A Southerner at heart, I find myself in love with places. We are forever pining on about our family homes, our small town barbecue restaurant, the sound of some lake where catfish splash in the night, or the woods where our favorite treestand sits. Sometimes our afflictions for place become the stuff of novels; Scarlett O’Hara is always associated with her beloved Tara just as Faulkner is ever infused into …
Hospitals are part of who we are
Susan was 76 and dying at home in the days before hospice and before the use of the POLST form. A neighbor came in the relieve Susan’s daughter who went to the store. Suddenly Susan stopped breathing and the neighbor called 911. The medics came and, not having instructions to the contrary, did CPR and brought her to our ER unconscious and intubated. The ER physician called me in the ICU saying, …
When the POLST form is controversial
I asked why physicians were dying by suicide. Here’s what they told me:
“I definitely graduated from med school with PTSD. It has changed me forever. My mom’s friend that I have known since I was born saw me for the first time since I went to med school and she [told my mom], “She has changed so much. Was it worth …
Fifteen minutes. Give or take. That’s about how long a patient typically spends with a primary care doctor during an office visit. If you’re lucky enough to be healthy, maybe that visit comes once every year or two. Or if you’re less healthy, maybe every few months. In either case, it’s not a lot of time. Not a lot of time to share all the relevant developments. Not a lot …
Making the 15 minutes more valuable: It’s time to flip the clinic
In my 30 years as a practicing psychologist, I’ve seen a lot of patients with many diagnoses. In that time, I’ve seen treatment approaches evolve. Periodically, when news of a mass shooting makes the headlines, the dialogue about mental health will rise to the top of the national agenda, but — in general — we still have a long way to go in our attitudes toward mental illness.
I think it’s …
It’s about mental health, not mental illness
From an early age, I was encouraged by my family to consider a career in medicine. I was told it was a well-respected profession, offering financial security and community respect. Seeing the white coats, stethoscopes, and grateful patients at my childhood doctors’ visits made the field mysterious and intriguing, and these stuck with me as I grew older. I also developed a love for music at an early age; I …
Being a whole doctor serves patients best
News broke recently that Daniel Murphy, second baseman for the New York Mets, recently took two days off for paternity leave, causing him to miss Major League Baseball’s opening day and the season’s second game to be with his wife and child.
Mike Francesa, a popular New York sports radio personality, devoted about 20 minutes of his Wednesday broadcast on WFAN to a rant against paternity leave. According to him, a …
Real men don’t leave their wives right after birth
Physician colleagues and their hospitals have been the targets of direct attacks during the past three years in Syria. According to UN war crimes investigators, Syrian forces have deliberately targeted hospitals, attacked field hospitals, and prevented patients from receiving medical care.
A United Nations Commission of Inquiry independent panel published its findings to draw attention to what it called “an enduring and underreported trend” in the conflict. The report …
Doctors on the front lines of the Syrian conflict
I have a set of wind chimes hanging from an arbor that catch my attention whenever I am out in the garden and the breeze kicks up. They were given to me by Mrs. Mary Marlboro’s niece. Mary had purchased them while in hospice with instructions for her niece to give them to me after she passed on. I had cared for Mary for several years after I removed her …
Can one have a voice without vocal cords?
I recently published an article on that garnered a lot of attention. It was titled,”The Myth of the Entitled Single Mother Remains as Relevant as Ever.” In it, I reversed the popularized notion that single mothers are a societal liability and suggested that instead, they are powerful forces in our local economies and influential leaders of future generations. I presented the idea that how society …
Addressing the structural forces that perpetuate inequality
From years of writing about chronic pain and illness, I’ve learned that young people carry several extra burdens, especially when their disability is invisible (as is more often the case than not). This piece focuses on young people, although some of its points apply to people of any age, depending on their circumstances.
1. Young people are treated as if their health issues can’t possibly be chronic. I confess that before I …
7 ways chronic illness imposes an extra burden on the young
Every year, it is estimated that more than 126,000 hospitalizations and nearly 17,000 deaths in this country are linked to overuse of over-the-counter (OTC) pain medicine ingredients — specifically acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs).
In my own practice, it’s not uncommon to find patients who are taking two to four times the recommended doses. This can have tragic results.
Recently, we had a young woman with liver failure. She had been …
What physicians can do to curb over-the-counter medicine misuse
You won’t read about the International Classification of Disease (ICD) on TMZ or hear it discussed on The View, but it has the potential to be an unpleasant October surprise in the healthcare world. It is a list of codes that physicians and hospitals use when billing insurance companies. These codes cover all manner of medical diagnoses for diseases, conditions, and injuries.
The first version of ICD appeared in 1946 with …
ICD-10 will accelerate the demise of private practice
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Postmodern cultural values have seriously impacted medical care and the patient-physician relationship. Corporate control of medical care, computerization of medical information and consumerism in the clinical encounter, plus the destruction of the myth of the physician are all embodiments of postmodern values.
Postmodern thinkers such as Foucault, Lyotard, Levinas, and Bauman offer powerful insights that can be applied to understand how current values have changed medical practice, including issues such as …
How the postmodern ethos challenges medical professionalism
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain at rest and no nocturnal pain. There are no clicking or locking symptoms. She has tried naproxen and ibuprofen but developed dyspepsia; acetaminophen provides mild to moderate relief. …
MKSAP: 76-year-old woman with left knee pain
Obesity and obesity related illness accounts for an enormous health care expenditure in the US today: approaching 150 billion dollars annually. In an era of health care reform and cost containment, preventative medicine is essential to success. Rather than rearranging networks, separating doctors from patients and limiting choice, our government may be more effective in reducing health care costs by focusing on slimming waistlines throughout the US.
According to a recent …
Reduce health costs by preventing childhood obesity
Imagine you want health care. You go to your doctor who recommends a medication. Your doctor tells you that the medication used to be prescribed one way 14 years ago, but very rigorous, more recent studies indicate a lower dose is just as effective. And has fewer side effects. And is less expensive.
You are pleased because a) your doctor is up on the latest medical therapies, and b) the least …
Arizona lawmakers have stepped into the doctor’s office
Confidence is contagious. So is lack of confidence.
-Vince Lombardi
“So, can you leave this here with us?”
I was part of a group of U.S. surgeons traveling to Eldoret, Kenya, seeing patients and helping the Kenyan ENT surgeons learn surgical techniques. Our two week mission allowed us to work across-the-table from Kenyan colleagues, discussing surgical approaches, demonstrating techniques, and reviewing all aspects of surgical care.
“I have never seen such a thing!” my …
Technology and confidence: Working with surgeons in Kenya
It’s a strange business we are in.
I can freeze a couple of warts in less than a minute and send a bill to a patient’s commercial insurance for much more money than for a fifteen minute visit to change their blood pressure medication.
I can see a Medicaid or Medicare patient for five minutes or forty-five, and up until now, because I work for a federally qualified health center, the payment …
If a doctor isn’t face to face with a patient, is he still a doctor?
After a relaxing weekend with my daughter, son-in-law and 2-year-old grandson, my wife and I made our way to the Atlanta airport to begin our trip home. The end of a trip — even a short weekend — is always sad. I never look forward to the travel home and usually want to snap my fingers and skip the travel.
My wife and I have trouble packing light and so, when …
Make a personal connection in the ER
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