Leave early.
Two words. Simple concept. But, one worth thinking about.
James Altucher explains it well, but this is the same guy who also thought he could save his business by becoming more like a Jedi Knight. Admittedly, the Jedi thing seemed to work for him, and his businesses, as well as the uncountable number of people he’s helped since then. …
A doctors lifehack: Leave early
Last night, one of my close and friends told me the story of her recent trip for her annual gynecology appointment. Her longtime gynecologist had retired, and she was meeting her new physician. After taking a history, the first new physician explained to her that since she always had normal Pap smears, including recent ones from the past several years, she …
It’s time to talk to your patients about high value care
Chronic insomnia affects 5 percent to 15 percent of Americans. It is far from only a nighttime problem. As all of us know from occasional sleepless nights, the following day is unproductive and sometimes dangerous. Sleep deprived people are more prone to accidents, and are more likely to have depression, anxiety, diabetes and high blood pressure.
It is no surprise then that …
This is the best way to treat chronic insomnia
Manny Alvarez is a 23-year-old college student with the misfortune of having not just a devastating cancer — but the wrong devastating cancer. The chemotherapeutic agents shown to be highly active against his specific tumor cells are FDA approved for the treatment of leukemia, but not for the stunningly rare kind of sarcoma with which Manny has been diagnosed. Nothing is …
There are only 3 ways to allocate health care resources
I am in my twenties.
I am a student in dental school. My seven classmates and I have gathered, notebooks and pens in hand, for the first day of our ten-day rotation at the Veteran’s Hospital oncology department.
Dr. Steele, a published expert in oral cancer, instructs us to follow him to the outpatient clinic. Some of those he’ll examine are initial consultations; …
The ability to diagnose cancer is a necessary evil
“What’s up with the ABIM?” “I just got a note about an alternative board. Should I join it?” “Aren’t you glad to be off the Board?”
These days, I get these questions from friends and colleagues regularly. When I first joined the board of directors of the American Board of Internal Medicine (ABIM) in 2004, the organization was a …
Dr. Robert Wachter: In defense of the ABIM
“Thank you.”
Looking back on my step 1 study period, I owe my sanity to three things. Numbers 1 and 2 include my best friend and Coffee Toffee ice cream, both of whom prevented me from falling apart at the seams on multiple occasions. Number 3 is a memory from volunteering earlier in the year, and it still stands out as the sole motivating force behind me ever finding my copy …
Looking a patient in the eye made all the difference in the world
When I chose a career in pediatrics, everyone had something to say about my decision. While most of my friends and colleagues were supportive, there were more than a few that just couldn’t understand why I would sign up for a lifetime of “ear infections and runny noses.”
Even among other medical professionals, it’s not uncommon for pediatrics to be viewed as a less-than-serious …
What is pediatrics? It’s more than just runny noses.
Every week, I am asked by patients if their heartburn medicine causes osteoporosis. The most effective heartburn medicines are called proton pump inhibitors, or PPIs. If you watch more than an hour of TV per week, then you have seen ads for some of them. Nexium, Prilosec, and Protonix are three examples of these medicines.
Many of them are now available over-the-counter at reduced dosages.
Patients today are incredibly informed, and sometimes …
Do heartburn drugs cause osteoporosis? A gastroenterologist answers.
One of the most distinctive aspects of a medical career is the vulnerability we see in essential strangers almost immediately upon introduction. Even without a medical degree, the third-year medical student will find out intimate details of one’s life while taking a history.
Patients will reveal their fears of a disease, embarrassing side effects of a new drug, a habit they are ashamed of. Halfway into third year, I have learned the …
A medical student, overcome with the gratefulness that she is in medicine
California is in the middle of an historic drought, with the government setting limits on how long people can sing in the shower. Farmers in the state may soon need to cut back on planting or production, as ground water dries up. But California is still fruitful ground for testing promising ways to improve how health care consumers, otherwise known as …
Can reference pricing be the answer to soaring health costs?
The scalpel hits the skin immediately, splaying it open with one smooth swipe. Two more swipes through yellow globular fat and I hit the glistening white fascia layer. If this weren’t an emergency, I would stop to carefully cauterize the small bleeding blood vessels in the fat layer, but there is no time for that now. I nick the middle of …
You’ll be shocked to see what an emergency C-section is really like
I never really watched medical shows, even before and during medical school. I watched maybe one season of ER, a couple of seasons of Grey’s Anatomy and House MD and maybe one episode each of Private Practice, Chicago Hope, Emily Owens MD and other random medical shows. The only medical show I made an exception for was Scrubs, because it was …
The problem with medical TV shows. A surgeon sets the record straight.
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Patient-doctor communication often has many facets, wrinkles, and twists. Medical school prepares a doctor minimally for the ups and downs of these patient interactions. There is no mannequin who can train each medical student how to deal with every personality, response, or even outburst by each patient. On the job training is sine qua non.
During and after medical school, it took …
Poker face: The complex psychology of the patient-doctor interaction
As a practicing gynecologic oncologist, I have spoken the words, “I’m sorry, you have cancer,” or some version of that sentence thousands of times. And although my delivery is fairly consistent, modified only slightly to improve understanding, my patients’ responses vary from stunned silence to uncontrollable, overwhelming cataplexy. The stalwart emphatically reply “I’m gonna beat this thing,” but the vast majority tentatively wonder “How long do I have?” and retreat …
Cancerism and the harms of our negative cancer bias
When my sister, Jessica, was a nurse anesthetist student at the University of New England, she had the opportunity to rotate at Johns Hopkins, and she seized it. She was young and fairly new to the medical world and so she did not recognize at first the name of the neurosurgeon with whom she would be working — Dr. Ben Carson. After receiving multiple comments from numerous people about how great it …
There is no shame in honest work, no matter what the job description is
My patient had suffered a terrible, crushing injury to his chest leaving many ribs and his sternum fractured, his lungs and heart badly bruised and his body on the edge between life and death. He was on a ventilator, the tube through his mouth into his windpipe pushed air into lungs that couldn’t draw for themselves. He was on constant medications for pain and to sedate him while we used …
An inappropriate use of medical jargon: Words do matter to patients
Recently, health insurance companies across the nation have petitioned to increase premium rates for customers covered under the Affordable Care Act (ACA). In North Carolina, Blue Cross Blue Shield (BCBS) has proposed a 25.7 percent raise in premiums; in New Mexico, BCBS requested a 56.1 percent raise; and, in Georgia, Alliant Health Plans has submitted a proposal for a hike as high as 85 …
Putting the increases in health premiums in perspective
November of last year found me living as best I could with several health issues, the most debilitating of which stems from never having recovered from a serious viral infection in 2001. I’ve been diagnosed with chronic fatigue syndrome, a little understood and much-misunderstood illness. It keeps me virtually housebound. For the most part, I’ve made peace with feeling sick all …
You can never be prepared for a diagnosis of breast cancer
Do you remember Mad Libs from when you were a child? A story is filled with blanks, and as you fill them in with inappropriate and ridiculous words, you laugh until you can’t see straight. You laugh until you can’t breathe, and your parents beg you to stop! Let’s be children again. Share these with the nurses, and give the shift a little levity.
Pain medication. You see, doctor, my pain specialist …
Mad Libs for medicine. Do you think you can use these?
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