How a medical-legal consultant helped refute a possible pre-existing medical condition argument

Physician
September 5, 2022

Doing medical-legal consulting is a great way to use your medical training in a non-clinical field that really helps people. One of the many things we can do is help attorneys refute the question of a pre-existing medical condition. Often opposing counsel will try to lay off accident injuries as not related to the accident or injury in question.

As you may know, medical-legal consulting is a new non-clinical field in …

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Medical education has woken up, and that’s a good thing

Education
September 5, 2022

A Black woman whose kidneys only function at 15 percent of normal wishes to be evaluated for a kidney transplant. Although this is very reasonable, before 2021, many physicians would have said, “I’m sorry, but your kidney function is not bad enough to be referred for a transplant.”

This is because the kidney function calculator used before 2021 overestimates kidney function for Black people, making her kidney function seem “too good” …

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How to make primary care rotations more appealing for students [PODCAST]

Podcast
September 4, 2022
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“It is time that every health profession school specifies their criteria for optimal teaching primary care practices and for the training that would optimize their students’ experience. It is time that we, as primary care physicians, advocate …

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Are we too scared to talk to our patients about their weight?

Conditions
September 4, 2022

Talking about weight isn’t easy. Case in point, I was scheduled to perform five back-to-back fluoroscopically guided procedures. This was not unusual, but all my scheduled patients happened to be seriously overweight. Excess fat and skin made it difficult to see my needles during the interventional procedures. Therefore, what was ordinarily a routine procedure suddenly became complex and challenging.

I am an interventional pain management physician. For many of my patients, …

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How whole-person care can make us better healers

Physician
September 4, 2022

My patient at a pain clinic on a military base in Virginia carried the deep wounds of war on his face. Not physical scars, but a sallow, slack complexion and a hollow-eyed look of exhaustion and defeat. A veteran of the war in Afghanistan, he had long been suffering from anxiety, depression, and other complications of PTSD, although his presenting complaint was back pain.

The patient, whom I’ll call Sergeant Carlson, …

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How writing a letter on Substack might recharge your life in medicine

Physician
September 4, 2022

“The good life is ever-changing, challenging, devoid of regret, intense, creative, and risky.”
-Friedrich Nietzsche

One year ago, bruised and battered like any physician practicing in this pandemic, I decided to double down on weariness and start writing a medical letter on Substack. I’ve been writing about once a week, with subjects ranging from the newest coronavirus variant of concern, to a reflection on the hidden strengths in frailty, to the pleasure …

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Grief on the front line

Physician
September 4, 2022

Several years ago, I wrote a piece about my experience of personal grief while working as an emergency physician in Australia. The grief I experienced was due to the untimely death of my older brother Martin — a high-achieving lawyer and sportsman — who slowly withered away as he lost his battle with a rare and aggressive lymphoma. It is fair to say that his death broke me, but …

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Skinny fat and normal weight obesity [PODCAST]

Podcast
September 3, 2022
YouTube video

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“Obesity is genetically common in our family. I was being gaslighted and judged by a bunch of obese people, most of whom were doing nothing to improve their health and obesity issues. Yet they fully believe to …

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My patient left against medical advice

Physician
September 3, 2022

“Mr. Stenson left AMA …”

“Why?” I said out loud to my attending.

“He left with his IVs in …” said his nurse in disbelief.

An hour earlier, before rounds, I sat down with Mr. S to talk about his anxiety attack.

Ten years ago, he was shot ten times in the chest, which left him with PTSD and depression. Not long after, he started having unprovoked panic attacks. What started as once or …

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If a program doesn’t care for fellows, could a union?

Physician
September 3, 2022

In my self-righteous youth, I bristled at the thought of physicians unionizing. Certain our collective altruism and professionalism would prevail. Unions were for oppressed laborers, not well-regarded, well-paid professionals. Reading the recent paper in JAMA and 30-plus years in the field have caused me to think again. That, and recently having provided support to a young physician couple with a newborn.

There is nothing quite as messy, all-consuming, and awe-inspiring as …

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Talk about death in plain, simple, easy-to-understand terms

Conditions
September 3, 2022

“You’re dying.”

I can often visualize the impact of my words as soon as they leave my mouth, the heavy weight sinking into the mind and body of my patient as they sit in the stark white hospital bed.

It usually isn’t the first time they’ve heard the sentiment. After all, we tell them countless times in different phrases we use as physicians, expecting them to understand, but none quite as precise …

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Coping mechanisms for medical professionals

Physician
September 3, 2022

I am a pulmonary-critical care medicine physician. I had a medical issue in 2020 and was on limited call responsibilities. When I came back, it was in the throes of the first wave of COVID.

It goes without saying that the last three years or so have been very difficult for everyone in the medical profession. We lost a truly horrific number of patients to COVID — in the early days, …

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If it’s not clinically pertinent, then stay out of my uterus [PODCAST]

Podcast
September 2, 2022
YouTube video

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“No matter how far we’ve come, women are still judged by fertility status but shouldn’t be.

If it’s clinically pertinent to ask about reproductive health, then yes, absolutely ask … in a respectful way. That doesn’t mean judging …

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Video visits as clinical touchpoints to improve older adult mental health

Tech
September 2, 2022

The COVID-19 pandemic has taken a profound toll on older adults, isolating them physically and emotionally from their communities and families. Mental health has suffered across generations and, as a practicing geriatric psychiatrist, I have had a front-row seat to the unique conditions older adult populations are facing. Despite rising rates of depression and anxiety, infection control measures have accelerated the adoption of digital health, including telehealth, opening myriad new …

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Drawing the line on unnecessary medical tests

Physician
September 2, 2022

How much medical uncertainty can you tolerate? Most patients have not given much thought to this consequential issue, but it hovers over them in their doctors’ offices. This is also an issue for medical professionals. Indeed, how both sides in the doctor-patient relationship navigate this will be instrumental in choosing the path forward.

Medicine is not mathematics. It’s a murky discipline with incomplete data and moving targets. Many of your symptoms …

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A room once full of vitality lies empty

Physician
September 2, 2022

More than two months after he died, his name still adorned the whiteboard of the hospital room he inhabited. As I stood there and gazed, recalling the memories he left me with, the nurse who tended to him entered the room and started to cry. Her love for Eric, she told me, did not enable her to erase his name.

He was disheveled, non-compliant, and plagued with multiple morbidities when first …

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Why this doctor prefers perfectionist physicians

Physician
September 2, 2022

Your plane is about to take off. Like most folks, you are just a little anxious about flying. It is very rare, but you know a lot of bad things can happen to the machine that carries you at 30,000 feet above sea level. Consider this: Would you rather the mechanic who inspects your aircraft be absolutely conscientious to every minute detail, be exquisitely perfectionistic in his examination of the …

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How technology can streamline tedious health care processes [PODCAST]

Podcast
September 1, 2022
YouTube video

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“Companies that embrace digital processes will reap the rewards, as shown by the Forrester survey taken in 2020 after the pandemic began. The survey found that digital document processes were helping organizations maintain their business resilience and …

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Smaller practices should participate in clinical research. Here’s how they can.

Physician
September 1, 2022

The COVID-19 pandemic and the resulting shutdown accelerated the adoption of decentralized clinical trials (DCTs). The number of trials with virtual and/or decentralized elements exceeded 1,000 in 2021 for the first time, according to GlobalData. That’s a 50 percent increase from 2020. GlobalData expects the number of site-less and/or virtual clinical trials to jump another 28 percent this year, potentially topping 1,400.

This presents a perfect opportunity for smaller and …

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