I failed my Step 1 medical school board exam by 1 point. This was very hard for me to process, and I consistently wondered if I would have passed if I had just waited an additional week. This new challenge led me to reach out to a new resource: the disability office.
Never before had I considered my medical diagnosis of endometriosis and anxiety as a “disability.” I had obviously done …
Requesting disability accommodations in medical school
As I write this, a rapidly spreading COVID-19 variant called Omicron is the uninvited guest this holiday season. I’d hoped that the vaccine would have had more widespread acceptance, and we wouldn’t be in this situation, but this is our unfortunate reality now. In addition, COVID-19 has metastasized the already inherent bureaucratic cruelty of the U.S. medical system into death by a thousand slashes of red tape. I will explain why …
The bureaucratic cruelty that is modern medicine
“The data are remarkable and promising, though beyond the numbers is a bigger picture. Each data point represents a life – a mother, uncle, grandparent, loved one, friend. Technological advances in image guidance and therapeutic delivery are allowing us to extend life – and quality of life – for …
How MRI-guided radiation therapy is changing the paradigm in pancreatic cancer [PODCAST]
One of my favorite passages from sacred writings is the story of Moses, still tending his father-in-law’s sheep, an ordinary day in an ordinary place, suddenly encountering God, the ground he stood on now consecrated into holy ground, admonished to “Take off your sandals, for the place you are standing is holy ground.” All of the world’s religions speak of holy ground. For Muslims, even the simplest prayer rug in …
You are standing on holy ground
Nurse: “I need help with the computer; patient transfer needs to be completed.”
Me: “Ma’am, the patient’s medications are on ‘MAR HOLD,’ which means Medication Administration Record Hold. Therefore, we cannot administer medication unless an attending physician releases this hold. Can we get the physician on the phone for him to reconcile the meds?”
Nurse: Reluctant to call the physician, insists on completing the transfer at the unit manager screen. Finally, she …
Physician informatics demystified
I just wanted to tell you that I had a wonderful patient as a consult today. She had a pretty bad prognosis and was a recently diagnosed hepatobiliary cancer patient. Pretty aggressive disease with wild metastasis. From her time of diagnosis to my consult was less than two weeks. But her cancer was advancing at a remarkable pace, and the oncologist was recommending no further chemotherapy if she remained this …
The price of love is loss. But still we pay.
“The unvaccinated patient is the addicted person, the overweight patient, the smoker in the waiting room. Our antipathy toward them endangers their health, maybe their lives. The unvaccinated will not be convinced with stigma. They will be convinced with integrity, sincerity, and love.
Stigmatization has never been an effective health intervention. And that’s exactly what …
Anger toward the unvaccinated will only cause more harm [PODCAST]
In 2017, I read an article called “I Don’t Know How to Explain to You that You Should Care About Other People.”
I don’t remember the details of the article; the name was enough.
As we enter our third year of a global pandemic, I think about that often.
I don’t know how to explain to you that COVID is real.
I don’t know how to talk to the ex who …
I can’t make you care. But you should.
With apologies to the late Yankees slugger Yogi Berra, for pandemic-weary Americans, it’s like “déjà vu all over again,” as new lockdowns and mandatory mask mandates are being imposed across the globe.
The latest threat, the Omicron COVID-19 variant, has been a major source of breakthrough infections, including among those who have been fully vaccinated and boosted, such as United States Senators Elizabeth Warren and Cory Booker.
Pfizer, Moderna, Johnson & Johnson, …
Covaxin: Doomed to the dugout or ready to join the field of vaccine options?
I opened my email recently and blurted out a heartbroken expletive that I can’t print here. Another member of our health care family had died by suicide. I didn’t know them well, nor had I known our colleague who died from suicide just a few months before, but I felt as though I had been punched in the gut. An image came again that has been arising in my head, …
We must start looking for drowning colleagues
“Physicians, nurses, advanced practice providers, medical assistants, and other health care workers are a finite resource. They don’t grow on trees. And, though we all seem to deny it, they are human.
The physicians I coach often wonder what they are doing wrong that their lives feel impossible. They are …
Hello, health care organization leader, are you listening? [PODCAST]
The middle-aged veteran curled up on the uncomfortable foam mattress appears irritated. Perhaps he is irritated at himself, knowing that he has gone through this process multiple times, or irritated at his providers, who simply think of him as a chronic alcoholic. I greet him for the first time, sitting on the empty bed opposite him. I ask him a set of questions that I must go through with every …
Appreciating patients as unique individuals makes us better physicians
When I entered the field of medicine, the goal was clear; to make patients “better.” Through my hospital-based training and practice as an internal medicine physician, I developed a strong interest in illness prevention — how can we keep patients from coming here in the first place? The answer became crystal clear. What wasn’t clear was how to focus on preventative care in the current structure of the U.S. health …
Skin-in-the-game doesn’t have to be scary
I recently had an email exchange with a friend and psychiatric colleague, Dr. Michael Myers, on the topic of professional courtesy. It’s a topic I’ve written about before. However, one of my essays stirred considerable controversy, so much so that readers’ comments turned ugly and unprofessional, and the commenting section on the host website was closed. It seems my op-ed struck a raw nerve primarily among millennials, many of whom …
Professional courtesy means being a “doctor’s doctor”
I complain about my job all the time. The frustrations are endless. For example, EMR changes that seem pointless and create more clicks, instead of fewer, the constant barrage of patient emails in my inbox that start with “I have a question about X result” because results are released immediately to patients before I have seen them, patients that arrive late without having filled out medical history form ahead of …
I loved my job yesterday, but I don’t love it every day
“Six air changes per hour and HEPA grade filtration of indoor air for our children is an investment in their futures for long beyond when the COVID-19 pandemic fades from view. We know there is poor indoor air quality in multiple schools, from inadequate ventilation to air pollution to …
Clearing the air our kids share: a prescription for healthy schools [PODCAST]
An excerpt from Medical Answers Now!: How Direct Primary Care Guarantees Fast Access to Your Doctor.
Virtually everyone understands the importance of major medical insurance as it relates to unexpected high-dollar care for severe injuries and significant medical conditions, but the value equation for health insurance is quite different when applied to coverage for primary care services.
The full potential cost for …
6 major disadvantages of insurance involvement in primary care
I was two months into my first year of medical school when I experienced it for the first time.
“Room 214 … oh yeah, she’s a real pain. She will probably talk your ear off and come up with a new self-diagnosis that she will want to get a full workup for. She always does.”
Nervously, I laughed it off. I grew up in a household where doctors are held in high …
The patient who just wanted to be heard
My energy level was plummeting as Mrs. Jones explained how much her shoulder, her knees, her back, her belly, her head, hurt. She was worn out.
“And I don’t ever think I’ll feel better. I’ve felt like this for so long and I think I’ll always feel like this. I’m so sore. And so tired. And my family doesn’t do anything to help. In the evening after I’ve finished making dinner, …
Depression is a notification that the old patterns are not working
Life can feel full of uncertainty when battling cancer, with few guarantees. “Is there still cancer in my body?” and “Will it come back?” are common questions that have long been difficult to answer confidently until recently. Advances in next-generation sequencing — and a growing understanding of how our bodies respond to illness and treatment — have brought us closer than ever to predicting our individual futures, at least when …
Tumor-informed residual disease testing can help inform cancer treatment
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