It was my first week of internal medicine rotation. A newly-minted third-year, I was rotating on the wards back in the spring, when I met a 90-something-year-old gentleman. He had come in for confusion after a fall.
There were no relatives or friends in the waiting room.
I was assigned to follow him. During his stay, his words were few; it was often difficult to engage him in conversation. Whenever I pre-rounded, …
“What diagnosis do you want to use for those ear drops you sent on Mr. Johnson,” Jenn texted me. “ICD-L21.8 for seborrheic dermatitis?”
Sigh. Welcome to prior-authorization hell.
These are generic ear drops I ordered for presumed fungal infection of the external ear. The cash price for the drops is $15 for a 10-milliliter bottle (I checked before prescribing them). “No,” I responded, “it would be ICD-B36.9 for otomycosis.” (translation: ear fungus)
Jenn …
The best teacher of medicine I ever had was during my medical residency. He was a tough, old-school physician, trained at one of the premier institutions in the country, and specialized in pulmonology and intensive care. Before I had even rotated through the ICU, I had seen him around on the medical floors—and must admit I didn’t like him very much at first. He seemed extremely serious, not particularly friendly to any …
Working in urgent care, I’ve started supervising some of the other providers at sites other than my own — 19 sites in all in Pennsylvania and Delaware — so I hear about a lot of patient situations.
The urgent care site where I work is in an affluent area. Most of our patients are employed or retired and have health insurance, though I have certainly encountered a number of patients …
A surgery resident from halfway around the world emailed me the other day looking for advice as she was nearing graduation. She confessed, “I am beginning to question myself if I am good enough … what is ‘good enough’ anyway?”
I had absolutely no idea how to answer the question – what is “good enough” for a surgeon?
First, I tried Google.
“Am … I … Good … Enough”?
2.5 billion hits and some …
As I enter the exam room, I hear, “Don’t get old honey!”
As a physician caring for a large population of geriatric patients in Florida, I hear this approximately five times a day. To this statement, I always reply, “There’s no alternative, though!” I also try not to get offended by repeatedly being called “honey.” Although I am waiting to someday state; “it’s Doctor Honey.” Usually, my level is offense is …
Brain surgery is getting smarter. The journal Nature Medicine recently published a study that found a new imaging technique that allows pathologists to diagnose brain tumors faster and more accurately than ever before.
The study focused on Invenio Imaging technology’s use of artificial intelligence (AI) in making accurate diagnoses. So, will computers replace doctors? That’s unlikely. Treating the human brain requires a human approach. But AI is …
Gun violence has become a public health epidemic. Despite countless deaths in mass shootings over the last two decades, the Dickey Amendment—a provision inserted into the 1996 spending bill which blocked federal funding for research on gun violence—remains on the books. While every politician, media pundit, and policy expert “know” the solution, the answers are not that simple.
In reality, the factors which have fueled the rise in gun violence across …
Protecting your lifestyle starts with protecting your income. Disability insurance provides a solid foundation for your financial future by providing you income when you’re unable to work due to an illness or injury. When most people hear the word “disability,” they immediately think of accidents. But the reality is that 90 percent of disabilities are actually caused by illnesses.
Disability insurance is more complex than other types of insurance. We recommend …
Spiraling costs, poor quality outcomes, and inequities in access to care are driving significant and long overdue changes to the way health care is administered and managed in the United States.
And while the U.S. spends more on health care per person than other wealthy countries, its health outcomes are no better than those in other developed countries. In fact, it performs worse in several health metrics, including life expectancy, infant …
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 …
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 …
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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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 …
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 …
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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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 …
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 …
On February 12, 2020, the National Board of Medical Examiners (NBME) announced that the USMLE Step 1 will transition to a pass/fail exam in January 2022 at the earliest. This move comes amidst increasing pressure on the NBME regarding its financial conflicts of interest, as well as the tangible sense among medical school deans that students were neglecting …
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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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