Why are so many community hospitals transferring children to larger facilities?

Policy
September 13, 2020

A recent edition of Pediatrics has some disturbing research: “Trends in Capability of Hospitals to Provide Definitive Acute Care for Children: 2008 to 2016.” What the paper really does is document what many of us who work in referral hospitals have noted for some time: More and more community hospitals are transferring children who appear in their emergency departments to other, larger facilities instead of admitting them to …

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A palliative care physician’s brain bleed [PODCAST]

Podcast
September 12, 2020
YouTube video

“As a runner, my pulse rests around fifty, but the ICU team had worried when it dipped to thirty-five, and my blood pressure hovered around ninety over fifty. Understandably, bags of saline were hung, and steroids were added. My headache improved, but my ankles disappeared, and I was often short of breath. Upon discharge, I went into full diuresis mode and …

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COVID-19 reveals gaping holes in locum tenens contracts [PODCAST]

Podcast
September 11, 2020
YouTube video

“I called the locum agency in the morning to air my concerns. To their credit, they admitted that the COVID-19 pandemic is an unprecedented event for which no one could have planned. They had developed a fund through which they could support health workers in need. If I took ill, I would have to call them for support. My health care …

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Health care should be apolitical, but it isn’t [PODCAST]

Podcast
September 10, 2020
YouTube video

“COVID-19 is a tragedy that could have easily been prevented if our leaders cared more about the well-being of their citizens instead of economies, stock markets, and their political campaigns. To all those arguing about how the economy is more important, I ask, how will sick and dead people contribute to an economy? How will sick and dead health care workers …

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So you want to be a doctor? Here are 10 myths debunked.

Physician
September 10, 2020

I’m glad you’re looking at a career in medicine. I hope you will be happy with your choice forever. To help you out, these are a few myths I wish somebody told me about when I was in your shoes.

1. You’ll be rich. You likely won’t. After two decades or so of med school and residency, you’ll be paying back student loans with exorbitant interests for a few more decades …

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Anesthesia touches nearly every area of medicine [PODCAST]

Podcast
September 9, 2020
YouTube video

“I suppose those of us between zero and ninety-three are blessed in our own way as well. We are here, swirling in a jumble of the inconsequential and consequential. We’ve enjoyed some of the world’s beauty and reserve the potential to experience more. Some of us will have longer than others, but perhaps we should focus on savoring rather than quantitating …

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Many medical marijuana program websites are silent about possible risks [PODCAST]

Podcast
September 8, 2020
YouTube video


“There are roughly 221 million people — including 48 million kids — in states where marijuana has been named a medicine. These include patients who suffer from depression and could see their symptoms worsen. Mothers who could give birth to babies with low birth weights. Children who could face an increased risk of addiction, depression, and suicide.

We must allow our citizens …

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Call a consult: depression vs. burnout

Physician
September 8, 2020

CC: “I feel like crap.”

HPI: 29-year old female internal medicine resident. Hasn’t seen sunlight in over three months due to 100 hour work weeks.  Crying at work. Always exhausted and irritable.  Isolated from friends and family.  Feels guilty that she is not effective at work and home.  States recent labs were normal.

ROS:

Gen: hypersomnia
HEENT: teeth grinding
CV: chest pressure, palpitations
GI: decreased appetite with weight loss
Neuro: headaches
Psych: apathetic, not suicidal

Meds: none

Social: alcohol on …

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Are the life sciences the best premedical majors?

Education
September 8, 2020

The medical school admission process can be overwhelming. There is no definitive path that guarantees admission. Prospective students are meant to create their own way that could bring them an acceptance letter. That is why some individuals with a 3.6 GPA and a 508 MCAT score get accepted, and others with a better academic record get rejected. They might be considered an outlier, but some are not necessarily …

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After 4,380 days, a pair of Danskos — and a calling — fall apart

Finance
September 8, 2020

My Danskos literally disintegrated last month.

I was in the hospital team room, finishing up my patient notes at the end of a busy hospitalist shift. I happened to look down at the floor, and there they were: black chunks on the carpet.

I thought, “Who left such a huge mess under the desk?”

I looked at the bottom of my black Danskos. There was a sizable chunk of the sole missing.

Finally, the …

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Rural communities have unique vulnerabilities worsened by the pandemic [PODCAST]

Podcast
September 7, 2020
YouTube video

 

“While Imperial County faces a confluence of vulnerabilities that have led to its susceptibility during COVID-19, it is not alone. Like an insidious undercurrent, these deficiencies are lurking in every region of the United States. Structural issues require structural solutions—to effectively contain COVID-19, our local, state, and federal leaders must address these underlying faults in the foundation of the systems which …

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Intentions don’t sanitize impact

Physician
September 7, 2020

While there are certainly instances of malicious intent in thoughts, feelings, and actions, most people operate with the intent to do good, be good, offer good to the world – but what we do isn’t always received in the way we set out to offer it.

In the words of Oscar Wilde, “No good deed goes unpunished.”

It can be frustrating and even paralyzing to consider this consequence, resigning us to, “What …

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Why doctors should be trained to speak out and lead the movement for social justice

Policy
September 7, 2020

Dr. Anthony Fauci, National Institute of Health Director of Allergy and Infectious Disease and White House Coronavirus Task Force member, recently underwent surgery to remove a vocal cord polyp. This is not surprising given that a major risk factor for developing vocal cord polyps is overuse of the voice, something Fauci has likely experienced during the COVID19 pandemic as he has been called upon to speak …

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Medicine’s culture forces us to ignore our health [PODCAST]

Podcast
September 6, 2020

“Physicians are steeped in a noxious culture that seems to be averse to creating healthy physicians. We ignore mountains of evidence that show exercise, sleep, and healthy eating is beneficial for cognitive function, learning, and performance — all aspects that physicians should optimize. But the current medical training system pushes physicians, residents, and students to the brink of their physical, emotional, and mental …

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Recognizing childhood stress is so important. Here’s why. [PODCAST]

Podcast
September 5, 2020
YouTube video

“Advocate for the children in your community. Studies show that one of the most powerful buffering factors for kids experiencing toxic stress is having at least one supportive, caring adult in their lives. Who in your circles needs you to provide this role? Studies also show that a healthy foundation of sleep, nutrition, exercise, and coping strategies can also mitigate stress …

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Medical student suicide is the trend that must end

Conditions
September 5, 2020

Last November, our medical school’s community faced a devastating loss, as second-year student R took her own life. As she was rushed to our hospital’s emergency room, some of R’s classmates, as well as her physician mentor, were on rotation and bared witness to her getting rolled in. Understandably, the loss of R cut deeply. While not often discussed, medical student suicide has been no stranger to medical schools both …

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A journey from security guard to nurse, and why nurses don’t get the credit they deserve [PODCAST]

Podcast
September 4, 2020
YouTube video

“The pharmacy department plays a vital role in hospitals. They prepare and dispense medications. Sometimes the pharmacist will receive an order from the doctor on a med whose written dosage he is not sure of. In some cases, the pharmacist will call the nurse in order to get clarification on this. The problem here is that …

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Now is the time for postpartum home visits

Conditions
September 4, 2020

I ring the doorbell, waiting patiently outside.  I hear a weak “coming” and some shuffling.  Who greets me is a mother in her robe, hunched over at the waist, supporting her protruding postpartum belly.  Her hair is disheveled.  Her mask is revealing exhausted eyes with attempted mascara to look a “little freshened up,” she confesses a little later.

“My husband is just getting the baby; please come in.”

I …

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