When I was a resident in radiation oncology, I thought I already knew a lot about medicine. After all, I had just completed an internal medicine residency, and had taken and passed my boards. Needless to say, I was more than a little bit irritated the first time a patient “coded” in the radiation therapy department and I was shoved out of the way by the intern on the code …
Know the human being behind the diagnosis
Folks must think than all doctors know all things medical. I know this is true by the questions that I have been asked over the years. While my expertise spans hemorrhoids to heartburn, I am routinely queried on medical issues well beyond the specialty of gastroenterology. When I can’t answer questions about a new medicine for hypertension or if an MRI of …
Does your doctor know ACLS? Does it matter?
A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty.
When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate …
Calling a consult: Disrespect from specialists hurts patients
We’ve run amok with wearing gloves in the hospital. And by “we” I mean every healthcare worker in sight. I see people putting on gloves before they’ll give a patient a clean warm blanket. This is not only ridiculous, it’s actually harmful. Here’s why.
We learned the hard way in the 1980s, during the early days of the AIDS epidemic, that the …
Hand hygiene in hospitals has gone too far
When Tiger Woods addresses the ball, he’s focused like a cat that heard a rustle in the leaves. He takes a few practice swings, moves up to position, adjusts his feet, steadies his shoulders, locks his eyes onto the target. He waits until there’s absolute silence, brings his breathing under control, funnels all his energy into the impending swing; takes the club back, and explodes in an immensely balletic movement. …
The initial cut of the surgeon is a leap of faith
How do we get the many disparate members of our healthcare team together to provide better care in a patient-centered medical home?
Doctors (attendings and residents), nurse practitioners, nurses, medical assistants, phlebotomists, registrars, medical secretaries, social workers, community care organizers, pharmacists … the list goes on and on.
As it is right now, everyone is so busy trying to do their own job, to keep up with all of their paperwork, to …
The medical home requires building a better team
A long time ago, in a bygone era, hospital discharges were simple. As a physician, you decided when to admit and discharge a patient from the hospital. Unfortunately, this process was often inefficient, costly, and subject to the whims of doctor and patient. Medicare, and other third-party payers, ultimately realized that this format made little sense and motivated keeping patients in the hospital too long. Many unethical doctors gamed the …
Medicare places hospitals in a discharge conundrum
I would like to begin this article with a question: Do the name and ethnicity of a doctor affect your decision when choosing a physician?
America has always been a melting pot with diverse cultures and ethnicity. The medical field is a melting pot in its own right with its own politics, conflicts, racial disparities and the like.
When I was starting medical school, my mother suggested that I should change my Chinese …
Do the name and ethnicity of your doctor matter?
The recent revelation of the NSA’s top-secret mass surveillance program by Edward Snowden has spotlighted the benefits and burdens of our increasingly digitally connected world. According to President Obama, monitoring our phone calls, emails, and web activity has helped thwart dozens of terrorist attacks. But the idea of the government keeping track of what had hitherto seemed private raises the specter of an Orwellian world in which everyone is under …
The mixed blessing of health information technology
To approve sainthood to a pope, the Vatican only needs one miracle. And there we have it, a new saint.
Pope John Paul was named a saint by Francis after a Costa Rican woman is said to have been cured from a brain aneurysm after praying to John Paul in 2011. His first miracle, curing a French nun of Parkinson’s disease, was also …
It’s a miracle: The connection between saints and doctors
Standing up from my computer terminal to go see another patient, I caught a glimpse of a small, spindly frail woman being rolled by paramedics into one of my shock and trauma rooms.
Very calmly, I remarked, “That woman is dying.”
The medical student who was rotating with me was unnerved that I would make such a pronouncement out of a mere casual observance, “Oh my goodness! How can you just say …
Failing a patient 3 times: A case of moral medical malpractice
Slowly but surely, patient safety is taking its’ rightful place at the forefront of American medicine. Ever since the landmark report from the Institute of Medicine in 1999, To Err is Human: Building a Safer Health System, the issue has been gaining increased traction year on year. Dismal patient safety statistics in some hospitals are correctly being highlighted by the media, with pressure growing on senior leadership and administrators to vigorously …
Aviation doesn’t hold all the answers to patient safety in health care
In July 2011, I made the decision to defer matriculation to medical school for a year. While I was hoping to relax in Philadelphia before entering a lifelong journey in medical training, what I got instead was one of the most emotionally tiring and challenging years of my life.
3 months after I decided to defer medical school, my aunt was diagnosed with acute myeloid leukemia. She was immediately hospitalized and …
Why are there so few women physician leaders?
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A recent review by CNN shows that the percentage of physicians who have gone to a direct pay practice has doubled in the past year. Currently, 6% of physicians are in this mode of health care delivery and the numbers are expected to rise as health care reform takes hold.
The beauty of direct pay physicians is that they are working for the patient, not an insurance company or government entity. …
The beauty of direct pay physicians
I am a fourth year medical student that attends an institution that does not have a department of family medicine.
Currently there are only 10 such allopathic institutions in the country. When I tell colleagues and friends that I intend to enter family medicine they say, “oh primary care?” While yes, it is true that family physicians obviously practice primary care, I am disheartened that my colleagues do not know or …
I am an orphan: A medical school without a family medicine department
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 51-year-old man is evaluated for a 6-month history of increased fatigue and decreased exercise tolerance. He is otherwise well with no significant medical history.
On physical examination, temperature is 37.3 °C (99.1 °F), blood pressure is 115/75 mm Hg, pulse rate is 76/min, and respiration rate is 14/min. The abdomen is soft with no …
MKSAP: 51-year-old man with increased fatigue and decreased exercise tolerance
I was lying in bed, watching something with my son when a chat message popped up on screen. It was my dear friend, Narin, whom I haven’t seen in years but remain in contact with (thanks to the wonders of social media).
“Did you hear that Dave died?” she had written. “I just read it in our college alumni magazine. I am so …
I am no more immortal than my own patients
As a family physician I look forward to the next few years in practice with a sense of uncertainty. One of biggest of these uncertainties is how to help meet the anticipated demand for primary care I expect. A number of changes are coming that will alter the supply and demand equation for patients and primary care providers. These include significant projected population demographics, and others that are due to …
How will primary care handle the influx of patients in 2014?
An attending once told me, “You can’t please ‘em all.” And it’s true. Sometimes in medicine, you just have to keep your head up and remember the bigger picture of why you are in this field.
A few months ago I did my internal medicine sub-I, which is a rotation medical students take in their fourth year when they are expected to perform on the same level as an intern. I’ve …
You have to develop thick skin in medicine
With immigration reform under hot debate, it’s important to remember that all of us except the Native Americans are foreigners. It’s what has made our culture so diverse. People from foreign countries ideally bring the best of their cultures to the US and enrich us all with the diversity of life. This advantage lessens considerably when those visitors want to enter fields in which understanding of endemic American culture is …
Foreign medical graduates are not the primary care solution
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