The potential to do dramatic good, as is the case with surgery, means that sitting and staring back at you at the other end of the see-saw is a grinning dysmorphic ogre. He keeps his eyes locked on yours, staring with the smug certainty that you can’t toss him off, up when you’re down; down when you’re up. The ugly little sonovabitch never goes away. It’s an issue for every healthcare provider. Were it …
A tiny baby on a big table in a huge OR
Even in its purest form, in the most perfect patient-centered medical home we can create, patients will sometimes need to move beyond the confines of primary care.
Each of us in primary care has a point that we choose not to venture beyond, into the realm of subspecialty medicine where we lack the experience and tools and support to fully implement complete care for patients with these particular problems.
It may be …
When patients move beyond the medical home
“Sticks and stones can break my bones, but words can never hurt me.” I learned this saying when I came to America, but before that, I learned a different story. A wood cutter got lost in the forest, it was getting dark and cold. He met a bear, who offered him to come to his den. The man entered and said “It stinks in here!” The next day the woodcutter …
Our words leave the most lasting impression
An excerpt from Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital.
At last through the broken windows, the pulse of helicopter rotors and airboat propellers set the summer morning air throbbing with the promise of rescue. Floodwaters unleashed by Hurricane Katrina had marooned hundreds of people at the …
Life and death in a hospital ravaged by Hurricane Katrina
An excerpt from The Heartbeat of Success: A Med Student’s Guide to Med School Admissions.
What’s all the fuss about extracurricular activities? Isn’t doing well in your coursework and on the MCAT enough to get into medical school? Nope. Extracurricular activities and employment are opportunities to explore your interests, become involved in your community, develop a project or earn money to support yourself. Saying you love to …
Applying to medical school: The fuss about extracurricular activities
A US District judge in South Carolina has ordered Tuomey Healthcare System (THS) to pay $238 million for violations of the Stark Law and False Claims Act (FCA). The judge originally ordered Tuomey to pay $277 million, but one of the government attorneys pointed out the judge had awarded $39 million more than the government had asked for, and the penalties were immediately reduced.
This case began in 2005 when Dr. Michael Drakeford filed …
Health care fraud: A hospital rolls the dice and loses
An excerpt from The Little Boy Inside and Other Stories.
“Hey Altman,” the chief resident says.
We’re in a small group outside a patient’s room. I look up.
“One of the high-fivers needs a central line over on Two North.”
High-fiver. Another code word from the secret language of medicine. High-five means HIV, positive or full-blown AIDS. Probably half the patients on Two North are dying of AIDS. “Got it,” I …
A medical short story: High five
All people are gifted. As an emergency room physician, I see a wide variety of gifts, such as yodeling, knitting, and swearing (mostly swearing). One gift I rarely see is math. As a whole, the U.S. sucks at math. When compared with other nations, the U.S. ranks 32nd in math (though first in confidence). Despite this, we expect mathematical coherency …
Reinventing the pain scale in the emergency department
The Affordable Care Act is a hefty 2,000 page law that is extraordinarily complex. Actually, have you ever seen a 2,000 page anything that’s not complex? It should come as little surprise that just over half of U.S. adults struggle to explain any of the components of the law. The survey conducted by the American Institute of CPAs, also found 48 percent of younger …
What the Apple Store can teach health exchanges
“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of …
Medical students may find themselves without a job
Hospitals struggle to get doctors and nurses to wash their hands. That’s a serious problem, since hand washing is one of the keys to reducing healthcare acquired infections that afflict more than a million patients a year and kill over 100,000. And it’s one of the reasons you should try your best to stay out of the hospital.
For the past few years …
Should patients be responsible for physician handwashing?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 31-year-old woman with cyanotic congenital heart disease is evaluated during a routine examination. She has Down syndrome and is accompanied by her guardian. She has never had cardiac surgery and has no symptoms.
Her blood pressure is 110/80 mm Hg bilaterally. The cardiac apex is displaced. A left parasternal impulse is present. There is …
MKSAP: 31-year-old woman with cyanotic congenital heart disease
365.
That’s how many days I’ve been away from our health care system. A year ago was my last day in my old practice. Here’s what I wrote in my journal:
This is it. This is the last day of work at Evans Medical Group. It’s more weird than anything. I am sad to leave the comfort of my old job, but happy to be able to spread my wings and be …
One year after being away from our health care system
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I was spiking a fever.
It was as if someone flipped a light switch inside my body. I could feel the sensation rise through the chest, and trample the dazed contents of my skull. Light, however, was a poor, lazy metaphor. There was no heat, only stimulation.
My belly ached from the repetitive heaving that preceded the fever. I envisioned the sandwich I had eaten that afternoon. I pictured small bacteria crowding …
Being the kind of doctor that I would want to care for my loved ones
I love football.
There is one thing that I absolutely believe to be true about the sport I love.
Any given team can beat any other team on any given day.
Sometimes my love of sports and the little metaphors that sprout from it spill over into my workspace as well.
At the end of each shift I work in telepsychiatry, one of the last things I do is complete an electronic log of …
The vast majority of folks I see want to kill themselves
For most of us, we have never experienced the current pandemic of senseless violence that we read about and visualize every day. I challenge you to find a newspaper tomorrow morning, or listen to a news broadcast, that will not report on dark and pernicious inclinations and accomplishments of evil practitioners.
If that challenge is not sufficient, then find an American over the age of 70 to attest that the world …
Targeting gun owners is an easy target, but off the mark
The research published about texting and driving never seem to add up to my in-real-life experience. In a typical day driving in Seattle I see countless people with their phones out, many with it wedged at the steering wheel, stuck between their right hand and the right turn signal post. Like all of us have come to observe, it’s the unusual or unexpected driving patterns that alert me to look …
Texting and driving: How to change old habits
As the Affordable Care Act (ACA) is implemented, many physicians are beginning to take stock in their own professional and personal lives. The practice of medicine is a privilege but it is also an occupation that can consume nearly all aspects of a physician’s life. In the past I have struggled with my own “work-life balance” and I have shared my thoughts on burnout in my previous blogs.
As a …
Will the Affordable Care Act worsen physician burnout?
A sudden life-threatening illness is every family’s nightmare. A loved-one suddenly develops an overwhelming infection or is in a terrible accident. She is rushed to the intensive care unit (ICU) and is put on a ventilator (breathing machine). Many medications are started or she is rushed to surgery for her traumatic injuries.
To the family, the first day or two is a blur of life-saving treatments, painfully waiting for the next …
The gaps in our current care of critically ill patients
A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …
What do we do with the extreme elderly?
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