Dear patients,
It has been a hard week. I wanted to take a moment to personally apologize for all that you have endured. As one who has witnessed your pains and struggles, I can only wince with each new passing hurdle you are forced to leap over. This business of disease and illness is not for the weak of heart (metaphorically, that …
Dear patients: My skill set no longer matches your needs
With its expansion of Medicaid eligibility, the Affordable Care Act (a.k.a. Obamacare) was supposed to go a long way towards providing healthcare coverage to millions of uninsured Americans. That accomplishment was dealt a large blow by the Supreme Court, when it forbade the federal government from requiring states to expand Medicaid coverage. Nevertheless, many states plan to offer Medicaid to anyone with incomes at or below 138% of the Federal …
What good is Medicaid expansion if no doctor sees Medicaid patients?
I’ve dedicated my entire career to helping those diagnosed with cancer cope better, so they can regain the best quality of life possible. I was heartened by a recent New York Times article detailing efforts by the National Cancer Institute (NCI) to change the definition of cancer and potentially eliminate the use of the word for those diagnoses that might never …
Should the definition of cancer be changed?
In my practice, as in most medical practices, we accommodate patients’ particular needs in all kinds of ways: wheelchair accessible rooms and hallways, interpreters of virtually all languages including American Sign Language, gowns and instruments in a wide range of sizes, information sheets and videos suitable for patients with a variety of educational backgrounds.
No one questions the appropriateness of these accommodations.
But what about when the doctor or nurse requires an …
Who accommodates a doctor with a disability?
Online dating is a bad idea for teens — especially young teens.
That’s why it wasn’t particularly responsible of Seventeen Magazine to publish a blog in which “dating blogger” Isabelle Furth floated the idea of using sites like Match.com to find dates. To be fair, she had concerns about the idea, and she’s in college, so theoretically old enough to make these decisions. But college kids don’t read Seventeen. Middle school …
Why online dating is a bad idea for teens
“It looks like you’ve done very well, Mr. Smith.”
“Thank you, doctor.”
He left the patient’s room and ambled back to the nurses station, legs tired and ankles somewhat swollen. It had been a long case and now he just had to type his note, send an email message, and review his schedule for the following day. He sat down at the computer and logged in. That’s when he looked up briefly …
The young doctor’s organized orientation to electronic dehumanization
After investigating the potential of cannabis as a medication over the last year, I had a change of heart. I am more convinced than ever that we need to study this like any other medication and not deny it to people who may currently benefit.
The response to our reporting on this topic has been robust, and we will continue to seek the answers people want …
A change of heart on medical marijuana
Lung cancer screening CT took its most important step toward widespread implementation last week when the U.S. Preventive Services Task Force (USPSTF) released a draft of its forthcoming recommendation that the 9 million U.S. people meet entry criteria for the National Lung Screening Trial (age 55-79, with 30+ pack-years smoking history and quit < 15 years) should undergo yearly low-dose lung cancer screening CT.
The recommendation earned a Grade B in …
Will lung cancer screening CT become standard of care for smokers?
Not long from now, the last cancer will be defeated, and even today most with the dread disease survive. However, many still fall. This leaves us with one of the toughest questions of life. How long do you continue to fight, when death is certain? When does striving become vain hope which drains quality and creates only suffering? What makes struggle worth the …
How long do you continue to fight when death is certain?
After eating at my favorite restaurant last week, I started to think why I enjoyed it so much. I have been eating at the same place regularly for years, but never stopped to think about what makes it special. After thinking about it for a bit, I came up with one word: consistency. I know that every time I eat there I can expect the same dish prepared the exact …
Do we need less art in medicine?
Just as in marriage, the ability to communicate is essential to any successful doctor-patient relationship. In fact, the most successful doctor-patient relationships are a lot like a marriage. Both parties must be willing to listen, to negotiate and to support each other’s decisions. Outcomes improve significantly when patients are engaged in their own healt hcare. Engagement only occurs when doctors and patients are able to effectively work together to solve …
Choosing a doctor is like choosing a spouse
I have been doing locum tenens work as a hospitalist for nearly two years. One of my reasons for doing this is that the practice of medicine in the US is very interesting, and by working in very different places I get to see how things work and don’t work, and make up cool theories. I have time to read and listen to people and have become curious about several …
Should hospitals subsidize physician salaries?
Having cancer has infected me and many others with the irritating tendency to view any persistent, troubling symptom through the lens of a recurrence or a diagnosis of a new primary cancer. A friend of mine who is nearly five years post-kidney cancer treatment casually remarked the other day that he needed to see a doctor about his sore ankle: it could be arthritis, but it might be cancer, of …
After cancer treatment, primary care becomes even more important
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We’ve all heard the phrase, “When you come to a fork in the road, take it.” Well, that saying may hold particular relevance while reviewing a new research report published in the New England Journal of Medicine.
The report is an important one. It is an 18 year follow-up of a study designed to show whether the use of …
Seeking an end to the prostate cancer and finasteride discussion
Dr. Sanjay Gutpa has come out on the side of medical marijuana. To him, that is a big deal. Here is a snippet of what he said:
I apologize because I didn’t look hard enough, until now. I didn’t look far enough. I didn’t review papers from smaller labs in other countries doing some remarkable research, and I was too dismissive of the loud chorus of legitimate patients …
Legalizing marijuana: What happens if Medicaid starts paying for it?
When a doctor, a lawyer, an accountant or any other professional graduated from university, or moved to a new town, he or she would most often locate a nice little office, prepare it for the big day and hang out a shingle to let the world know that new services are available. The world back then consisted of the immediate neighborhood in the big city or an entire small town …
Independent doctors: Update your shingle for today’s digital times
Many, myself included, have written about the overuse of head computed tomography (CT) scanning in children. This concern has become more focused now that we have some data on the radiation risk of those scans. The bottom line is not that we should stop doing head CTs in children, but that we should always balance the risk against the benefit, just as we should do with all medical testing. In …
What is the ideal number of CT scans for headaches in children?
“What, me worry?” could pretty much characterize how Obamacare supporters are reacting to the news that the administration is delaying or modifying the implementation of some of its requirements. Like Alfred E. Neuman, they are expressing a public confidence that there is no reason to worry, everything is fine, the announced delays aren’t really that important, and Obamacare will be up and running and ready to start enrolling people on October 1. No worries.
“The …
Will delays pose a big problem for Obamacare?
Four months after having a knee replacement, I stumbled into the bathroom at 3am, not fully awake, hoping to urinate.
Losing my balance, I fell. The result was a compound fracture of my left leg — the one with the prosthetic knee.
Gazing at my shiny white kneecap, I lost all logic, all control. I simply cried.
At eighty, I was unprepared for this unexpected anatomy lesson: my twenty-nine years as a surgeon …
The fall and recovery of a cardiac surgeon
A few weeks ago, a middle-aged man decided to tweet about his mother’s illness from her bedside. The tweets went viral and became the subject of a national conversation. The man, of course, was NPR anchorman Scott Simon, and his reflections about his mother’s illness and ultimate death are poignant, insightful, and well worth your time.
Those same days, and unaware of Simon’s real-time reports, I also found myself caring for my hospitalized …
What I learned from my mother’s hospital admission
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