eyebrows were frozen at an anxious angle. Although his mom was healing well from her injury, I could see that he was worried about next steps. He asked staff repeatedly about his mom’s pain management, and reviewed every therapy session she attended.
His mom, on the other hand, was deceptively charming. She was a thin, well-groomed elderly woman …
The stress of being a caregiver to an elderly parent
Last week I was playing golf with some friends. The Boston area has been having a bit of an Indian summer, and we are lucky to still be getting out there (long may it last). The conversation during one of the holes turned to health care information technology, when my friend, who is also a physician, told me about his experiences with a (certain famous) new electronic medical record that’s just been installed in their …
The bait and switch of health care IT
Christine Sinsky, MD, from the American Medical Association interviews Pamela Wible, MD, after her TEDMED talk. Watch periscope video here. Fully transcribed below:
Dr. Sinsky: This afternoon we’re here in Palm Springs, and I’m delighted to be here with Dr. Pamela Wible, who gave a terrific TED talk last night. I’m Dr. Christine Sinsky, the vice president of professional satisfaction at …
I never realized the true meaning of palliative care amidst the harried practice of emergency medicine. The pressure being placed on me to do more often becomes the same expectation I place on patients to receive more treatment.
Gloria, the wife of my patient with terminal mesothelioma, shed a light on palliative care for me with the insightful words, “We know that there is no cure — we just want to …
The palliative caregiver shines a balanced and soft compassionate light
The iconoclastic psychiatrist Thomas Szasz said that mental illness was metaphorical, not real, because mental diseases lacked biological substrates. The absence of a substrate predisposes psychiatry to overdiagnosis and avoiding overdiagnosis is psychiatry’s biggest challenge. This challenge has been taken up by Allen Frances in Saving Normal. Like Szasz, Frances writes in cultured, erudite prose. Unlike Szasz, Frances believes that psychiatric illnesses are real. To save the mentally ill, to save …
DSM-5 is psychiatry’s maladaptation in the grey zone masquerading as science
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old woman had a burning sensation involving the right side of her forehead and the tip of her nose for 2 days, followed by increased redness and the development of lesions involving the tip of her nose. Medical history is significant for hypertension, and her only medication is ramipril.
On physical examination, vital signs are …
MKSAP: 52-year-old woman with a burning sensation on her forehead
