“A thousand times we die in one life. We crumble, break and tear apart until the layers of illusion are burned away, and all that is left, is the truth of who and what we really are.”
The coronary care unit (CCU) rotation is a unique place. Postoperative cardiothoracic surgery patients among many other pathologies from heart failure to heart transplant fill the unit, and it is the job of the …
A powerful reminder of medicine’s humbling nature
I just stepped out of the administrative building at medical school and hear a big commotion. I look over and see an elderly male slouched on the ground bleeding profusely from his mouth and nose. Blood is soaking the front of his collared shirt and pooling on the ground. Bystanders are making a scene and not sure what to do.
I drop the items I’m carrying and calmly approach the man and …
Sucker punched and bleeding. Do you know how you’ll respond?
I like to think that doctors are still a profession made up of people who want to help others. Sure, there are other benefits to our jobs. The technical challenge, the intellectual rewards, the financial security. But honestly, we do really get a lot from helping others.
It’s satisfying to look to your fellow man in a time of need and heal …
Doctors need to take care of each other. Starting now.
Rarely are health care professionals given the opportunity to truly ponder a crucial aspect of patient care; the truth behind what it feels like to lie in a hospital bed, vulnerable, disoriented, and stripped of every basic human dignity. I have spent over 300 days as a patient in hospitals and more than three decades in and out of doctor’s offices and testing facilities. I have a profound respect for …
What you say matters: An insensitive comment in the ICU
I didn’t really notice him standing in line. But how could I? Hundreds of kids came through the high school gym yesterday. His turn for the heart and lung portion of the high school sports physical had come. He said he was going to play baseball and basketball. How could he with that arm he carried so carefully? I am not …
A high school physical that shook this student to the core
Draping a shroud of 30’s Depression on any dust bowl child can thicken the skin, so my 88-year-old patient learned to be fiercely independent with a “talk to the hand” attitude, and “don’t get in my way” personality. Even after her husband passed away, she remained autonomous traveling and golfing in her social circuit.
Living life as a smoker was always a threat to her health, and this year became a …
Why you should have your end-of-life discussion now
I keep getting served a Facebook ad from the American Association of Medical Colleges imploring me to ask politicians to fund residency training for medical school graduates. The link leads to a webpage with neat graphics and a series of well-designed cartoons dramatizing an ominous shortage of 90,000 doctors expected to occur by 2025.
Now, the notion of “doctor shortage” by itself is meaningless. Doctors — …
Want to become a doctor? Ask yourself the following questions.
What is it like for physicians to fail their ABMS Maintenance of Certification® (MOC) program examination? How does the largest member board of the ABMS, the American Board of Internal Medicine (ABIM), respond to doctors who fail their secure examination?
As I continue to confidentially collect information from physicians who have failed their MOC examination, I thought it would be important to publish …
So you failed maintenance of certification. What now?
Lately I’ve had the opportunity to work in an outpatient clinic where the regular doctor is out sick for a prolonged period of time. It is a breathtakingly beautiful little community, with green hills and a crystal clear river. It is also troubled by methamphetamine and prescription drug abuse.
The little clinic in town is unwittingly a partner in this crime. Like …
Please forgive us for prescribing controlled drugs to just about everybody
I was driving to work the other day, and there was a story on the radio about the Congressional reaction to the latest recommendations for breast cancer screening from the United States Preventive Services Task Force (USPSTF).
Here’s the background. USPSTF published recommendations in late 2009 for the use of screening mammography in different age groups. For women between 40 and …
This is why it’s so hard to rein in mammogram screenings
A new clinical report from the American Academy of Pediatrics is a rare beacon of coherent thought about lice and children.
Rather than humiliating children and driving them away like lepers, the AAP recommends common-sense steps to identify and treat lice. Some facts really shouldn’t be in dispute:
Common sense guidelines for children with lice
The other day, a teen patient of mine told me she is pansexual.
We were having the usual talk I have with teen patients, the one where I we talk about sex and sexuality and birth control and sexually transmitted infections. But over the past few years, that conversation often takes interesting turns when I ask about sexuality, like it did the …
Bruce Jenner is evolving the birds and the bees talk
Imagine a surgeon removing a gallbladder miles away from where he or she actually is. Imagine when you are ill, a physician has the ability to diagnose you from your living room. Telemedicine.
Telemedicine itself is not a concept that is all that new. In the 1930’s, Italy used telemedicine to communicate with ships at sea, while in the United States, NASA …
Telemedicine is medicine’s sexiest new field, but why aren’t we ready for it?
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Thankfully, many medical conditions that once were never discussed in public, such as cancer, AIDS, and even infertility, have largely shed their stigma and sense of secrecy.
Miscarriage holds an unusual place in medicine in being both common and something that many in society thinks is rare. One in four pregnancies ends in miscarriage, and there are 1,000,000 miscarriages each year in the U.S. — yet miscarriage remains shrouded in privacy …
The taboo nature of miscarriage must end
Some years ago when my father underwent bypass surgery, he was anxious, depressed and in pain as he lay in the hospital bed tied to IV catheters and tubes. Each day, his surgeon, his hospitalist, and other consultant doctors whisked in and out, asking how he was feeling and then ordering a treatment plan. A few years after his full recovery, …
A nurse is an essential partner to patient care
Recently, I was back in the United Kingdom for a short trip home. It happened to be the week of the general election, and after a long campaign the country finally went to the polls on Thursday.
For those of you unfamiliar with U.K. politics, for the last five years there’s been a coalition government between David Cameron’s Conservatives and the Liberal Democrats (the first coalition government for 70 years). The …
Fixing health care really depends on the economy
I wasn’t the first simple country surgeon, you know.
When I was a resident, our training program broke us into two teams — one that served general surgery, pediatric surgery, and trauma; the other, general surgery, transplant, and oncology. Every day was an intricate dance to see all the patients (generally between 20 and 40) for the assigned team, operate all day, …
3 things that make a surgeon great
An excerpt form Baby City: An Inside Look into Labor & Delivery.
I am going to make this medical student cry.
I don’t know how I know it, but somehow I can sense it. I know it the second she walks into the resident room on labor and delivery at Cadence Hospital, her perfect blond ponytail swinging behind her. And I’m certain of it when she holds her slim …
A medical student on her obstetrics rotation: Behind the scenes
I was volunteering at one of the free clinics associated with my medical school last weekend, and while teaching a medical student how to sew a cut, he queried, “That is an interesting technique, who taught you how to suture? Are you a surgeon?”
“I am actually a radiologist,” I replied. “To answer your first question, I was actually taught this by an obstetrician during my third year of medical school.”
Puzzled, …
What this radiologist learned from his obstetrics rotation
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman is evaluated for redness that developed over her right leg at the site of a mosquito bite. She is otherwise healthy and takes no medications.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 120/70 mm Hg, pulse rate is 70/min, and respiration rate is 14/min. There …
MKSAP: 25-year-old woman is evaluated for redness at mosquito bite
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