This is a speech I gave recently at our local hospital when I was given a “physician of the year” award for my work managing medical detox in our community for 20 years.
At first, when I was told about this honor, I was really unsure why my clinical work in medical detox would warrant “physician of the year.”
I am not as skilled a diagnostician as many of you. I’m not …
Managing medical detox: A speech about compost
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old man is evaluated for a 3- to 4-month history of diffuse, intractable itching involving most of the body. He uses emollients regularly. He cannot identify any precipitating causes. He was relatively healthy before the onset of the itch but now feels chronically fatigued. The itch is relentless. He has used …
MKSAP: 72-year-old man with diffuse, intractable itching
I was very happy to come across a new article in the Washington Post discussing the pros and cons of shortening medical school education to three years. This article could not have come at a more timely moment for me, as I just had a discussion about this very topic last week with one of my fourth year medical student colleagues.
Sitting in her Chicago condo as she completed modules for an …
Should medical school be shortened to 3 years?
Once in a while someone asks me if it is hard to be a mother and a surgeon. Certainly, any surgeon-parent can appreciate that juggling a household full of schedules, classes, meals, bedtimes, and activities with a practice full of office visits, pre-operative clearances, post-operative check-ups, and surgeries has its challenges. And to be sure, before I became a mother I had no idea how this would impact my work.
What …
Being a mother has made me a better physician
I was recently readmitted to the hospital for my second round of chemotherapy.
I’m doing a regimen called Hyper-CVAD, which involves four rounds of two alternating cycles of treatment, for a total of eight rounds of chemo.
For my first cycle I got cyclophosphamide, doxyrubicin, and vincristine, along with an intrathecal injection of a drug whose name I’ve since forgotten. This round I’m getting intravenous methotrexate and cytarabine and TWO (insert frowny …
When undergoing chemotherapy, savor the small victories
When counseling patients and families about end-of-life care, I try to focus on a simple, clear standard. Knowing that events are overwhelming and complex, I say, “Look at each treatment, each action and each moment and ask; How does it improve quality of life?” My goal is to reduce the choices during a chaotic time of life to the simple goal of comfort.
For example, most families are very concerned about …
The role of chemotherapy in palliative care
Just a little over a week into 2014, my new year started off with a bang — literally — as I got into an automobile accident that involved my car sideswiping another vehicle and then crashing my car into a tree at 30 MPH. The car was totaled, but fortunately, I (mostly) walked away from the accident with only a fractured sternum and bruising.
Just a little over a week from …
Learning about Obamacare from a car accident
The night before I was leaving for a three-week medical mission trip, I was called urgently to the ICU to see Rachel (name altered), a previously healthy woman in her late 40s, slightly overweight with dirty blonde hair. She had started a new job as a customer service agent. Rachel was the sickest patient I had seen in months, and I could not figure out what was going on.
A week …
Influenza can make you critically ill
Overheard in the gym:
“Yeah, but I heard that ____ can be dangerous.”
“Oh, they wouldn’t let us buy it if it was.”
Lately, the public’s faith in the safety of prescription and over-the-counter drugs has been making me uneasy. Advances in drug development mean that many of us truly can live better lives through their wise use. But are we adequately guided and protected by a) regulators, b) our clinicians, c) a …
Patients need to take an active role in their medications
Case 1: You have a 94-year-old woman with multiple medical problems in hospice who develops a fever (subjectively hot to the touch), shortness of breath, and a cough producing yellow sputum. Her daughter asks if she can be treated with antibiotics “to make her feel better.” The patient is not well enough to make decisions, but in earlier conversations had stated a goal of remaining comfortable at home, while also …
When should you use antibiotics in hospice care?
Elton John had it right: “It’s sad, so sad. Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.” Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved?
Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double …
After a medical mistake: Honesty is the best policy
For many of my out-of-school hours as a child, no adult had any idea what I was doing.
This has everything to do with who I am today, in some remarkably good ways.
As a parent, I can’t help but wince at the lack of supervision I received, especially given what my friends and I did. We spent hours in really tall fir trees, pretending they were houses. I lived on Long …
Sometimes being a good parent means doing less, not more
Gastroenteritis, often called “stomach flu,” is common in children. It has nothing to do with influenza, the “true flu,” which is caused by a respiratory virus. Gastroenteritis is caused by a different set of viruses. These viruses are generally transmitted by what physicians call the fecal-oral route, which sounds kind of gross.
What we mean by that term is that the bug is in our intestinal tract and gets on our …
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I trained in internal medicine and cardiology at the tail end of the era of lifetime board certification by the American Board of Internal Medicine. In fact, my timing was perfect — I was “boarded” in medicine in 1987, and in cardiovascular disease in 1989, which (I am pretty sure) were, respectively, the last years that the ABIM offered certificates without an expiration date in those disciplines.
Late last year, I …
Board certification: Valid indefinitely is no longer rings true
The medical and health app market is growing rapidly, there’s no question about it. One as yet unanswered question though is how to regulate this emerging industry. This is something we’ve talked about before in a viewpoint published in JAMA Dermatology as well as on iMedicalApps. While it is still early on and we will in many ways have to see which approach is most suitable, its clear that some way …
Should hospitals regulate medical apps?
There is a dark cloud of discouragement, dejection, disheartenment, and all other synonyms of despair, hanging over the medical profession. It’s not that all physicians live in constant gloom and doom, although quite a few do, particularly those still in private practice, but the profession itself seems to be losing its luster.
Some doctors seem content to pragmatically adapt to the new and duller definition of their old profession, but in …
When doctors complain: How to resonate with the public
Many times over the years, I have witnessed the following scenario in my exam room.
Here’s the set up of this one act play.
Characters:
Elderly patient
Attentive daughter
The doctor
Scene 1
I’m seated at my desktop computer. The patient is seated before me. The patient’s daughter is seated next to her mother.
A patient comes to see me in the office with medical issues that strongly suggest that a colonoscopy should be performed. As an aside, …
Patients sometimes have good reasons to refuse colonoscopies
Most of us would agree that health care costs are too high in America. They must be controlled or else we won’t have a sustainable health care system here. And we should acknowledge that, on average, all doctors in America are paid higher than their overseas counterparts. But we should also agree that expenses for doctors to earn a degree, maintain that degree and licensure, and pay their malpractice premiums …
The New York Times takes a cheap shot at specialists
Before any patient can go to the operating room, they need medical clearance from their primary physician. I look at this as a good thing.
Occasionally, a routine chest x-ray reveals lung cancer. Or, blood work shows abnormal values that point toward leukemia.
The bottom line for me is that I never argue when a primary care physician or specialist, such as a cardiologist, says the patient is too sick to have …
How to proceed if patients push back
Pretty much every conversation I’ve ever had about working to change physician culture boils down to two words: “medical education.” That was especially true at the 2013 Lown Institute Conference, which focused on the issue of right care: eliminating harmful overuse and harmful underuse. This comes down to reforming the way today’s physicians practice — eliminating the ordering of expensive tests and treatments that provide little to no benefit to …
It’s never too early to talk about cost-conscious care
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