The doughnut shop I pass on my drive to the hospital isn’t the kind of place where you might expect to see outpourings of random kindness. It sits in the shadow of a raised highway, a few doors down from a bail bond business and a block away from a prison complex that resembles a medieval castle.
One Sunday before Valentine’s Day, the line to get served there was long, checkered …
What paying it forward in health care looks like
The headline reads, “Study: Mental illness rate higher in soldiers.”
The article goes on to offer alarming statistics:
The rate of major depression is five times as high among soldiers as civilians; intermittent explosive disorder, which results in episodes of extreme anger, is six times as high; and post-traumatic stress disorder was nearly 15 times higher than among civilians, the study found.
This would be pretty scary if true — but …
The military is off-track when dealing with mental health problems
It’s not that I was stressed out about being alone with the kids. My wife had gone out of town before. It was the darn mornings. I’m used to racing out of the house at the crack of dawn, when the rest of my family is still asleep. My most productive hours of the day are before most people even wake up. With my wife gone, the mornings with the …
Savor the moments that make a life
When I first learned to take care of patients in the hospital, as a third-year medical student, we used a mnemonic to help us remember what to order when a patient was first admitted. Patients would come in to the hospital from a doctor’s office or from the emergency room and the nurses needed a set of orders to know what to do for the patient. The mnemonic we used …
A requiem for handwritten admitting orders
I recently got back from a brief trip to Florida. I went down there to celebrate my mother’s 85th birthday. As you might expect, her social circle has shrunk in recent years, but she did get a number of cards and calls from friends and family members. The cards were on display in her kitchen, and a few calls came in while I was there. One in particular pointed out some …
The patient offered a diagnosis, and the doctor missed it
In a recent New Yorker article about him, Dr. Mehmet Oz was paraphrased as saying that “Marcus Welby — the kindly, accessible, but straight-talking television doctor — is dead.” If he believes that, Dr. Oz needs to get out of New York.
At 51-years-old, I’m a little too young to remember the television show Marcus Welby, M.D, that aired on ABC from 1969 to 1976. A colleague told me the show was pretty …
The country doctor is alive and well
I am writing this from the Apple Worldwide Developer Conference (WWDC) in San Francisco. There were many (I can not recall a set of software announcements of this scale from Apple) new technologies that were announced, demoed and discussed, but I will limit this entry to a few technologies that have implications for health care.
If you remember the state of digital …
What Apple’s Healthkit and Health app mean for physicians
You will never see my face or know my name. You probably won’t give much thought to what happens to your blood after your doctor says, “I think we need to run some tests,” and the phlebotomist draws it into the tubes with their colored tops. I know I never did, until I became a medical laboratory technologist.
Over the course of a normal day at the hospital lab, my coworkers …
Our unsung work is essential to treating patients
Earlier, I wrote about the tragic case of a young girl in California who was declared brain dead after what most media sources called a tonsillectomy. In fact, the patient had a much more extensive procedure for treatment of obstructive sleep apnea. In addition to having her tonsils removed, she underwent an uvulopalatopharyngoplasty (UPPP) and resection (removal) of her inferior nasal turbinate bones.
As I stated before, I …
Must a surgeon mention death as a complication?
Whatever we learn to do, we learn by actually doing it; men come to be builders, for instance, by building, and harp players by playing the harp.
-Aristotle
I groaned. “Don’t make me operate with him again! I assisted him in surgery just last week!”
I was low man on the totem pole and there was no point arguing. All of the residents and fellows kept track of the rotation and I knew …
A surgeon hopelessly disinterested in teaching
The fate of the Affordable Care Act (ACA) will be the big issue in the upcoming mid-term congressional elections, with Republicans and their allies continuing to press for repeal, believing that it is a winning issue with voters (or at least the base voters who lean Republican). Opinion polls are not as clear-cut, though. Although more Americans continue to have a less favorable than more favorable view of the law, …
4 ways to improve the Affordable Care Act
There is, of course, stuff we can chew and swallow that isn’t food. Play-Doh comes to mind. As does Silly Putty.
My thoughts turned to those substances, among others, when my friends at Time magazine asked me recently to opine on the suggestion that junk foods should carry warning labels. My first inclination was: No, that’s too much. But then it dawned on me: Is anything that …
Should junk foods carry warning labels?
I argue with my father a lot. He works as an intensivist at a community hospital in Indianapolis while I am about to graduate from a highly academic internal medicine program in Chicago. Needless to say, we have very different perspectives.
He sometimes expresses views similar to those written in an article, “When I Was a Resident: How Duty Hour Rules Are Creating a Lost Generation of Physicians.” I started residency the …
Duty-hour regulations do not define me as a doctor
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Whether it’s a knee replacement avoided for years or an urgent life-saving tumor removal, when the decision for surgery occurs, too often the patient begins a journey into a complex system of fragmented medical care. Perioperative care, which generally refers to the three phases of surgery — preoperative, intraoperative and postoperative — can be variable and fragmented. …
Better outcomes and lower costs: The perioperative surgical home
Next in a series.
As a patient, you have probably had the experience of meeting a physician for the first time and very quickly becoming comfortable that he or she has your very best interests utmost in mind. The sense comes quickly; you become comfortable, less anxious. Unfortunately you may have had the opposite experience of encountering a well-educated, well-trained physician who, although technically an expert, left you cold.
As a …
Do you trust your primary care physician?
I just realized what all these new insurance intermediaries, programs and organizations remind me of: derivatives. And we all remember how well that worked out for stocks a few years back.
Let me explain.
A few years back, a bunch of Wall Street financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing …
The health insurance shell game reminds me of derivatives
Computerized physician order entry (CPOE) is being rolled out across our nations’ hospitals. The old days of written, and often illegible, orders from doctors are fast becoming a thing of the past. The potential for this measure to improve patient safety and transform medical practice is unquestionable.
As a physician who has worked in several different hospitals since finishing my residency, my time in practice has coincided with the new age …
How to improve computerized physician order entry
I’ve had many Twitter conversations with cancer screening advocates who fear that the U.S. Preventive Services Task Force’s “D” (don’t do it) recommendation against PSA-based screening for prostate cancer will lead to a dramatic spike in prostate cancer deaths as primary care physicians screen more selectively, or perhaps stop screening at all.
I seriously doubt these apocalyptic forecasts (for one thing, prostate cancer causes only 3% of deaths in men, and the decline …
A physician’s guide to interpreting cancer statistics
A woman in her 70s came into my clinic recently. Her primary doc found a mass so she came to the hospital for a biopsy and passed out on the table so they scanned her head and found a mass there, too. She started radiation and then came to meet me in the outpatient clinic.
She had trouble expressing herself because she’d had a stroke two decades ago, but it didn’t …
During this visit, my job was to watch
The incidence of esophageal adenocarcinoma has increased more than five-fold over the past four decades in the U.S. While the rate of rise in incidence of esophageal cancer has slowed somewhat in recent years, this malignancy is still associated with a dismal prognosis. Barrett’s esophagus, the precursor lesion to esophageal cancer, is easily identifiable on routine upper endoscopy and can be monitored for the development of precancerous changes. We generally …
Esophageal cancer: How far should we screen?
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