While on my inpatient psychiatry rotation, I had the opportunity to work with an adolescent female with a troubled past and a significant history of psychiatric illness. It was through coloring that her barriers broke down and we were able to establish a safe space for difficult conversations. She was safely discharged two weeks after her suicide attempt. As she left, she gave me a hug and handed me this:
Through our patients we find ourselves
Recently, I treated a young patient with diabetes in the hospital. Throughout her young life she had struggled with glucose control, and on this day her struggle left her in a state of diabetic ketoacidosis (DKA). DKA is a life-threatening condition that diabetics often face when their body is unable to uptake enough glucose, leading to utilization of fat and consequential build up of acidic ketones, which cause blood levels …
Pizza or insulin: What does our society value more?
As we enter the New Year, I like to reflect on where we’ve been and where we’re heading in medicine. By far and away, this is the most tumultuous time I have ever experienced in health care.
It’s strange really.
I thought I’d try to make some realistic predictions of what patients should expect in the year ahead now that the “Patient Protection and Affordable Care Act” (PPACA) begins to sink it’s …
3 health care predictions for the New Year patients should know
Recently, while on a locums assignment in a very small, rural hospital, I cared for a gentleman with chest pain. His discomfort seemed classic for an MI, but his EKG did not. So I treated him as normal with aspirin and nitrates, and waited for his cardiac markers to come back from the lab. In the interim, his chest pain worsened. Sure enough, he developed an anterior MI. The tombstones …
Rural medicine reminds physicians of their value
Henry Markram is one of the world’s leading neuroscientists. After a brilliant career of influential research, he has been charged with leading Europe’s Human Brain Project, a $1.3 billion project that aims to build a supercomputer model of the brain. But Markram is also the father of a boy with autism. And that has changed everything.
Maia Szalavitz’s poignant article The Boy Whose Brain Could Unlock Autism chronicles Markram’s personal and scientific …
The intense world paradigm for understanding autism
I love digital media. I love my iPhone and my iPad. And as much as I admire those who go on digital vacations, I’m not going to do so anytime soon. But I had two moments recently that made me realize that we all need to take a closer look at our digital habits.
The first was when I was leaving work one evening. As I waited at the crosswalk outside …
3 digital resolutions for 2014
I don’t have much in the way of eyebrows. They were victims of too much plucking back in the 1960’s and when you do that, sometimes they don’t grow back. There’s a very nice woman in Solana Beach who shapes and darkens what I have left, infrequently, when I bother to think about it which isn’t very often.
I was in there about a year ago when she told me, “I …
The cost of peace of mind: A case of unneeded bilateral mastectomy
One of the spinoffs of being an oncologist is that you do not to take the world for granted. Each morning, I walk around the yard and smell the morning breeze. I am thankful for my children, my wife and my own health. I am thrilled, if occasionally skeptical, to have the opportunity to pay taxes in a country that I love. So, who would believe I would take our …
Why I will never take EMRs for granted again
I have two patients with phenylketonuria (PKU). Both are about my age. Laura, a non-verbal, slender woman with weathered features but the mind of a very young child, lives in the community. Her sister, Regina, has lived all her life in a nursing home. She doesn’t have a wrinkle in her face, and seems mostly unaware of her surroundings.
The two girls were born several years before Dr. Robert Guthrie developed …
2 patients who are part of the history of medicine
The exam room and hospital bedside are usually non-partisan zones. Though there have been exceptions — anti-nuclear activists Dr. Benjamin Spock and Dr. Bernard Lown come to mind — physicians tend not to be particularly political people. And even when they are, their politics don’t usually intersect with their clinical work. When President Reagan was shot and joked with surgeons, “I hope you’re all Republicans,” the response from one doctor (a Democrat) …
An anesthetized patient fell to the floor headfirst from an operating room table during a laparoscopic appendectomy in Scotland. The table had been tilted into an extreme head down position to facilitate the operation. Fortunately, no injury occurred.
The Edinburgh Evening News account says that there were 10 staff members in the room at the time the case started, but no one had placed a safety restraint on the patient.
A …
A patient falls off the OR table: Who’s to blame?
With the exception of rare and particularly bleak days, I don’t tend to think of myself as a moron — nor, as far as I can tell, do those who know me well and love me. I will hazard a guess that neither you nor those who love you think of you as a moron, either. So let’s be bold, proffer one another the mutual benefit of …
We are missing the big picture when it comes to nutrition
I guess it shouldn’t have been a surprise.
Her house was exactly as I expected it to be. The door couldn’t have been more fitting; red wood with a green holiday wreath attached perfectly in the center. The carpet was so white that I almost took off my shoes on the front porch before entering through the threshold. The room was warm. The ambient temperature was accentuated by a plethora of …
Inside a home visit: Seeing her as she really was
ADVERTISEMENT
I was a junior medical student, wearing a short white coat, pockets stuffed with reflex hammer and spiral bound Washington Manual of Therapeutics, rubber tourniquet and pens and pads. I was on a rotation out at the Dwight David Eisenhower Army Medical Center in Augusta, Georgia. DDEAMC was not too far from my home away from home, the Medical College of …
How to sign your name: A decades-old lesson that still resonates
Is Physician “Shadowing” a Shady Practice? asks Dr. Elisabeth Kitsis in a post at the Doctor’s Tablet, a blog run through the Albert Einstein College of Medicine. She concludes that yes, it is, and invites readers to share their opinions on having high school and college students shadow physicians.
I was reminded of my fantastic 8 week shadowing opportunity as a college student through the Project AHEAD program at the Charles B. …
Shadowing physicians continues the cycle of paying forward
How’s my practice doing?
I am now up to nearly 400 patients, and while Jamie and I have talked about hiring a new staff person, we seem to be hitting our stride in this different practice model and have not yet been overwhelmed. New patients are coming with regularity, some still coming from my old practice and many others through word-of-mouth from satisfied patients. Yes, people still seem very satisfied with …
A year into direct pay: It doesn’t suck to be a doctor anymore
I was recently in the break room at the hospital scarfing down a power bar between three-hour cases. The truth is, I was multi-tasking: eating, writing on a chart, and checking my email in my phone.
I had received an email from a businesswoman, whom I have known for a few years. She wanted to know if I wanted to join her for lunch next week.
I had to laugh out loud.
The …
Doctors experience the world a bit differently
His right testicle had jumped into his abdomen after he lost control of his motorcycle on the highway. My 43-year-old patient, whom I’ll call Richard, in otherwise healthy condition, was brought to the ER with severe pain. Fortunately, his testicle was still intact and only needed to be put in the proper place.
I am an attending physician in the emergency department and trauma center at San Francisco General Hospital. I …
Price transparency alone won’t solve our health system’s ills
We guard the privacy of patients in my hospital zealously — we take care of a lot of celebrities since we’re right in the shadow of Beverly Hills. And of course we live in terror of HIPAA violations, those federally mandated HHS rules that protect individually identifiable health care information and could bring down “civil money penalties” upon us if we don’t keep our patients’ medical records strictly confidential.
But for …
Flu vaccination by government mandate: A violation of HIPAA
A colleague once said, “Every plan is excellent, until it’s tested. It’s execution that’s the problem.” And so it is.
Clay Shirky wrote an excellent article about the gulf between planning and reality. Although the focus was on the misadventures of Healthcare.gov, the US government’s insurance exchange website, the broader lessons that he presents are worthy of consideration in many other settings.
Shirky notes: “The management question, when trying anything new, is ‘When does reality …
Bridging the gap between planning and reality
Get free updates delivered free to your inbox.
