The phone rang one evening and a pleasant voice was on the other end. “Hi, my name is nurse so-and-so and I’m the educational coordinator for your upcoming knee surgery. Do you want to go to the patient orientation session?” she asked. “It’s very helpful to go over things before and after your surgery and to answer any questions you might …
A cardiologist undergoes knee surgery. Read what he learned.
Background
Under the 1997 Death with Dignity Act, Oregon was the first of the now-handful of states to allow physicians to write a prescription that, when filled and administered, would cause intentional death.
Let me be clear: Death with dignity is not offered to Oregonians en masse or even on a whim. To legally qualify, a patient must be 18 years or older, a resident of Oregon, capable of making and communicating …
Death with dignity: Perspectives from a medical student
One of my residents presented some research that she had completed under my supervision. Since I left the staff of the U.S. Preventive Services Task Force four years ago, it has been my sense that the Task Force has substantially lowered its evidence “bar” for recommending a preventive service, an impression confirmed in private discussions with colleagues who closely follow the group’s activities. In a JAMA editorial published last year, Drs. Steven Woolf …
Evidence-based preventive care: Should it be free?
In the pediatrics playroom, the medical team and I, a medical student, hunkered down in child-sized chairs to review patient progress notes. A television screen nearby diverted my attention. On CNN, video of protesters alternated with Eric Garner’s final moments. The television was mute, but I could hear Garner say, “I can’t breathe …I can’t breathe …” One moment, he is …
Why you should protest the deaths of Eric Garner and Michael Brown
Preventing infection after surgery is very important as not only are these infections often uncomfortable and make you feel very sick, but they also increase the risk of more serious complications. For example, if you are less mobile because of an infection after surgery you are at higher risk for a blood clot or if you need a prolonged hospitalization because of an infection in your surgical wound you are …
Antibiotics during gynecological surgery: When are they necessary?
My dad was a wonderful guy who could fill the room with his personality. He grew up during the Great Depression and was a World War II veteran. I was thinking of him recently while considering how much health care delivery has changed in the last 100 years.
When asked about his health, my dad would always say, “I feel great. I don’t have any aches or pains.” This is telling. …
Can connected health improve the lifestyle challenges patients face?
There are certain universal laws that appear to govern the broader workings of the world around us. For those of you unfamiliar with Pareto’s principle, it’s a concept that was first applied in economics and then found to be a governing rule in a whole host of different arenas. It’s no understatement to say that understanding and acting upon this concept can be transformative, not just in your work but …
The 80-20 rule: Apply Pareto’s principle to hospital medicine
Every fall I write about bronchiolitis because it is one of the most common respiratory ailments affecting infants and children under about two years of age. It is the most common reason infants end up in the hospital during the winter and early spring months. Every year we get severe cases in the PICU. Pediatricians have struggled for decades to figure out how to treat bronchiolitis but we don’t have …
Analyzing the new treatment recommendations for bronchiolitis
The safety concerns that keep clinicians awake at night often aren’t issues that you could fit onto a safety and quality dashboard. They aren’t the kinds of things that feed metrics on the CMS Hospital Compare website or any of the other sources of publicly reported quality measures. They are intensely local, and no less important for being so.
This reminder came to me recently during a quarterly meeting of Comprehensive Unit-based …
Hospitals have to strive for zero harm
Is it just me, or is the world of medicine getting way more complicated?
Sometimes I long for the good old days of practicing medicine.
First, the hospital switched over to electronic medical records, which required us to attend Saturday morning classes to learn how to tell the nurses our patients could go home after surgery.
Next, our office got an insurance memo that …
Don’t look back to how medicine used to be
Two weeks ago, I went on an awesome vacation to Las Vegas. It was my first paid vacation of my medical career and by all accounts it went very well. I won $50 on the penny slots and got to see my old friend, the Hoover Dam. Many “Vegas vacation” lines were uttered as we walked across the dam bridge and asked all the dam questions we could think of. …
Death is not a failure of the health care system
Postpartum depression may be a misnomer. A more accurate term might be postpartum neglect — not by mothers, but of mothers.
The human infant is uniquely helpless in the early weeks and months of life. His arms fly up over his head at random moments in a primitive “startle reflex.” His sleep patterns have no rhyme or reason. He eats and poops round the clock. Serving an evolutionary purpose, in part to achieve an upright …
Postpartum depression may be a misnomer
People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments.
These days, America’s emergency rooms have filled …
Holidays in the ER: What you’ll see is a lot of humanity
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Recently, allegations have been spread by women who claim that as teenagers, they were sexually assaulted by Bill Cosby. Some have not made any mention of these crimes until decades later; while others have said that they did report the allegations at the time of the assault, but were not believed. Due to Cosby’s notoriety as a celebrity, this has fueled …
We must listen to and assist all young victims of sexual assaults
I was a fourth-year surgery resident, on the transplant team. It was a difficult rotation, because the doctor who ran it was sexist and got along better with you if you flirted with him. He made innumerable sexual wisecracks in the OR while we were working, and preferred to round with his arm around me as he made further innuendoes.
I wasn’t …
The time I almost got fired for saving a young woman’s life
Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything from bowel and bladder habits to pain control, not to mention catching early warning signs of infection, mental status changes, or …
5 ways how doctors can round with nurses
In 1978, under the pseudonym Samuel Shem, psychiatrist Stephen Bergman published “The House of God,” an iconic novel drawn from his medical internship in Boston in the early 1970s. Earlier this year, Dr. Bergman spoke at the commencement of the New York University School of Medicine. With his permission, the following is adapted from those remarks.
I began writing The House of God as a catharsis, to make sense of what seemed like the worst year of my life.
These are …
Stay human in medicine: Lessons from The House of God
The conversation was almost comical, until I thought more deeply about it later. Apparently I was on “the list.” Insurers make such lists for customers who are searching for a doctor who accepts their coverage. Every so often my name comes up on these lists, and I get a smattering of phone calls from perspective patients. Maybe a few times a …
Our health care system makes no sense. But what if it did?
Once upon a time, in a medical school far far away, I was taught that my sacred oath was to the patient. The one patient; not the patient down the hall, in the next town, or in a country halfway around the world. I would commit my heart, soul, sweat and blood to the suffering and healing of the person directly, immediately in my care. This was a noble calling …
Physicians must expand the vision of their role
An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation …
Why does treating heart attacks cost so much money?
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