The first time a woman went into the final stage of labor, I watched from a corner of the room. As a third-year medical student, I was on my six-week clinical rotation in obstetrics and gynecology, and it was day one of the two-week portion on the labor and delivery floor. As a loudspeaker announcement projected over the woman’s screams, and nurses and doctors rushed in response, I instinctively clasped …
I’m writing this for my tribe of worriers and self-doubters, people for whom ever-present test stress is inextricable to the med school experience. Sure, every medical student becomes preoccupied fretting over exams to some degree. That’s part of what you sign up for. But our preoccupation is something greater than that—it towers over us and bullies us. It makes us cower in the corner, begging to be spared from harm.
We’re …
Having recently testified in several legal cases involving strangulation, here are some facts we all need to know about this extreme form of domestic violence (DV). I invite other subject matter experts to share their personal opinions on what is important.
1. Strangulation is assault with a deadly weapon – an act with known potential lethal consequences. Formally defined, strangulation is an external force applied to the neck cutting off blood …
I have been fortunate in that I have not had to hospitalize any patients in the past four weeks. This means I have an extra 60 minutes or more to prepare for the workday in my office. The streak ended this weekend when my associate, taking his rotation of being on call, hospitalized one of my patients with pneumonia.
In many cases, pneumonia is treated as an outpatient. You receive an …
I am frequently asked: “Why are you pursuing a dual MD/JD?” Neither profession is a family business; no one in my family is a doctor or a lawyer — but I’ve always dreamt big. I always wanted to get the most possible out of my education. Beginning in elementary school, I knew I wanted to be a doctor, but it was not until college that I …
My next patient was a healthy man in his early 20s following up for eczema. His case had not been severe, so I had anticipated that the prescription strength steroid cream I had given him would have addressed his symptoms faster than I had promised. His chief complaint had been itch—a symptom—something that he was experiencing. He hadn’t even noticed the rash. It was what one would call “bread and …
“Slowly comes the hour, it’s passing speed how great.”
– Samuel Cowper
Our careers will end someday.
Of course, we know this deep down, but I think we lose sight of it amid our training and the day-to-day grind of our jobs.
But just this past week, I was given a little reminder.
At our Christmas party, we took some time to honor one of our colleagues on his journey to retirement. He had spent …
The other night, while I was getting out of my car, my oldest son, standing on the porch, excitedly yelled out, “Mom, look at this lego structure I made!”
I couldn’t see it, but I could tell how happy he was to show it to me. “It looks neat from here. Let me get closer.”
My husband appeared, knowing how tired I was, “Mom worked a long day. Why don’t you let …
There’s so much negativity out there when it comes to health care, it must be a concern to any young person thinking about entering the field. I certainly spend a lot of time writing about all the challenges we face, and have to hold my hands up to (occasionally) spreading some of that negativity as well! Guilty as charged. That’s why it’s important for anyone outside of health care (or …
It wasn’t until I first had to manage the aftermath of a sexual assault on a psychiatric unit one night during my residency that I realized psychiatry might have a problem with sexual safety.
My fellow residents and I had never been informed of a management policy for inpatient sexual assaults, and my program’s curriculum was silent on how to handle the issue.
Because the assault involved a psychotic patient who was …
I bid farewell to four people this month who I’ve been caring for in my outpatient psychiatry practice — all under sensitive circumstances but ultimately moving in positive directions. As I write formal discharge letters, the unique role psychiatrists and other mental health clinicians play in the lives and minds of the people we care for is on my mind.
It is the nature of our healing practice to build trust …
I’ve noticed a theme in my clinic since I started practicing medicine: when a patient understands what is being said about their care, treatment, and services, they’re more likely to fulfill critical health care responsibilities. No one should be surprised by this, but as our nation and hospitals increase in diversity, the issue of health care equality for LEP (limited English proficiency) patients is becoming more pronounced.
Today, this population of …
Ninety minutes before my Sunday night shift, my two-year-old, Titan, comes screaming up the stairs looking like a scene out of a slasher horror movie. His older sister sheepishly admitted to chasing him into the edge of a door frame. We created an ED bed on our kitchen counter and slipped a pillowcase up his arms, behind him, with him laying …
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I went to a bar last night — and I looked good: red coat, black dress, knee-high suede boots. I was feeling pretty good.
I met my best friend at this bar — he lives elsewhere now — but this is his favorite spot in the world. Like Norm in Cheers, he is also their favorite customer.
We ordered dinner, and my best friend stepped away to talk to the bartender. I …
I recently had the pleasure of interviewing famous television and film actress, Claudia Christian. She has played significant roles in many notable movies and shows, including lead roles in the long-running sci-fi series Babylon 5 and the Disney film, Atlantis: The Lost Empire. In our podcast interview, we discussed treating alcoholism using the FDA-approved drug, naltrexone.
Why listen to an actress about medical treatment for addiction? First of all, doctors generally …
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The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge is shaping …
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There was a time, before treatment algorithms, when physicians would rely on the detailed bedside and/or office observations of their patients in conjunction with the most recent published peer-reviewed studies.
Time spent with each patient was considered essential and appropriate to reach a proper diagnosis and treatment plan. Now, due to corporate mandates to produce higher RVUs, time is regarded as an unnecessary luxury, to be controlled and curtailed. Yet recent …
Over the past 40 years, the number of U.S. hospitals declined by 12 percent, from more than 7,100 in 1975 to 6,200 in 2017, according to the latest American Hospital Association survey. And, yet, despite shuttering nearly 1,000 facilities, hospitals remain the nation’s largest source of health care spending, accounting for $1.1 trillion annually (or 33% of all national health care expenditures). Much of that money goes …
Many physicians will decide they want or need to make a transition from the practice of clinical medicine to “something else” at some point during their career. Whatever the motivation for their job transition, most doctors appreciate a rational, structured process that enables then to get from where they are to where they want to be. Fortunately, there are some easily accessible resources that can add value to your work/career …
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Prior authorization — a utilization management (UM) process used by health insurance companies to determine coverage for a prescribed procedure, service, or medication — is now becoming a mandatory requirement by the vast majority of large insurance companies.
While prior authorizations are pursued at the front-end for almost all planned medical services, there has also been a steep increase in denial of payment for services at the inpatient level for both …
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