Standing on the edge of his hotel balcony, a doctor describes the rolling hills. He tells me, “It’s a beautiful place to die.” Ten minutes later, he agrees not to injure himself — for now.
I’m not running a physician suicide hotline. But doctors keep calling me.
It’s midnight, and I’m speaking to a psychiatry intern. Bullied by residents and her attending, she …
Assisted physician suicide: Are doctors killing doctors?
In the last year and a half, I’ve been able to go to Africa 4 times and Haiti once, for which I give thanks that the world still produces abundant fossil fuels. That much airplane travel does make me feel a bit guilty, even though I’m not actually vacationing.
Going to far away places to practice medicine has always been something I hankered after, and it turns out that knowing how …
Real-life examples of ultrasound in the developing world
“The patient’s pain is still 9/10, doctor. We’ve already given morphine IV and then changed to Dilaudid IV and then we increased the dose of Dilaudid. Can we give it every two hours instead of every three hours?” the nurse asks me over the telephone. I sigh heavily into the receiver, unsure what to do, feeling more like a drug dealer than a doctor. The patient is on horse-sized doses …
The prescription painkiller epidemic has changed the face of medicine in America
In a recent grand rounds on the future of medicine, the buzzwords were “collaboration” and “managing of the health of populations.” The same day, a group of ten residents were presented with their patient data about cancer screening rates. In both venues, the call to “population health” elicited sighs of exasperation. It’s just another checkbox we are being asked to click off. How can we be assessed on that as …
How to make outpatient population health more exciting
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 21-year-old male student is evaluated for a murmur heard during an athletic preparticipation physical examination. He is asymptomatic. His medical and family history is unremarkable and he takes no medications.
On physical examination, the patient is afebrile, blood pressure is 118/76 mm Hg, pulse rate is 68/min, and respiration rate is 14/min. …
MKSAP: 21-year-old male student is evaluated for a murmur
There have been huge advances in patient safety, but that doesn’t mean there is no risk when it comes to having surgery and anesthesia. Each year there are more than 100 million operations and procedures performed with anesthesia. Doctors who specialize in anesthesia — we’re known as physician anesthesiologists — play a critical role in keeping patients safe and comfortable before, during, and after surgery.
Before surgery, a physician anesthesiologist checks …
Physician anesthesiologists do more than just “put you to sleep”
Dr. Wes has written passionately against MOC: ABIM Pleads for Mercy.
But perhaps we should ask first: Why MOC at all?
Contrary to years of propaganda promoted through pseudo-science and journal article citations on the ABIM’s website, might MOC have really been created because the ABIM’s consolidated fund balance dropped 43.2% from $54,009,086 on June 30. 2001 to $30,691,329 by June 30, 2013 while the Standard and Poors 500 index increased 37.7% …
In order to interpret the world, we tell ourselves stories. All day long. About everything. That guy in the grocery store who clipped your heels with his cart? A jerk. The car that cut you off at that intersection? A jerk. A little old lady stopping in the middle of the aisle at the grocery store? Senile.
It is automatic, it takes no effort, and it is completely egocentric. It is …
It’s important that we get our stories right
Let’s talk about vaccine ingredients. I am reading less about vaccines causing autism (we all know that theory is utter nonsense, right?) and more about vague concerns regarding the chemicals in vaccines. To begin with, we are surrounded by chemicals. Water (H2O), caffeine (C8H10N4O2), sugar (C12H22O11) are all chemicals. But perhaps it is the unfamiliar ingredients that people find intimidating.
Let’s tackle the ingredients in the measles, mumps, rubella and varicella (MMRV) vaccine …
Don’t be scared: Let’s see what’s really in vaccines
Medicaid expansion “is one of the biggest milestones in health care reform,” according to the Obamacare Facts website. The goal was to provide insurance coverage to low-income Americans, specifically the uninsured. The major problem with Medicaid is low reimbursement. “Due to low payouts, many doctors don’t take Medicaid, and the quality of care tends to be poor,” admits the website. The solution was to raise the amount doctors get paid under …
How Medicaid’s bait and switch fooled doctors
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old man is evaluated as a new patient. He was diagnosed with type 2 diabetes mellitus during a health insurance evaluation 6 months ago. At that time, metformin was initiated. Medical history is otherwise unremarkable.
On physical examination, blood pressure is 145/94 mm Hg; other vital signs are normal. BMI is 29. …
MKSAP: 60-year-old man with type 2 diabetes mellitus
Have you ever tied your shoes and found that the bow unraveled and you almost tripped over your own laces? Learning to tie your shoes is a life skills task that you learned as a toddler unless you were trained on Velcro straps! You performed the task of tying your shoes nearly every day of your life believing that you were …
What physicians can learn from tying their shoes
My last patient, Joyce, a 45-year-old single mother of four with high blood pressure and diabetes, is late. She was in the emergency department last week with dizziness and blurred vision, a blood sugar of 345 and a blood pressure of 190/110.
Her last office visit was a month ago, when weighing in at 222, she joked that she wished she could pull those numbers at the casino’s slot machines. She …
Food insecurity is an undiagnosed medical problem
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Once an alcoholic, always an alcoholic.
This is one of the main tenets of Alcoholics Anonymous, and it serves to encourage its members to commit to absolute abstinence. It is also a belief, I have come to realize, held by the many medical residents I have encountered.
When an alcoholic patient is admitted to the hospital, it is no secret that he (or she) is an alcoholic. This is because it feels …
An alcoholic patient, and his effect on a medical student
Every year 300 to 400 physicians commit suicide. More than 10 percent of doctors are thought to have depression, a frequent precursor to suicide. Rates of depression and suicide
Does medical student debt lead to suicide?
The medical condition provocatively called exploding head syndrome, or EHS, brings back the disturbingly graphic images of the 1981 sci-fi horror flick Scanners where the main character blew up people’s heads with the power of telekinesis. Fortunately, as ominous as exploding head syndrome sounds, no skulls have actually exploded, and the condition is reassuringly non-life threatening. For the people who experience the symptoms of EHS, however, the ordeal can be …
Exploding head syndrome: Is it really terrifying?
Measles Makes an Unwelcome Visit to Disneyland
Health Alert after Disneyland linked to measles outbreak
Mickey, Minnie and measles for nine Disneyland tourists
The headlines from January 7th and 8th told an increasingly serious story about America’s vaccine civil war — a story that was to explode in the weeks ahead. We’ve come to expect that kind of story to be uncovered by a major news network with expertly trained, …
2015’s biggest health story was broken by a doctor, not a reporter
A few weeks ago Bill Maher made a number of critical remarks about medicine and physicians. I sent Mr. Maher the following response in an effort to address his comments. I am sharing this with you in hopes that other physicians will also speak out in defense of our profession.
Dear Mr. Maher,
Let me start by saying that I have been a …
Bill Maher criticizes doctors: A physician responds
Three years ago I received some of the best news of my life — that I have dopa-responsive dystonia. (Yes, a neuromuscular disorder was welcome news.) Painful, life-interrupting muscle contractions had made the dystonia diagnosis likely several years before, despite poor response to standard treatments, and I was fighting through graduate school: trying to compensate for medication-induced memory problems, increasing need to work from bed, and a disappearing social life. …
A domperidone dilemma: A patient’s perspective on ordering from Canada
More and more hospitals are realizing that the 30 to 50 percent of waste occurring within their organizations is not only real, but a tremendous opportunity. This is good news for both our patients and our health care system. The bad news is that many hospital executives believe that this waste is largely limited to processes like materials management, ER wait times and operating room first-starts.
The next step in our …
Where is the waste in health care?
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