Over the past few years, I have realized that I have come to resent the word “just.” Certainly not in the civil sense of the word: social justice is the driving force behind virtually all the work I do these days. I am talking about using “just” as a qualifier. As in, “Oh, I’m just the medical student,” or, “He’s just a nurse.” We use it blatantly as an offense …
Just: A word that I’ve resented since leaving clinical medicine
Back in the day, legend has it that when space programs were just developed, NASA soon discovered that ball-point pens will not write in zero-gravity. Unfazed, NASA spent a large amount of money developing pens that will work in space, while the Russians simply used pencils.
It turns out that this legend is only half true, but the lesson remains – sometimes, we get bogged down trying to solve …
Building residency training from scratch: What would you do?
When I think of Big Joe, I see his overalls, and how he filled them. And how a couple of months after I operated on him, there was room for both of us in there. Big Joe: farmer, salt of the earth, tough, stoic. On the day I met him, if it’d been Halloween, I might have tried to stick a candle in him. That’s how orange he was. My …
Big Joe: Living proof of our fallibility
An editorial by two oncologists in the New Year’s issue of Annals of Internal Medicine discusses overdiagnosis, a controversial health problem that some have called “a modern epidemic” but others, including the editorialists, feel is a minor concern. Although many chronic conditions are overdiagnosed, cancer is the most thoroughly studied, as well as the most emotionally charged.
I am a generally healthy man with no family history …
Overdiagnosis: An epidemic or minor concern?
Dear hospitalists,
This is just a note to say that we, in emergency medicine, appreciate you. Like all of us, you are stuck in an endless loop of unending residency. Don’t worry, it isn’t an episode of The Twilight Zone. It’s just your life. No, it’s our life!
As specialty after specialty withdraws from the practice of medicine, you, and all of us, …
Dear hospitalists, we emergency physicians appreciate you
“He’s dead, Jim.”
So here’s my beef. At the recent Forbes Healthcare Summit there was a lot of focus on speakers and vendors offering very cool new tech, from future “Tricorders” that can diagnose multiple diseases, is non-invasive, and hand-held; personal genomics, where data from your own genome is cheap and easy to get and can be integrated with clinical knowledge to produce better care; targeted therapies for various diseases, …
Let’s solve our most pressing healthcare problems first
The best clinicians I have worked typically speak enthusiastically of how much they learn from their patients. Perhaps because it is (happily) not a daily event, or perhaps because it is so much more personal, clinicians do not talk much about what they have learned from being a patient themselves. The other end of the stethoscope is a good place to learn about medical care.
During the diagnostic phase of my …
The best physicians learn from their patients
Two weeks before the Newtown, Conn, shooting I was at my doctor’s office for an annual physical exam answering questions on an intake survey. Questions like “Do you smoke? How much?” and ” Do you wear the seat beat?”
And then one question stuck out: “Do you have any firearms in the house? Are they stored in a locked area?” What business …
Firearms violence is a public health safety issue
The September 2012 issue of the AARP Bulletin has a story about a woman who sued an elder-law attorney for legal malpractice. Bear with me. It’s an interesting tale.
In 2004, a man consulted an elder-law attorney to set up a trust that would distribute his assets fairly. He had a daughter from his previous marriage and his wife had five children from her previous marriage. The story is …
Are hospitals learning from the lawyers?
Skill to do comes of doing.
-Ralph Waldo Emerson
We are in the last steps of getting surgery arranged; the counseling is complete and the consent is on the clipboard. Just as the patient is putting pen to paper, she asks, “When I’m asleep, you’re not going to let some trainee practice on me, are you? I mean, I wouldn’t let the brand …
The quandary of resident involvement in surgical procedures
Here in the Boston area, we’ve all been shaken by the news that a known sexual offender raped and molested children for years at a daycare just north of the city—even babies. It’s beyond horrible. For those with a child in daycare, this story is especially terrifying. You can’t help thinking: could this happen to my child?
Ultimately, the sad truth is that we can’t always stop these …
A sexual predator at a daycare: Do your homework when choosing
On my birthday several weeks ago, I was lucky to get an iPad Mini from my husband. I already have an iPad and have shared my experience. In fact, we gave all of our residents iPads (one of them contacted Steve Jobs and got a response), and documented an improvement in efficiency on the wards. So why the Mini? What is …
Using the iPad Mini in the hospital: One doctor’s experience
A recent editorial in the New York Times about non-physician health care providers or NPPs, has drawn more than 260 comments. Who are these NPPs and why do so many people care about them?
Historically, nurses have a long history of stepping in when there are gaps. For example, in the early 1900s anesthesia was given by med students and interns, and …
Why your nurse practitioner is your friend
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Wikipedia defines patient portals as “… healthcare-related online applications that allow patients to interact and communicate with their healthcare providers. Some patient portal applications exist as stand-alone websites and sell their services to healthcare providers. Other portal applications are integrated into the existing web site of a healthcare provider. Still others are modules added onto an existing electronic medical record system. What all of these services …
Do patient portals increase patient engagement?
This little cartoon, courtesy of xkcd, highlights a problem we have had for some time, but which is getting worse–highly antibiotic-resistant bacteria. Soon after the first antibiotics appeared, especially penicillin, doctors noticed the phenomenon of developing bacterial resistance to them. The cause is evolution in action. The replication time for bacteria is extremely fast, as short as …
We cannot be complacent about drug resistant bacteria
Here is a little appreciated fact: Patients cannot order medical care; they can only accept or refuse it. Only a doctor can order medical treatment. In an extreme medical situation, the doctor can offer CPR, but it is the patient’s job to accept or reject. Any patient can refuse CPR. This refusal is known as Do Not Resuscitate or DNR, and for obvious reasons needs to be made ahead of …
When is making the decision to be DNR appropriate?
You need a doctor, and I love what I do. But this work just isn’t sustainable.
In 2009, I finished medical training and joined a clinical academic practice. For those not in the know, doctors can — very generally speaking — work in one of two domains: in private practice, or on faculty at a medical school where they see patients, teach, and/or do research. Some docs manage to keep a …
Don’t make me leave primary care
Assembling the right medical team is important to keeping you healthy and saving money. Besides you, one of the most important people on this team is your regular doctor. For many people, this is their primary care physician (PCP) or primary medical doctor (PMD). A highly trained and well-qualified primary care doctor can advise you on what preventive tests and treatments are truly necessary to stay healthy.
If you view your …
An excellent primary care doctor is your trusted health care advisor
Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It’s high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle.
These stresses, if unmanaged or poorly managed, can …
Dealing with psychological stress of being a doctor
Here are the sad the financial facts. You have heard them before:
Anyone who discounts that fact that we women physicians are discounted …
6 ways to close the gender pay gap in medicine
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