I almost fell off my chair. It was bad enough that he showed up to the ER. But what happened next really blew my mind. He fell and bruised a rib. The pain in his left chest had obvious enough origins. But triage had put in for an electrocardiogram and the interpretation apparently scared the resident. The attending took a look, and shook his head.
“Left bundle branch block. Better call …
When the business of medicine trumps appropriate care
For people of color, skin cancer may not be top of mind as a significant health threat. But as I tell my patients in the multi-cultural borough of the Bronx, NY, skin cancer does not discriminate and it impacts all populations regardless of color.
While somewhat rarer in skin of color, skin cancers, including potentially deadly melanoma, do occur and can be quite …
Skin cancer does not discriminate
An excerpt from How a Blog Held Off the Most Powerful Union in America.
The long-term decline in private sector unions in America has been well documented. From almost 25 percent of the workforce in 1973, the rate of unionization has fallen to under 8 percent in 2005. Some unions, though, have been able to buck this trend, most notably the 2.1 million-member national Service Employees International …
How a blog was a potent weapon against a union’s corporate campaign
Ah, the addictive power of modern food. Never underestimate it.
On a recent trip to New York I happened to be flipping through the channels on my in-flight TV when I ran across Mike Huckabee doing an interview on Fox News. I was surprised to see that he had gained his weight back. The former governor of Arkansas and presidential candidate had staked quite a bit on the success of his …
Did Mike Huckabee foreshadow his journey back to obesity?
I’ll start with this: it’s great to be back.
I’ve been on hiatus from blogging for the past few months because of the exam I took last week: the medical boards, or Step 1, an eight hour test that covers all of the first two years of medical school to prepare us for the hospital wards. To give you an idea of what it entails, most second-year medical students use a …
The process of studying changed the way I think about medicine
I used to be a stickler for time. One of my first blog posts was about how it felt to go to work without my wristwatch.
I also used to be very particular about knowing the purpose of each visit, partly to help me manage my time, and partly to help me feel prepared and in control of the visit.
I often questioned why my colleagues’ patients would sometimes end up in …
What is the role of the physician in today’s health care system?
This is a topic that comes up from time to time for often spirited discussion. The most recent example comes in a couple of articles in the New England Journal of Medicine. One was a research paper; the other was a pro and con discussion.
The research paper studied cardiac arrests that happened outside the hospital. The authors tested the premise that allowing families to watch the efforts of …
Should families be allowed to witness CPR?
Experts, most recently former CMS administrator Don Berwick, tell us that no less than 20% – 30% of medical care is waste. At the very least, waste is harmful to all those who pay for Medicare. But often it’s directly harmful to the patient as well.
I recently saw a friend at a party. Since we’d last seen each other my friend’s spouse had died. (I’m deliberately avoiding gendered pronouns and …
How waste is directly harmful to patients
Here’s a joke I love: A man goes to an old-school psychiatrist who, at the first session, administers some Rorschach tests.
“Just tell me the first thing that comes to mind,” the doctor instructs the patient as he shows him the ink blots.
“Sex,” answers the patient.
“I see,” says the doctor. “And this one?”
“Sex.”
“And this one?”
“Sex again.”
“Well,” says the doctor, “I see we will have to work on your obsession with sex.”
“Me??” …
The controversy over DSM-5 and the cataclysm in mental health
I remember going to see the movie “Oliver” in the theater when I was a kid. Since this was my first movie in a theater, my mom made me a treat: a bag full of raisins and chocolate chips (Raisinets for Dutch people) and sent me there with my sister. It was a fine film, with Oliver getting kicked out of the …
American health care: The problem of always wanting more
It was bound to happen.
By “it,” I mean that the small group of specialty hospitals (usually orthopedic or cardiology-focused) across that country that are owned by doctors were going to have their “See! We Told ‘ya so!” moment.
Doctor-owned hospitals. How many are there? Two hundred and thirty-eight of them in the whole country (out of more than five thousand)–somewhere between four and five percent of the total in the U.S. (numbers courtesy …
Doctor owned hospitals: Are the rich getting richer?
Of all the different criteria people use when deciding for whom to vote in presidential elections, I’ve never heard anyone talk about the importance of a background in clinical psychology—but it’s always struck me as important for a president to have as for a clinical psychologist. Certainly, foreign policy experience, a firm grasp of the principles of economics, a bold and confident leadership style, and the ability to get people …
Why politicians should have backgrounds in clinical psychology
In the wake of the Newtown shootings, as a country we are all taking a step back, looking at our laws and our policies and thinking about what we can do to prevent unspeakable tragedies like the deaths of those children from happening again.
I am not a gun owner and never will be, but I am not advocating getting rid of all the guns. I totally get that there are …
If I’m wrong about guns, can you please explain why?
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I recently blogged about the question of what the difference is between a doctor and a nurse, now that advanced practice nurses can do so many of the same things physicians do. As both a nurse and a doctor I thought maybe I could wade into that quagmire. In that post I suggested that the real difference is one of ultimate responsibility. A reader pointed out that this …
The medical model versus the nursing model: A difference in philosophy
If you drink coffee, I have some bad news and some good news. The bad news is that the more cups of coffee you drink, the higher your risk of dying early. The good news is that if you “risk adjust,” then the more cups of coffee you drink, the lower your risk of dying early. Let me explain.
According to a Read more…
Can coffee help you live longer?
We were instructed not to knock, that the examiners would invite us in when they were ready. Even under the bright lights and unforgiving atmosphere of an operating room emergency, I couldn’t recall being this nervous. Yet today, in the dimly lit hallway of a three-star hotel, my hands trembled without a bleeding patient or sharp instrument anywhere nearby. I glanced left …
It’s not hard to do surgery, it’s hard to get to do surgery
I know what I want in healthcare. I want it to be efficient, effective, thoughtful and inexpensive. I want it to create healthy people who don’t need very much health care. I want it to involve elegant solutions to problems that take less time, money and effort. I want it to be so much easier and less expensive that taking care of all of our people uses even less resources …
What does American healthcare want?
How to effectively keep tabs on a patient’s multiple medical problems? And how to do so without losing sight of the whole person?
The first question is the one I wrote about in a recent blog post. The second was the theme of many of the responses and also LinkedIn.
I love this second question; it’s an issue that’s always been of interest to me. Plus it’s especially relevant in geriatrics, where …
How to effectively follow a patient’s multiple medical problems
The unexamined life is not worth living.
–Plato
There are obstacles to dignity at the end of life. Disease inflicted pain and debilitation, cost and confusion, poor planning and fear, all aggravated by our societal ignorance regarding dying, result in unneeded suffering and isolation. In addition, it occurs to me that a hindrance to control and quality is that we are overwhelmed by the pressure of our day-to-day lives. In other words, …
When I first heard of the tragic accidental shooting death of a 2-year old girl by her 5-year old brother, at first I thought it was because some adult left their gun out and was not supervising the children properly.
Not too many things surprise me anymore, but this time I was surprised when I found out that poor supervision was only part of the issue and that the 5-year-old was …
Giving a gun as a gift: How young is too young?
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