Not too long ago I suggested hospice to a patient who had progressive cancer, although she likely had months to live. “I don’t think it is time,” she replied, “hospice is for morphine.”
“That is not how I see hospice,” I replied, “I think hospice is about getting the best care and support, even if there is no real treatment for the disease. It is about living well, maybe better. Even …
When hospice is about living, not dying
What I found most disturbing about the man’s arm was not the deep, stellate laceration on the underside of his biceps.
It was the swastika tattoo next to it.
“Sir,” I said, “we’ll have you fixed up in no time. I’m going to numb up the wound, irrigate it, then repair the laceration with sutures and send you home on antibiotics and pain …
When treating neo-Nazis, should physicians have a choice?
A recent case that I saw in consultation at the patient’s request highlights the pervasive problem of overdiagnosis and overtreatment of endometrial hyperplasia. This 46-year-old woman was diagnosed with simple hyperplasia without atypia within an excised endometrial polyp, for which both her gynecologist and pathologist recommended hysterectomy. The basis for this recommendation was a perceived increased risk of endometrial cancer, either currently lurking within her uterus or to be developed …
Why hysterectomy for many endometrial hyperplasias is often overkill
Go into any hospital today and notice that between every great nurse and patient sits a computer terminal. The quantified health movement has created the great digital divide, between the patient and everyone else.
The nurse of old used to actually touch the patient. No more. Now, they wheel in a computer console, sit down and record the digital output of the wired up patient, every vital sign, every drug order or …
Quantified health and the great digital divide
I wear a lot of hats in my job. Though I’m a physician who specializes in the practice of anesthesiology, I don’t spend all day every day at the head of an operating room table.
Many days I spend in an administrative leadership role or conducting research studies. These functions support the best interests of my patients as well as the science …
What I love about being an anesthesiologist
Every so often you have a patient in your practice that you sort of know, but really don’t. You’ve seen the name somewhere, but your mind draws a blank when asked about him. You may even have a vague idea of what he looks like, but if he were to bump into you on the street, you won’t even recognize him, despite the fact that you’ve been inside his heart …
The long, tragic odyssey of a HMO patient
Being a nurse is a risky job. Needle-stick injuries, violence, back injuries, and infectious disease are all potential threats. But until recently, nursing was not usually viewed, like police work, or commercial fishing, as a life-endangering career choice. Those who risk their lives for their work go into it knowing the risks, and receive intensive training and protective gear.
Not so the …
Ebola: Who’s looking out for the nurses?
I wish Dr. Nancy Snyderman the best of health. I’m happy that she remains free from the deadly Ebola virus, and hopefully it will stay that way.
It must have been extremely difficult for her to be under quarantine, especially since she was feeling healthy. It’s simple: When you feel good, you want to be active. In Dr. Snyderman’s case, she …
Nancy Snyderman shows indifference for her role as a medical communicator
In June 2014, the first patient with Ebola arrived at Liberia’s county hospital, Redemption. As tensions grew around the city of Monrovia, administrators at JFK Hospital began to devise plans for handling patients with suspected Ebola. Officials from the CDC then came and gave us lectures. They discussed prevention of spreading and what our plans would be in the event of a potential outbreak. Before that moment, there were no …
Working in an ER in Liberia: A physician shares his story
Many physicians are discouraged by the state of medical practice in 2014. Maintaining job satisfaction and well-being for the duration of a decades-long medical career can be as daunting as completing an uphill marathon. In addition to keeping up with the explosion of medical knowledge and maintaining certification in your specialty, what concrete practices can you adopt to insure that you will make it to the finish line in good …
8 tips to survive the marathon of a physician career
I recently attended my 10-year medical school reunion class party, and I have to admit, I had a great time. From the beginning, my class was special. We had 104 amazing people who were truly inspired to make a difference.
However, regardless of how talented and hard working you are, medical school is one of the most challenging things you will ever …
To medical students and residents: It really does get better
We all start out as idealistic medical students, downright puppy-like in our devotion to our patients, eagerly bounding to their rescue and spending hours listening to their concerns. Somewhere along the way, we start shutting down, seeing patients as demanding and feeling as if we’re always fighting them off.
I used to do it too; hide behind my layers of staff, complain to …
Why doctors are afraid of their patients
Pain is one of the few things in life universally common to all races, all ages, virtually all people for the history of time. Though it is always with us, it is also the most difficult of human feelings to describe or even talk about. Doctors in an attempt to understand the degree to which we hurt invented a 1 to 10 pain scale.
I was very fortunate my first 47 …
The pain scale: Rating your pain needs context
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Few will argue that the overall health of Americans has deteriorated in the past quarter century. Diabetes or prediabetes afflicts nearly 120 million people. Roughly two of three Americans are either overweight or obese. Pharmaceutical companies focus on drug discovery as a solution. Thousands of apps for smart phones are being developed to change our destructive behavior. But, lacking in both of these is a true solution, one that draws …
Improve patient behavior with virtual assistants
On July 1, 2014, I retired after 35 years in practice. Or at least so it seemed. Before and after retirement, my cardiology group asked if I might be interested in part-time work. At first I said no. Due to my retirement, a physician’s poor health, and one partner’s departure due to chronic complaints of being overworked and under-appreciated, the group found itself without three doctors. As my retirement approached …
A retired cardiologist goes back to work. Paperwork greets him.
With all the news about enterovirus 68 sending hundreds of children to hospitals, it’s easy to panic when you hear about a case in your neighborhood — or, even worse, if your child starts coughing.
But please, don’t panic.
This virus has certainly caused trouble and tragedy. But enteroviruses are incredibly common, causing 10-15 million illnesses a year — and usually, those illnesses are minor. This one, for reasons we don’t fully understand, is …
Enterovirus 68: Why you shouldn’t panic
Polypharmacy, or use of multiple psychiatric drugs, for treatment of attention deficit hyperactivity disorder (ADHD) is on the rise. A recent study compared treatment with basic therapy (stimulants plus parent training) with augmented therapy (those two plus risperidone, an atypical antipsychotic). The study concluded that treatment with risperidone was superior.
When children show dramatic improvements in behavior on risperidone, now being prescribed with increasing frequency for ADHD and …
Should we use antipsychotics to treat ADHD?
This New York Times article stimulated thoughts about teaching internal medicine: “Better Ways to Learn“:
In the new book, “How We Learn: The Surprising Truth About When, Where, and Why It Happens” (Random House), Benedict Carey, a science reporter for The New York Times, challenges the notion that a high test score equals true learning. He argues that although a good grade may be achieved in the short …
Improve how we learn in medicine
An excerpt from Getting Into Medical School: A Comprehensive Guide for Non-Traditional Students.
Tranditional vs. non-traditional
Traditional premedical students enter a four-year university directly after high school and begin taking courses for their major while also working on their required pre-med core sciences in order to finish their studies in a timely fashion. Most of these students finish their sciences by their sophomore year in hopes of taking the Medical …
Getting into medical school for the non-traditional student
A friend of mine, a diabetic who has been pretty passive about his medical care, suddenly learned the importance of patient engagement a few weeks ago when a matter affecting his pocketbook grabbed his attention. A bill arrived from Express Scripts, the pharmacy benefit manager (PBM) for Emblem Health, a Medigap plan offered to former New York City employees.
For years my friend had been taking the drug gemfibrozil that diabetics …
The rise of generic drug prices: It’s tragic for patients
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