“I’m doing my part. I want to get better and go home,” Dorothy says as she looks up at me from the hospital bed. We talk about her family and work life, and she tears up several times during the conversation especially when she talks about how her mother died of cancer. “I’m afraid to go that way,” she divulges. Her 450-pound body fills the oversized bed entirely, and the …
The first step to combat the nation’s obesity epidemic
Dear trainee,
I was once in your shoes. There was a time where I wore a beat up white coat, pockets overflowing with cards and knew every nook and cranny of the hospital. I was the doctor that woke up the patients in the am, gently asking them to roll over so I could listen to their lungs sounds. That was me.
If you’re anything like me, then you are counting the …
A letter from an educator to medical trainees
For too long we have let politicians, insurance companies, lawyers, administrators, and consultants tell us what is best for our patients. Over the years, we’ve stood idly by and watched as the field we love is debased, one superfluous policy after another — foolishly believing that if we just worked a little bit harder, we could make up for all the extra rules and regulations. We’ve dedicated our lives to …
The time to reinvent medicine is now. #TakeBackMedicine
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We all go through it. We all have regrets in life. They simply become painful, unescapable daydreams of “what could have been” if only I had only … I often remind young college freshmen who have finally gotten a taste of freedom stepping out of their parent’s home, that what they choose to do in the next 4 years just may dictate the rest of their lives.
Our 20s can make …
The top 10 mistakes premedical students make
When I first applied for medical school, I beamed about exploring not just the science of medicine, but also the art. But what is that art? Some would say it’s clinical experience, combined with being cultured and compassionate and communicating with clarity/conviction. But how would one teach that art?
Journal Watch’s Dr. Allan Brett recently reviewed a multicenter U.S. study following ~300 metastatic cancer patients who had failed initial chemotherapy. The study showed …
Can you teach the art of medicine?
We’ve all seen them: those once paper but increasingly digital forms that enthusiastically request our feedback. “Tell us how we’re doing,” they cheerfully announce, or, “Help us improve!”
Some of us even send them out as part of our practices or health systems or educational programs.
We also fill them out, both as regular citizens and as clinicians. Or we mean to. I certainly try to, with some exceptions. Recently, I deleted …
The problems with patient feedback forms and how to fix them
Medication non-adherence is a hot button topic in health care. Physicians lament patient “non-compliance” with their medical advice, and policy wonks tell us that more than half of patients do not take their medications as directed. Missed opportunities to control chronic illnesses such as diabetes, heart disease, and cancer surely do cost us untold billions of dollars and millions of quality life years lost annually in the U.S. …
Patients are taking far too many medications. It’s time to fix that.
Is a doctor guilty of malpractice or murder or is the patient responsible for his or her actions when there is a death by overdose?
This is the question that a jury in Los Angeles will have to decide as they are presented the facts in the case of Dr. Lisa Tseng.
The prosecution’s version is that Dr. Tseng handed out opioids like candy without any regard for standard of care. …
After a drug overdose: Is it malpractice or murder?
Katie had always come to clinic in an anxious and frazzled state. Hair blond hair disheveled, large handbag open, items at the verge of spilling out. Yet she came, dutifully, to meet her counselor, to attend group therapy, to get vitals checked by her nurse, then to drop off a urine sample. But not today. Nor did she return to clinic over the next three weeks. Katie was found by …
The tragedy of opioid addiction in the young and homeless
Two of the most commented posts on my blog are about charging patients for missed sessions and how psychotherapies end. As there is no single correct approach to either of these, there’s plenty of room for practices legitimately to vary, and plenty of room for patients, i.e., most of my commenters, to express their likes and dislikes. By my reading, many commenters assume that cancelation and termination policies mainly feed their therapists’ wallets; they …
You can’t tell whether a psychotherapist is impaired
A strong wind would have knocked Geraldine to the ground. At 78 pounds, she was underweight, chronically ill, and in need of acute medical or psychosocial care every time she came to the clinic. A survivor of domestic violence with severe mental illness, she had a history of substance abuse and was infected with both HIV and Hepatitis C. In chronic pain but too high a risk to prescribe opioids, …
Why we are #ProudtobeGIM: A general internal medicine top 10 list
Doctors do not know everything. We make mistakes and mistakes in judgment. Sometimes we make the mistake of speaking when we should keep silent. At times, patients ask us questions that we can’t or shouldn’t answer; and yet we do. It shouldn’t be our objective to force certainly into an issue that is amorphous and murky.
Here’s a response that I recommend in situations where certainty is elusive.
“I don’t know.”
I saw …
What to say when medical certainty is elusive
It occurred to me towards the end of our conversation that there was a large gaping hole. We had talked about physician burnout, career choices, and his current plans. He had drawn a map of his future. It originally shot like a straight arrow towards clinical medicine, but now veered precipitously. I took a moment to first clear my thoughts, and then my throat.
Medicine, I explained, is still as …
Medicine can still be noble. If we fight for it.
Dear doctor:
Attached please find the medical records of Mr. Ron C., who is transferring medical care to your office. Ron is a 63-year-old gentleman with recurrent lung cancer, which has spread to his opposite lung and bones. There are multiple treatment choices for his disease, which we have discussed in detail. However, Ron is leaving my care, because he does not trust me.
As you are well aware, metastatic lung cancer …
Treating cancer: Doing nothing is also a choice
Hospital cafeterias are important places. Great progress has been made over the last few years in raising the standard of the food served (to both patients and staff!), with much more emphasis too on making the options healthier and nutritious.
Speaking as someone who has worked in several different hospitals, and with my own general interest in health care quality and improving the patient experience, it’s always very interesting to look …
The cafeteria can tell you a lot about the hospital. Here’s how.
Pharmaceutical drugs cost too much. The new ones are always so expensive.
Hence, we need more regulations. And, the government should impose them. Set price limits. Cap drugmaker profits. This will make it better for all of us. The paternalism of our government should be the strongest when we are ill. Because we may need that medicine.
The government should regulate things more so we can get it cheaper.
Case in point. One new medication …
Less regulation in health care. Please.
Studies show over and over again that empathy is the key to physician-patient communication and is directly related to patient satisfaction, adherence to medical treatment, lawsuits, and clinical outcomes. Yet despite its importance, many doctors still struggle with showing empathy.
The reality is that while most medical students start school with high levels of empathy, it doesn’t take long before that empathy is beaten out of us. Studies show …
Can you fake empathy until it becomes real?
The doctor sprinted to the side of the bed and slapped her interlaced hands over the man’s heart. What made his heart stop remained a mystery, but she knew she had to get it beating again. She pushed her hands into his chest, an internal metronome pacing her efforts. After every few pumps, she glanced up at the cardiac monitor. Still no pulse.
“Well, it’s obvious why he’s dying, isn’t it?” …
All actors should have to take a CPR class
I’m supposed to speak at the body donor memorial in September. I told the organizers my speech was written. “Don’t worry,” I assured them. “I have it all in my head, just need to get it down on paper. I’m a writer; it’s my process.” But the truth is that I am struggling with what to say. I’ve tried to write it, but I just end up drinking a pot …
How anatomy lab changed this medical student forever
At the heart of American medicine is the concept of bedside manner, and with it the concern that doctors are cold and unemotional. Indeed, doctors are exposed to disease and misfortune on a daily basis. A patient who presents with stage IV metastatic stomach cancer is just one of the many hundreds or thousands of such patients that will walk through the hospital doors in the coming years. Quotidian exposure …
The day I saw the humanity in medicine
