I started seeing patients the moment we arrived at Apollo Hospital in the small rural town of Bilaspur. There was no time to rest. These patients had been waiting for us for weeks to arrive. It was during this clinic time, on this day, that I realized something that really struck me to the core. I have been to India to do these missions many times. Heck, I have been …
This was not a congenital deformity, but a preventable crime
There is a stunning gap between what we know and what we need to do in health care to make it more affordable, accessible, and higher quality. In a recent piece by NPR, research shows that when it comes to treatment of low back pain, doctors are prescribing more powerful pain medications (narcotics) and ordering more imaging tests like MRI and CT scans when there is no evidence these are …
To change health care, we need more physician leaders
I’ve had my share of unsuccessful experiences with doctors and at medical clinics, including being intimidated by them. But after twelve years of chronic illness, I’m happy to report that I’m doing better in this uncomfortable setting. Here are six strategies to help minimize the odds you’ll be intimidated and to help ensure you make the most of the short time allotted …
6 tips to prevent being intimidated at the doctor’s office
The price has been in lives. The capture and killing of Osama bin Laden occurred without loss of any U.S. military lives. It was hailed as a hugely successful special forces and intelligence operation. Still to believe that the operation was accomplished without the loss of life is both incorrect and naive. The lives lost have been those of polio vaccination workers murdered in the backlash against the use of …
Immunization workers murdered: The price of killing Osama bin Laden
I think we all have fantasies from time-to-time what we might do it we were made King for a day (only benevolent kings, of course—no despots need apply!) What decrees might we issue to make the world a better place? What changes would we order to make our politics better? What improvements would we institute to make health care better? Well, here’s my (health care) list:
1. I would decree that every …
My health care wish list if I were king
These days they have navigators for everything. When we got lost back in the day, we used to consult a map, or lacking a map, we would pull in to the nearest “filling station” (what we used to call gas pumps) and ask for directions from the friendly young man who would appear to wash our windshield, check the oil and the tire pressures, and of course, pump the gas. …
When a doctor offers to speak the language of medicine for you
Several years ago I wrote an article for physicians on the topic of balance, and one of the suggestions was to place family first. There are two stories that I have learned since the publication of that article that I would like to pass along.
Balance in a doctor’s life is best achieved if there is balance between family and work. One of the best suggestions is to place …
Doctors need to place their families first
In recent months, AAFP President Reid Blackwelder has been editorializing and debating what they see as the encroachment of nurse practitioners (NPs) and other “mid-level providers” (physicians are, presumably, “upper-level”) on the practice territory of family physicians (FPs). Dr. Blackwelder has repeatedly said that NP and physician roles are “not interchangeable.” The AAFP’s position on this issue seems to be resistance to the increasingly common decisions by state legislatures to …
Why family physicians are a threat to themselves
At first we thought it was funny when the doctor said, “Fatigue. That’s a tough one. At 75-years-young, your chronic conditions are catching up with you, sapping your energy.”
That was the end of exploring the presenting problem at my husband’s twice a year primary care visit.
On the way out to the parking lot, we said we’d like to be bugs on the wall when, 25 years from now, someone says …
A doctor’s attitude toward his older patients
A patient calls or emails me with a problem. I talk with them over the course of a few days, using whatever form of communication works best. Eventually, they need to come to the office to be seen – either for something needing to be done in-person (examination, procedure, or lab test), or because of the advantages of face-to-face communication. At the visit, I not only deal with one problem, …
Radical changes to how I think about care
Faith and reason entered my medical universe recently.
A patient underwent surgery to resect a colon cancer. The tumor had metastasized to the lymph nodes, an unfavorable prognostic event. The surgeon entered the room and advised the patient that her survival is likely limited to 1-2 years. The patient and her husband were devastated. The distraught husband spent the next 24 hours sobbing in a painful and despondent state. He related …
We have come a long way in medicine, treating serious illnesses and preventing life-threatening diseases. As a hospital-based physician, I treat various severe diseases every day throughout the ICU, medical, and surgical floors. On a normal day, I roll at a fast pace — admitting, treating and, discharging patients has become fairly routine for me. On any given day, we have an …
Helpless. That is how I felt when my mother found out she had a fibroid the size of a cantaloupe living in her uterus. In my role as a medical student I might have dismissed the finding as nothing serious, telling my patient, “Don’t worry, it could be much worse.” But as a loving son I was not quite as cavalier. At first my mother resolved to ignore the fibroid, …
Good doctors are those who genuinely care about patients
ADVERTISEMENT
Over the years, since the early 1990s, I’ve been treated for depression. Initially adjustment disorder, and lately, major depression. Perhaps I’m just getting older, and the “black dog” heavier. Then, I ponder all the changes I’ve encountered and wonder if they haven’t played a part. It may surprise you, but I’m thinking primarily of setting right now, and how much the therapeutic scene has morphed over those same years. I …
The relationship with my doctor has been taken away
It was spring. My medical school class, two years along in our five-and-a-half year endeavor, had earned the “medicinae kandidat” degree. We were now worthy of leaving the basic sciences and research center on the outskirts of town and starting our preparatory clinical, “propedeutic” semester at the University Hospital. In Sweden, at that time, we used a lot of Latin words and phrases. Crohn’s disease was Morbus Crohn, chart notes …
Do you worry about the diseases you learn in medical school?
Electronic cigarettes are here, settling over the country, quite literally, like a fine white fog. Smokers in turn, have been turning to them as a tool to help them quit, though the device manufacturers are not allowed to market them that way in U.S. It seems intuitive that a device that mimics the action of smoking but without the combustion and …
E-cigarettes: Are they effective? Are they safe?
You may not remember me, but when I asked how you were, you said, “alive.”
A few weeks earlier you were afraid of going under anesthesia and not waking up. They said you’d do great; that this was routine; that we’d see you again soon. Then you coded on the table. I’ve never met someone who was grateful for life the way you expressed to me that day.
You may not remember …
You may not remember me, but you changed me
The man who had been seated in room 2 by the medical assistant had been seen 6 months previously for a small, pigmented lesion behind his left ear, which a punch biopsy subsequently proved to be malignant melanoma in situ. He was sent to the Mohs surgeon in the interim who carefully excised just as much skin as was absolutely necessary and …
Melanoma refuses to abide the laws of general civilization
Last week a woman told me that she had a miscarriage in her bathroom. She was terrified. She didn’t know what to do. So she flushed it down the toilet.
A miscarriage is the spontaneous expulsion of a fetus from the womb before it is able to survive on its own. One in five pregnancies ends in miscarriage. Many women don’t know they are miscarrying. Those who know usually suffer grief …
What happens to all the miscarriages?
“Doc, if I have cancer, I don’t want to know. Stop bugging me about this colonoscopy.”
Mr. H said to me, his primary care physician, during our appointment. He folded his arms and nodded his head, indicating that his decision was final.
“Mr. H, as uncomfortable as colonoscopies seem, they can actually find lumps that might grow into cancer, and cut them out before they ever become cancer. That’s why I’m bugging you so much about this.”
I …
For patients, reforming the RUC matters
Get free updates delivered free to your inbox.
