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“It’s one of the hard things about anesthesiology. A window opens, you work like all get out, doing all sorts of things while the breeze blows in, then it’s shut again. Sometimes, you see your patient once …
Your anesthesiologist cares for you [PODCAST]
I am a nurse. I am tired and defeated. Thursday, I went to work at 7 a.m. after the strike, only to want to leave as soon as I walked into the hospital. We were short-staffed … again. I made an “aware” which is a hospital forum where anyone can report unsafe staffing, hospital conditions, maintenance, or security issues. My aware went to my unit manager where we had a …
All I ever wanted to be was a nurse
An excerpt from The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture.
Ours is a culture wholly averse to death and even aging; think of how many products are geared toward erasing or “reversing” the signs of oncoming infirmity, the physical reminders of life’s finitude. Here, then, …
The journey is to find the gift in the challenge
Over the years, I have mentored a lot of trainees. After discovering coaching and seeing my career transform after I started working with a coach, I have become a coach myself. I definitely use coaching techniques with my mentees, but the relationship I have with them is different from the one I have with my coaching clients. Coaching and mentorship are different but complementary approaches to moving your career forward. …
Coaching or mentorship: What is the solution for physicians?
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“Securing prior authorizations is a daily ordeal for most doctors’ offices. Doctors report that, on average, they must get insurance company approvals 41 times every week. Of the authorization requests that are denied, fully 73% ultimately get …
Insurance companies deny medical care. And that’s wrong. [PODCAST]
You may just think differently. Not wrong.
It is a gift to be on a team where people think differently.
However, some leaders want people to all to think like them. And they become upset and frustrated when you think differently.
So we step back and observe why they may be frustrated. We may observe in ourselves why their opinion and approval matter so much.
The discomfort may push you to abort your own …
It is a gift to be on a team where people think differently
“Mark my words. AI (artificial intelligence) is more dangerous than the nukes.”
– Elon Musk
The other day, as soon as I walked in to work, already running my usual ten minutes late, I was hustling from my office to the clinic when I saw one of our physician assistants in the hallway. Otherwise known for her calm composure, it seemed odd that she was visibly distressed. She had forgotten her laptop …
Is Elon Musk right about the future of medicine?
I’ve lived through multiple economic downturns since 1999.
Bear markets and recessions can be scary.
The uncertainty and fear can be exhausting.
Currently we are in the midst of battling fears of record inflation, gas prices, an ongoing recession, interest rate instability, supply chain disruptions, insecurity in food, energy, and housing, along with surging debt and currency crises.
This is all happening against the backdrop of war, climate crisis, and a world recovering from …
Economic uncertainty is the new norm, but financial insecurity doesn’t have to be
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“I think about my preeclampsia-specific and general knowledge gaps. I could not recall learning about postpartum preeclampsia in my prenatal classes. I wasn’t given any written instructions on what symptoms to expect with my blood pressure returning …
My postpartum blood pressure spike [PODCAST]
I wondered whether to recommend Nuedexta for my elderly relative with worsening Alzheimer’s disease and daily spontaneous crying. Often she would deny feeling sad and couldn’t account for her sobbing. Avanir Pharmaceuticals released Nuedexta in 2010 to treat pseudobulbar affect: involuntary emotional outbursts due to certain neurologic conditions or brain injury. I wasn’t sure if these crying bouts qualified as pseudobulbar affect. But my biggest hesitation was the breathtaking …
How drug prices are manipulated
As a physicians’ attorney who focuses his practice on physician contract review, I have seen some truly horrendous results after physicians have signed agreements they did not understand. Here are just a few of the “war stories” I have experienced.
24/7 call “for a few years”
One physician employment agreement I reviewed had several points that I felt should be clarified. The employer’s attorney accommodated most of my requests for clarification in …
Physician contract horror stories
Many people assume that there is a tradeoff between making money and making an impact—that you can’t do both at the same time, or at least not to a high level. This has been the prevailing thinking, especially in the business sector.
But over the past few decades, a new field of “social entrepreneurship” has proven this assumption wrong. A spectrum of possibilities now exists for people aspiring to reap profits …
Social entrepreneurship: business that’s good for people
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“Despite these high numbers, we cardiologists often look to genetic screening last in our diagnostic workup. But without genetic screening, we can’t always see the whole picture in our cardiomyopathy patients. Once we’ve excluded coronary disease as …
Think about genetics in heart disease [PODCAST]
A recent JAMA Pediatrics study confirmed what I see in practice as a pediatric primary care psychologist in Texas, one of four minority-majority states. The study reported alarming gaps between Black and Hispanic kids compared to white kids in attendance at primary care wellness visits—important appointments where children and parents can receive preventative and developmental services, timely immunizations, and answers to common questions. …
One in four Americans carry a diagnosis of arthritis, a significant cause of limitation from basic life activities to disability. One in ten adults has to limit their activities due to pain caused by this disease. Yet, a massive shortage of specialist physicians and geographical and licensure barriers restrict access to specialized medical care, especially in rheumatology offices. Also, the cost of arthritis is 303 billion dollars yearly …
Why expand telemedicine for arthritis patients?
Brain matter was spilling out the top of the patient’s head in the trauma bay. It doesn’t take a neurosurgeon to know that this is not normal. My pager screamed, “GSW to head – ED Room 1.” Gunshot wound to head – Emergency Department Room 1. As the neurosurgery resident physician on call that night, it was my job to evaluate this patient STAT. I wish I could say this …
Ending gun violence in America should be a no-brainer
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“Lacking a supreme being in which to place our faith, my wife and I decided to make the most difficult decision of our lives and discontinue life support. I still wonder if we made the right decision, …
A physician’s reflections with certainty in medicine [PODCAST]
I came out as transgender in my post-baccalaureate years. I grew up in California and was enjoying my time in college at Boulder. Although I had been severely bullied in middle school, there were never any problems for me in the adult world.
Discrimination was not something I thought really existed because I had not seen it.
Blissfully discovering my new self, I began my social transition. I was finally coming into …
Where do trans and visibly queer people go to residency?
As Americans, we live in one of the most affluent countries in the world. Outwardly, many of our citizens seem to possess the necessities of life: shelter, food, job employment, and world-class health care. But what happens when we take a closer look? Do we see cracks in the foundation?
If we are honest, the answer is a resounding yes. When one looks at the area of health care, there is …
Is our health care system based on untruths?
“The patient has a severe infection of the hand and is not improving on the current antibiotics,” I explained to the medical director at the insurance company.
“I understand. However, the patient has no elevated white count or fever, and I cannot get it to meet the criteria, so I will have to deny the necessity for the patient to stay in the hospital,” she explained.
I felt my voice rising and …
The slippery slope of utilization management
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