There is a scene in the movie, The Matrix, in which the main character Neo is offered a choice between the red pill and the blue pill.
This is your last chance. After this, there is no turning back. You take the blue pill — the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill — you stay in Wonderland, and I …
Learning from physician burnout: Which pill will you choose?
As a pathologist, I recognize the importance of every diagnosis. Behind each slide is a patient, a family, a network of family and friends. A string of dominoes that is set into motion with my diagnosis. All treatment begins with a diagnosis. Each day I make these diagnoses, but on holidays, it takes on even more meaning. As the rest of the world is celebrating the season, coming together, medicine …
Pathology plays a central role in the era of personalized medicine
Recently the Mayo Clinic named a patient as a visiting professor for 2015. The patient, Dave deBronkart (otherwise known as “e-Patient Dave”) was chosen by the internal medicine chief residents to fulfill this unique role, where he would have the opportunity to lead grand rounds, give educational talks to medical students, residents and faculty, and truly emphasize the message of patient engagement and empowerment.
So what is an …
How patients can be medical educators
Recently, at a holiday meal with my extended family, it came to light that neither of my typically developing teenage children really knows how to tie his or her shoes. It seems that for the past decade or so, both have been using the “bunny ears” technique introduced to preschoolers for tying their shoes. My children appear never to have moved on from there to the mature “around the tree” …
Children with developmental disabilities and the guilt parents feel
The following is based on an actual case that occurred a long time ago in a galaxy far, far away.
A 65-year-old man arrived in the emergency department by ambulance after being found unresponsive. His respiratory rate was 40 per minute, heart rate was 170 per minute, and temperature was 102.2°. He did not respond to Narcan or an ampule of 50 percent dextrose. Blood sugar was 600 mg/dL. The diagnosis …
The best doctors expect the unexpected
There’s a great song by Don McLean called “American Pie.” The chorus talks about “the day the music died.” I thought about that song in my hospital a couple years ago, when the music died there, too. I’ve noticed that our physician burnout and nurse frustration have increased in the years since the music died. Could it be a coincidence?
McLean’s song was about a plane crash in 1959 that claimed …
The day the music died and how a hospital lost its joy
A medical student asked to speak to me about a month ago at the Philadelphia College of Osteopathic Medicine, where I am an instructor of family medicine. He has been very active in our school’s Primary Care Scholars program and community health outreach activities. “Dr. Chan,” he said, “I am so torn. I really love primary care, but I am so …
Want to practice primary care and be debt free? Here’s how.
Last August, the American Academy of Pediatrics (AAP) issued a statement regarding school start times, really a plea to all middle and high schools to start the school day no earlier than 8:30 a.m.
The statement emerged as a result of accumulating evidence showing that earlier school start times effectively restrict an adolescent’s ability to get regular healthful sleep.
The timing of the AAP’s …
Kids need more sleep and later school start times
A new study about physical activity, obesity, and mortality has been propagating so many headlines and so much commentary, it’s pretty much a given that if you are seeing this, you have seen something like: “Inactivity kills more than obesity.”
As is generally true in such cases, few of the people opining about the study seem to have actually read it. I suppose that’s understandable — once you get to particulars …
Inactivity kills more than obesity: Let’s go beyond the headline
Mr. Dwyer isn’t my patient, but today I’m covering for my partner in our family practice office, so he’s been slipped into my schedule.
Reading his chart, I have an ominous feeling that this visit won’t be simple.
A tall, lanky man with an air of quiet dignity, Mr. Dwyer is eighty-eight. His legs are swollen, and merely talking makes him short of breath.
He suffers from both congestive heart failure and renal …
We forget to ask patients what their goals are
Recently a friend of my husband’s in San Diego had a mammogram that showed some suspicious microcalcifications in her right breast. She underwent a stereotactic biopsy which revealed ductal carcinoma in situ, the earliest form of breast cancer also known as stage 0 breast cancer. This type of cancer is non-invasive and does not metastasize, however, if untreated it can progress or recur as a more serious type of breast …
Stop with the curbside consultations. They don’t help anyone.
When babies are born prematurely, they often lack surfactant: a soapy substance produced in the lungs that helps to keep the air sacs open. Without surfactant, these tiny babies fight to breathe, a condition known as infant respiratory distress syndrome. Within the past 50 years, the delivery of artificial surfactant therapy has revolutionized neonatal care, saving many lives that previously would have had no chance at survival. As a neonatal intensive …
Let’s be judicious in our use of surfactant
Her heart was failing; her ejection fraction was unmeasurable. Her hip was broken, and she developed a pulmonary embolism post-operatively. She was painfully close to death. Yet at some point, the hospital finished and spit her out at the nursing home.
She was confused.
I tried to take the best history that I could. Her answers where usually no more than a single word. Her physical exam revealed a desperately weak woman, …
Doctors who attack other physicians
ADVERTISEMENT
As part of the increasing push for health care quality improvement, a lot of energy is being focused on improving our communication with patients and making sure that patient-centered care is more than just a buzz phrase. Gone are the days when the doctor-patient interaction was a wholly paternalistic one, where the doctor’s word was taken as final and absolute, and patients weren’t encouraged …
You’re lucky to be a patient in America. Here are 3 reasons why.
Flossie Marks used to complain now and then about shortness of breath on exertion. She never had chest pain and, after all, she carried firewood from the basement to feed the wood stoves and fireplaces in her large Victorian house. At 81, who wouldn’t be a little short of breath doing that?
Last summer, she finally sold the house where she and Eli had raised four children and hosted nine grandchildren …
A house call is worth a dozen tests. And then some.
We all went into medicine to save lives. Deep within even the most cynical of us, is still that pre-med hopeful that believes we can and should restart each non-beating heart, make the non-breathing breathe and fill with blood those who’ve bled, filling them back with life. We expect that a patient’s condition will improve while under our care, or at …
To the doctors who have lost patients. This is for you.
Patients admitted to the hospital ward sometimes get sicker instead of getting better right away. Often this can happen acutely. Depending on the circumstances, ranging from a “rapid response” for unstable vital signs to a cardiac arrest (a “code”), previously uninvolved hospital staff might be called on to help. Despite the commotion, these events are a period of time for the health care team to shine. At inpatient emergencies, …
Avoid the blame game during inpatient emergencies
You live like this, sheltered, in a delicate world, and you believe you are living … And then some shock treatment takes place, a person, a book, a song and it awakens [you] and saves [you] from death.
– Anais Nin
On June 12, 2013, my driver and I were on our way to Sierpe, Costa Rica from Manuel Antonio when the road entered a palm tree plantation. About 50 meters in …
The spookiness about sudden death
This place sucks had become my mantra as I powered through every bloody, chaotic, understaffed shift.
Fresh out of residency, I had accepted a job in the ER of a community hospital which — though it had appeared calm, functional, and replete with helpful consultants during the 15-minute tour I took during my interview — had turned into exactly the opposite when I …
A doctor quits. Before doing the same, consider these 5 things.
I will always remember my awkward medical school interviews. Filled with bioethical scenarios and questions to measure my ability to prevent an impaired physician from practicing, the interviewers seemed hardly interested in my prior career achievements or humble beginnings.
Such discussions carried on through the first two years of medical school. They never taught us how health care reimbursement works or why …
A tragic physician story the match doesn’t want you to hear about
Get free updates delivered free to your inbox.
