What to do with the extremely defensive doctor

Physician
February 18, 2020

Let’s talk about the doctor who is excessively defensive.

I divide this kind of communication blocker into two varieties: physician personality and physician mode of practice. The physician with a defensive personality is one who interprets questions from parents as questioning of her medical judgment. Unlike the supremely egotistical doctor, who is often sufficiently secure in her image of herself that she is magnanimous toward parents who ask questions, the overly …

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Why direct primary care is the future

Physician
February 18, 2020

I recently wrote about my new type 1 diabetes diagnosis, the quest for affordable meds and supplies, and the subsequent financial savings found through transparent pricing outside of my insurance plan. I summarized that health care “coverage” is very expensive, whereas medical services may be found much more affordably.

My next step was to establish an ongoing primary care physician relationship.

I contacted one of the large medical …

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Medical error is not the third leading cause of death

Policy
February 17, 2020

Ever since the publication of the infamous 2016 BMJ opinion piece claiming medical error should be considered the third leading cause of death in the U.S., the debate on the true incidence of deaths caused by medical error has been raging. Many, including me, felt the estimate of 251,000 deaths per year from medical error was grossly inflated. For example, the paper extrapolated the number of deaths from …

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What happens when abortion services aren’t available

Conditions
February 17, 2020

In my very first job as a doctor — working in a London hospital in the 1980s. I always took a ridiculously detailed past medical history for every patient I saw. I started to notice how many elderly women had had septicemia, a life-threatening infection in which enormous amounts of bacteria enter the bloodstream.

The neighborhood surrounding the hospital had once been the worst slum in London. And it didn’t take …

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What do hospital discounts really mean?

Policy
February 16, 2020

Our local newspaper recently ran an article on the top of its front page, stating that our monopoly health system is now “expanding health care cost discounts.”  The article was actually a press release – free advertising on the front page. As a primary care physician who refers patients to this health system, I wanted to know what these discounts really meant.

So, I asked the newspaper in an editorial, “what …

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The Hufflepuff of medicine

Physician
February 16, 2020

Recently, my mother waited for over an hour for what turned out to be a 5-minute visit with her primary care doctor. Her doctor seemed rushed and stressed, her questions perfunctory, the management plan hurried. And then she was gone. “It’s like she didn’t even know I was there,” my mom relayed to me.

This is a physician who is thoughtful, intelligent, and kind, with excellent clinical instincts. After this visit, …

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Numb: How I survived as a physician

Physician
February 14, 2020

On my final day of work before beginning my self-imposed  burnout sabbatical, a colleague asked, “Why don’t you just get on medication?” I remember thinking, “What am I medicating?  I feel nothing.” I was in the vice grip of burnout, overwhelmed, and physically and emotionally exhausted.  But mostly, I was numb.

But in reality, I have always self-medicated – with work.  As a professional ballet dancer turned doctor, my life has …

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Heart of a doctor. Mind of a doctor. Soul of a giver.

Physician
February 14, 2020

Calling.

I am awakened by the loud, screeching sound of my pager. I feel my heart race. I look at the clock.

It is 3:07 a.m. It’s cold in the room. I am shivering. I stand up quickly, instinctively. I feel the soreness of my feet for a brief moment, but push that thought aside and look quickly at my pager. It reads, “room 2309, death pronouncement”.

My heart sinks. She is mine—my …

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The simple step that helped this physician lose 10 pounds

Conditions
February 13, 2020

By the time I turned 40, I had gained and lost 40 pounds at least ten times. It started with the “freshman fifteen” plus another twenty-five in college. In medical school, I was introduced to sweetened coffee beverages, and I snacked on pretzels and candy to stay awake while studying. I got through overnight call during residency by using my meal tickets to buy chocolate-covered ice cream bars. And once …

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As I become a better baker, I hope that I will continue to become a better doctor

Education
February 12, 2020

Growing up in a Korean household meant that I had very little experience with the type of baking that most Americans are used to; My grandma made rice cakes, not birthday cakes.

But during my third year of medical school, an intern recommended a show called The Great British Bake Off. After watching a few episodes and seeing what devoted home bakers could do, I was smitten and resolved to bake a …

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Cervical cancer guidelines leaves women confused about annual pelvic exams

Conditions
February 11, 2020

There is good news and bad news in the world of women’s health.

The good news is that women do not need annual Pap smears. The bad news is that, upon hearing the good news, many women incorrectly assume they no longer need annual pelvic exams, either.

Historically, Pap smears were performed annually, and during the same time as pelvic exams, so it is understandable why women would conflate the two. But …

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Why doctors need life skills

Physician
February 11, 2020

Medical school prepares doctors for patient care: perform a history and physical, and based on the findings, consider the next diagnostic tests to order, review all data, and develop a treatment plan. By graduating from medical school, you are skilled to perform those duties with a certain level of competency and confidence.

Success in the next phase of this journey and the rest of your life depends on honing those skills …

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Medical residents need parental leave

Physician
February 10, 2020

My wife and I had a baby a few months ago. Or, more accurately, she birthed a child while I sat in the corner, contemplating the miracle of reproductive physiology in a vasovagal fugue. In the months leading up to and following that wondrous moment, we found ourselves navigating the labyrinthine complexity of parental leave in graduate medical education.

To start with the positive, we are both residents in the same …

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Health care is like lions for lambs

Physician
February 9, 2020

I just watched the movie 1917 at the theatre. Shot in a unique way giving an immersive experience, showing the frontline reality of war through an unforgettable human story, it has to be one of the greatest war movies ever made. I’d encourage everyone to go watch it. I learned a fair bit about the First World while I was in high school in the United Kingdom. Its stories are …

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How you can show patients you are listening

Physician
February 8, 2020

Being a physician is an important role. It’s easy to forget the impact that you have on a patient just by being at their bedside.

It’s huge.

Have you ever been a patient? It’s an incredibly vulnerable experience.

You’re not really sure what’s happening and what is going to happen next.

People are really putting their faith in you to understand their needs and to ease their suffering. It’s a powerful thing to ease …

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MKSAP: 32-year-old woman with loose stools, bloating, and weight loss

Conditions
February 8, 2020

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old woman is evaluated for a 6-month history of loose stools, bloating, and a 3.2-kg (7-lb) weight loss. Her medical history is otherwise unremarkable. Her brother has type 1 diabetes mellitus, and her mother has autoimmune thyroid disease. She reports no other symptoms and takes no …

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