“You can’t just let me bleed like this, Doc. I need to get out of here.” So said John, a man in his seventies, with kidney cancer spread to his Ampulla of Vater. Renal cell cancer is among those that sometimes behave in very strange ways. John had had his removed, along with his left kidney, about nine months earlier. At the time, it was thought likely to be …
The curious equilibrium between a patient and his tumor
My patient ran away from the hospital.
This ordinarily is almost common place for a hospital bordering the south side of Chicago. In the last two years at the hospital, I had first grown surprised, and then helpless and finally weary to such mysterious absconding. This time however, it struck a chord.
Long before Mr B ran away, I had an inkling the new diagnosis of HIV would be difficult for him …
Why my patient ran away from the hospital
As I pulled into the parking lot across the street from the large urban hospital where I now work, I considered the number of cars in the physician parking lot. Could there really be a physician shortage when the lot borders on full by 8am? While I fully believe that there is a maldistribution of physicians in the United States, my mind took off pondering what the parking lot would’ve …
The discussions about physician shortages are misplaced
Long relying on feedback from not only my patients but also family and friends, I try to continually improve upon how I provide care. A family member points out what they don’t like about a recent office visit and I make a mental note. A patient I referred to a specialist is less than thrilled about the way she was treated, again I make a mental note. Many of my …
Stop the Us versus Them mentality in medicine
Nothing is more delicious to the eyes of a five year old girl then the shimmering, metallic glare of a Zippo lighter. So when her Mom ran over to the neighbors to borrow some sugar, she climbed up the rickety kitchen cabinets and stood on her tip toes in order to reach the top shelf and pilfer the object of her desire.
After tripping clumsily back down, she sprinted to the …
You never know what’s behind that exam room door
Physicians have historically been fairly well compensated for their efforts and thus have enjoyed many of the comforts of modern life. Most would agree this is the result of years of hard work, perseverance, intellect and dedication. In general these are also traits along with professional integrity, which raised physicians to a position of relative prominence and trust within our society. But in recent years that social position and economic …
Does contracting with third party payers compromise ethics?
“You see, Dr. Oz was right, you’re ordering way too many tests for me,” a patient told me today after seeing news reports of today’s press conference in Washington DC by the Choosing Wisely campaign. This campaign, according to news reports (WSJ, PBS, ABC, NBC, NPR, AAFP, and others), points the finger directly at doctors for ordering “worthless” and unnecessary tests (that’s why the press, like patient advocates, love this story, because …
A primary care doctor takes issue with Choosing Wisely
Let me tell you about a possible paradigm-changing idea in the seemingly hopeless matter of controlling runaway healthcare costs—a topic that has far-reaching implications, not just for healthcare, but for our nation’s economy and vitality.
Organizations of doctors have decided to embrace common sense in the practice of Medicine.
Led by the American Board of Internal Medicine Foundation and joined by many other medical societies, the Choosing Wisely movement aims to …
Choosing Wisely is the health reform we need
Have you ever said, “I’m going to be perfectly honest with you” or something to that effect? Have you ever had someone tell you that they were going to be perfectly honest with you? Have you ever thought about what statements similar to these really mean? You should.
Trust is an earned commodity and hard to get back once lost. “Doc, I’m going to be perfectly honest with you” means that, …
When it comes to medical care, honesty is essential
I have been asked to write up some of the core takeaways from the health care social media presentations I have been giving recently, so I am sharing a version of this narrative on HealthBlawg, in two parts. This is Part II, you may wish to begin with Part I.
The American Medical Association has promulgated a social media policy; so has the Veterans Administration. The two represent very different approaches. The AMA essentially …
The legal landscape of health care social media
At the end of the day, I do not see social media as an end to itself. I enjoy the conversation and the opportunity to learn outside the walls of my medical school without having to put in too much effort. I relish the (illusion of?) freedom that it provides by drawing together the world’s most technology and innovation-driven minds. It allows high-level discussions of even the most esoteric topics …
The ethics of social media use for the medical profession
I have a confession to make.
As soon as I finished reading the Annual Report to the Nation recently, I got up from my desk and took a walk for 20 minutes.
What, might you ask, compelled me to do this?
The answer is what made me take a walk is the same reason I am writing this follow-up commentary. Sitting …
Lower your cancer risk and take a walk
The pressures mounting on most institutions as the years trudge by are mounting. They are mired in mountains of regulations, the need to implement millions of dollars of IT “improvements,” streamline their most productive service lines, strip down their front-line staff to dangerous levels … and all this while their reimbursements are being crushed.
Consider that a profitable hospital currently operates on a 1% margin.
Consider that the hospital is considered the most costly …
Why your local hospital may not be relevant in the future
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Impersonal and self-absorbed as Manhattan may be, it’s still embarrassing to cry on West 32nd Street. I looked for a store, any store, and ducked inside. The pace of my steps and angle of my head as I buried myself into a back corner, thumbing through pants twice my size, gave me away. A store clerk walked over and asked if I was okay. I knew I’d have to meet …
When doctors are called providers
Year: 1979
Setting: George Washington University Hospital
Position: Intern
In sharing my global health background, I would be remiss if I did not talk about some of my American experience. After all, Washington, D.C., is remote from Palo Alto and Paris! I am in my late 20s and an intern at George Washington University as an exchange student from Brazil. My mentor, Stanley Talpers, MD, has organized a rotating program for the interns, …
Always treat your patient with compassion
The next time I receive medical care, I want to know how much it will cost before I agree that it will be done — and that includes no matter who pays the bill.
And, doctor, I want you to know and I want you to care how much what you prescribe is going to cost me or somebody.
You say it is beyond your control to know? I say, insist.
Rise up, …
Why we need an economic informed consent
If you are a second-year medical student, there is one thing on your mind at this time of year: Step 1. Although scary, there are things that you can do to help calm your anxiety and get your best score.
Set a goal
In my opinion, before you start really preparing for Step 1, you should have two things clearly in mind: where you are with your score and where you want …
How I scored a 257 on USMLE Step 1
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman is evaluated for a 1-year history of progressive exertional dyspnea. She does not smoke cigarettes or use illicit drugs. The patient has a history of obesity and has used various appetite suppressants but takes no other medications. She has no significant family or …
MKSAP: 54-year-old woman with progressive exertional dyspnea
If your computer has ever slowed way down you may have been advised to “defrag,” which puts all parts of a file together in the same place on the drive, enabling it to run faster and more efficiently. In much the same way, your health care needs to be defragged. For most people, health care is extremely fragmented, creating errors, delaying diagnoses and treatment and increasing costs.
Even for the very …
Your care is fragmented, here’s how to fix it
If you cannot measure it, you cannot improve it.
-Lord Kelvin
Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.
-Nassim Nicholas Taleb
Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the Quantified Self blog in 2007. By 2012, there were regular meetings in 50 cities and a European and American conference. …
Is the quantified self movement the future of American health?
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