I sometimes think doctors forget what it’s like to be patients. But I’ve been there, and I know how frustrating and scary it can be. I remember one night, I was lying in a hospital bed, resting peacefully. I heard a noise and opened my eyes to a room full of chaos. Nurses everywhere. A crash cart. Someone holding paddles. I tried to speak, but couldn’t. …
4 things this doctor learned after his heart stopped beating
Help, I need somebody! Help, not just anybody! Help, you know I need someone, help!
– The Beatles
We are all here on earth to help each other; what on earth the others are here for I don’t know.
– W. H. Auden
“Help the doctor!”
I’m sure most surgeons have heard this exasperated statement at some point in the operating room. It is said with that special mix of …
Help the doctor! When systems and the system fail physicians.
Physician burnout has been previously described as heartbreaking, and this may be an understatement. The growing complexities of health care delivery, intricacies of documentation practices as required by Meaningful Use, and difficulties inherent to billing and reimbursement are only a few of the issues faced by residents and attending clinicians these days.
Unfortunately, these topics are still not formally taught in American medical schools.
As students, we really do not know …
Ranking your residency for the Match: Red flags to watch out for
For years, policy experts have been predicting the end of fee-for-service. Yet it can be said of fee-for-service that, like Mark Twain’s alleged demise, reports of its death have been greatly exaggerated. (Actually, this is an often-used misrepresentation of what Twain actually said. After the New York Herald incorrectly reported that he was “grievously ill and possibly dying,” an “amused” Mark Twain wrote that “the report of my death has been …
Physicians need to be ready for the end of fee-for-service
Once the 2008 economic spiral began and, unemployment escalated with wallets and purses zipped closed, causes were not initially recognized. Since then, the causal details of this downturn were ferreted out pinpointing emanation from Wall Street banks.
Public discontent demanding change has been ignored allowing potential for recurrence. Why? Business has influenced legislators swaying their vote as they filled campaign coffers.
In the …
The frustrated and marginalized American doctor
Two problems loom large over the American medical care system. First, we spend outrageous amounts of money on health care, with too many patients receiving too many services at too high a price. Second, our malpractice system is an international embarrassment, with too many health care providers sued by too many patients for too little reason.
Many experts have pointed out that these problems are two sides of the same coin. …
Medical malpractice reform won’t save money
Infrastructure is never quite as interesting or exciting as innovation. The grand opening of a new building incorporating all the latest integrated technology is far more exciting than bridge repairs. In our fascination for the innovation, we often turn a blind eye to our nation’s crumbling infrastructure.
In the United States today, one quarter of our bridges are structurally deficient or functionally obsolete and more …
What do bridges and public health have in common?
The non-medical reader may wonder what I am complaining about. Of course, many of you have to be credentialed in your fields as well, whether law or accounting, law enforcement or public service, education, nursing or a trade. But those of you in medicine know how difficult it can be to become credentialed as a physician, either by a state for purposes of a license, or by a hospital in order …
Medical credentialing: Explaining yourself when you’re off the grid
“I had no idea how much cancer sucks.”
My patient’s observation seems silly, basic. Of course, cancer sucks. It maims, humiliates and kills. It takes. What made the statement remarkable was its source. This is not a medically naïve person, waiting to die. Rather it was spoken by a patient in complete remission, likely cured, who is an expert in cancer care. To her amazement, it changed life forever.
I think that …
The cancer metamorphosis is different for each patient
The president’s proposed Precision Medicine Initiative, as mentioned in his recent State of the Union address suggests it’s probably time to get ready for some changes in our daily routines as health professionals.
I’m not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better …
Are we prepared for the genomics revolution?
Early on in my career I called an Indian internist in the middle of the night to admit a patient to him.
The patient was an 88-year-old female with advanced dementia, a terminal brain disease. She had aspiration pneumonia, which is often the final common pathway of this illness. She was in respiratory failure, in septic shock and was a “full code.”
I can still recall our 4 a.m. conversation:
“Hi, Dr. …
What can we learn about palliative care from Indian physicians?
Cases of measles linked to an exposure at Disneyland continue to spread, not just in California, but in several other states and in Mexico. The numbers of cases are climbing — and so are the number of exposed people who might get sick — and expose more people before they realize they are sick. Measles is extremely contagious; if someone has it, they will infect 90 percent of the people …
Why the Disney measles outbreak could be a game-changer
A cartoon of an angry looking physician, a spotted boy, and some anxious parents in The New Yorker reads, “If you connect the measles, it spells out, ‘My parents are idiots’.”
A facetious article in GomerBlog announces, “Big Pharma Admits They’re Just Trying to Kill Everyone with Vaccines.”
Even television host Stephen Colbert gets in on the make-fun-of-anti-vaxxers act, recently declaring, …
What doctors must learn from the anti-vaccination movement
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Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe”?
I hate that I can’t completely say they are …
Answers to your questions about the measles outbreak
Significant snow in New England every winter is about as certain as sun in Florida every summer. When I moved to the USA from the south of (old) England to do my medical residency in Maryland, my first few years living in the United States were relatively snow-free.
But when I started my first job as an attending physician in central Massachusetts, I was in for a big shock. I had …
What hospitals can learn from snow preparedness
Our family loves to hike. Traveling the trails is a deeply happy place for us. In fact, I don’t think there’s ever been a time when one of us suggested taking a hike, and everyone didn’t unanimously and enthusiastically agree. A few weeks ago, my family took a lovely hike in a state park in Massachusetts. It was a gorgeous day: temperature in the upper 40s, blue skies, no wind. The …
Like hikers, patients also need guides
I am a physician, but I also consider myself a mother hen. When I have a census of patients, I think of them as little chicks, perhaps old roosters, clucking hens, tender capons. Some are old, some young, some have been chased out of the coop by an angry dog, caught in the wires and sent to me for care. Some …
We need fewer paternalistic physicians and more maternal ones
I was glad she never asked if I had done this before.
My first nasogastric tube was placed on an elderly woman with chronic liver disease. As her illness worsened, it gradually turned her skin yellow, her abdomen swollen, and her mind foggy. One day, we realized that she was at too high a choking risk to swallow her medications herself. She would need a plastic tube to do it for …
Lessons from my first nasogastric tube
Fecal microbiota transplantation (FMT) has emerged as an increasingly common treatment for patients with refractory Clostridium difficile infection (CDI). Unlike standard antibiotic approaches, which only exacerbate dysbiosis and may perpetuate CDI recurrence, FMT restores normal gut microbial community structure and function of the gastrointestinal tract. However, a number of challenges need to be overcome before this procedure is widely accepted in mainstream clinical practice.
Before I jump into highlighting …
4 reasons why fecal transplants aren’t mainstream. Yet.
The letters are usually four pages long and begin by saying that my patient has received a temporary supply of the medication I prescribed.
Next, there are general paragraphs about how the drug either isn’t on their formulary or the quantity exceeds the plan limits. None of these letters contains a reference to an online formulary physicians can access to compare covered alternatives.
Then there are several cumbersome explanations about the appeal …
Which drugs are on formulary? A little help, please.
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