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“When Lauren came to my office as a 16-year-old, she had been diagnosed with postural orthostatic tachycardia syndrome (POTS) and a few other chronic illnesses. By the end of the appointment, she left with a diagnosis of …
If you can’t connect the issues, think connective tissues [PODCAST]
Big Tech has had a surprisingly small impact on U.S. health care, so far.
Artificial intelligence, for example, outperforms physicians in many complex tasks (like reading mammograms and analyzing chest X-rays), yet AI remains woefully underused. Meanwhile, many have tried to spur operational efficiency using big-data analytics, but care delivery remains as inconsistent and ineffective as ever. Perhaps the most telling example of Big Tech’s struggles in medicine: 9 in 10 …
Amazon vs. Apple: Only one will rewrite the rules of health care
Sometimes hiding things can work to our advantage: an early pregnancy, a disfiguring scar, public speaking anxiety … Easter eggs! But, more often, they are just temporarily hidden from public view, and, in the grand scheme of things, it can actually be a relief when they are “found.”
Enter the world of chronic disease, and things rapidly become much more complex. Chronic disease can often become manifest without any external visual …
The hidden world of chronic disease
“I just moved here from Portland two weeks ago,” said Ms. Shelly in a weak voice.
When I walked into the room, I immediately noticed her blood pressure was 224/108. The patient was mostly sleeping, but when I started speaking with her, it was apparent to me something was wrong.
“Do you have a history of any heart problems?” I asked Ms. Shelly.
“I had aorta surgery two times…” she murmured before falling …
My patient with an aortic dissection almost died
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“Depression involves withdrawal, withdrawal from oneself and others. Feeling safe enough in a relationship to reveal our innermost feelings safely is connective and should be considered a valued part of the anti-depressant lifestyle. Continued relationship satisfaction is …
A 15-minute relationship fix [PODCAST]
In my first bioethics class, the components of health education (HE) were just being developed, and despite the passage of time, full understanding remains elusive as HE proved far more complex than originally conceived. We learned, simplistically, by present standards, that the provider (MD, DO, PA, NP) only needed to deliver information at a patient’s level of understanding, and the patient would provide a reasoned response. The constant over the …
Literacy and patients’ understanding of health education
An excerpt from A Short Primer on Why Cancer Still Sucks.
The United States has the world’s most expensive health care system. It spends about twice as much each year on every American as the Canadian system spends on Canadians. Per capita, the U.S. spends far more than Canada on drugs …
A stark contract between American and Canadian health care
As physicians, we equate terms like “disorder” and “syndrome” with pathology. If a diagnosis is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, it’s considered a “problem.” In the case of neurodevelopmental diagnoses, I am becoming increasingly aware that this may not be the case. As a neurodiverse individual with many neurodiverse family members and friends, I believe there is nothing “wrong” with our brains. Different …
Who are the neurodiverse people in your life?
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In this special episode, KevinMD is on the other side of the microphone as he’s interviewed by Dr. Alex McDonald, originally aired as a PermanenteDocs Chat presented by The Permanente Federation at Kaiser Permanente.
He shares his …
KevinMD on PermanenteDocs Chat [PODCAST]
Something is wrong. You can feel it, but you cannot put your finger on it. You go through the motions daily, but your joy is gone-its soul-sucking. Your patients sense it too. They used to love coming to see you, but now they see the changes. The light has gone out of your eyes. You used to love your job, but now it feels like a burden. This is not …
I will not sell my soul to modern medicine: Curing physician moral injury
I don’t know about you, but I’m tired of spouting the same old worsening childhood obesity statistics, applying the same dilute and sometimes broken strategy, not getting anywhere, judging myself as a doctor, then shifting the blame to my patient and their parents, then feeling powerless and defeated.
Lather. Rinse. Repeat.
It’s a cycle we’re stuck in, and it’s not serving anyone, especially our patients.
I’m not going to go over the impact …
Health care’s 3 epic childhood obesity failures
Well, I am that family physician and geriatrician who is now almost 70 years old. And I cannot believe it because, in some ways, I am still like 27 years old!
First of all, I’m very healthy, and I’m lucky that nobody in my family had colon cancer or any cancer. Most of my relatives lived into the late 80s, and my grandmother and my grand grandfather lived to the ripe …
I’m a doctor who just had his first colonoscopy in my 60s — without anesthesia
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“As we slowly emerge from the physical withdrawal required during the pandemic, the emotional toll of this past year will become increasingly apparent. Complicated problems demand organized, financially-supported solutions. We need a mental health infrastructure bill now, …
We need a mental health infrastructure bill [PODCAST]
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There is something special about that childhood friend. It’s a bond that lasts a lifetime, something we can only experience fully in our formative years. My friend was Richard. We were inseparable in school growing up, then roommates in college, growing into manhood together. When it came time for medical school, I went to Dallas, and Richard to Houston, where he would start his career. We drifted apart in those …
An awkward conversation with a friend might just save someone’s life
An excerpt from Azazel’s Public House.
Pete tried to invade Tommy’s brain and force an oops moment. But the ramparts of the neurosurgeon’s mind were unassailable.
Clancy, unaware he was battling on two fronts, tried to spare any brain that had a …
The ramparts of the neurosurgeon’s mind were unassailable
There are no clear statistics, polls, or studies to know exactly how many physicians each year, or within their working lifetime, switch specialties. But with physician dissatisfaction scores steadily rising, this is becoming a very common sentiment.
First, I want to normalize and encourage everyone to practice self-compassion during this process.
I personally changed specialties early in my career and have numerous colleagues who also changed. We all profess immense happiness in …
How to change your specialty during residency
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“Just before the pandemic, I walked 96 miles (154.5 km) in seven days on the West Highland Way in Scotland, though I was hardly alone in this endeavor. About 250 people start the walk each day, including …
Walk to reduce your loneliness and improve your well-being [PODCAST]
In Australia recently, a woman successfully sued a hospital for $2.4 million for a series of misdiagnoses that left her quadriplegic. A London woman was recently misdiagnosed four times before doctors discovered she had cervical cancer.
A Canadian woman recently filed a $3.5 million lawsuit claiming she was misdiagnosed and ignored when relaying her symptoms to doctors; she could have died. A 26-year-old woman nearly died after a …
Shame not on us: Diagnoses and treatments need to be transparent
“Arriving at an acceptance of one’s mortality is a process, not an epiphany.”
– Atul Gawande
Imagine a group of old (mature) friends gathered for a “girls” weekend in balmy Florida. The friendships started in grammar school and have continued for the better part of 50 years. These women have met at least once a year for more than 25 years and shared life’s ups and downs. On this trip, one of …
Making death conversations fun!
The nicest patient I’ve ever met was Mr. Harris.
I first met him in the ED with his son and daughter by his side, noticing a foley bag filled with bright red blood.
He was an elderly gentleman with ALS and was brought by his children for hematuria and blood clots overnight. Never happened before, and we were all unsure of the cause. Urinalysis soon showed likely UTI, so we started antibiotics. …
The nicest patient I’ve ever met
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