“In the months just prior to the infantile spasms, as Josephine’s mind had begun to develop and grow, so, finally, had my love for her. My lack of affection for her up until that point had troubled me, and it was with relief that I had realized I was beginning …
A shift from the medical perspective of disability to a mother’s perspective [PODCAST]
Two decades ago, high deductible health plans barely existed. Today, more than half of the U.S. workforce is on one, which are plans with deductibles greater than $1300 per individual or $2,600 for a family.
It’s a growing, undiscussed problem for public health. Most doctors have had patients refuse treatment due to out-of-pocket costs caused by their high deductible health plan. All the while medical debt continues to …
High deductible health insurance is bankrupting Americans
I wish you and your family a safe, healthy, and happy holiday season. I hope your new year is bright and better. And in the campy spirit of the family newsletter some folks send out each year (which I love to read), here is one from me to you.
This year as a family doc was challenging. Again.
At times it was inspiring, frightening, and exhausting. I started the year with a …
A holiday greeting card from the land of primary care
My 5-year-old proudly told me during lunch, “Did you know animals don’t cry?” When she told me this, I had to think about it and then immediately Google this. Having small kids teaches you many random facts, including that sharks don’t blink because they don’t have eyelids.
So, when she told me her new fact, I was intrigued.
Animals, unlike humans, do not have a prefrontal cortex.
This is an area of the …
Let’s not become a nation of physician-robots
Most patients believe and trust a diagnosis and treatment plan their physician provides them. So why is a second opinion in medicine so important? The “practice of medicine” is a term used to imply a variety of diagnoses and treatments. Yes, there is a standard of care in every medical discipline, but there are also many physician-driven distinctions in getting to a definitive diagnosis with a treatment plan. These decisions …
Think again: Get a second opinion
“Medical debt is the mortal enemy of the patient, the physician, the hospital, the community, the state, and the nation. When we think of others’ debts, we tend to think such debts are their personal responsibility. If they’re unable to pay the debt, it’s their problem. (We make it a …
Medical debt is the enemy of everyone [PODCAST]
Smoking cigarettes is well known to cause heart disease, lung cancer, and premature death. In the face of these risks of death, quality of life issues that affect smokers are often overlooked. Although some quality of life issues such as cost, cravings, inconvenience, illness, and stigma are well known, some important effects are largely unknown to the public. For one, smoking is connected with a surprisingly large variety of pains.
Tobacco is a painful addiction
Introduction and background
As an emergency department medical director and physician, a busy emergency department can be a thing of beauty to me. We work hard to set up systems that will provide the care our patients need. Despite our best efforts, almost daily, variables occur that throw the system into chaos and lead to inefficiency. The COVID-19 pandemic unveiled and exacerbated many challenges that affect our ability to provide the …
The goal of health care is in peril
Please also see the original 12 days of COVID.
On the first day of COVID, the ongoing pandemic gave to me,
An insurrection in Washington, DC.
On the second day of COVID, the never-ending pandemic gave to me,
Two backordered gloves.
And an insurrection in Washington, DC.
On the third day of COVID, the society diving pandemic gave to me,
Three anti-vax Karens.
Two backordered gloves.
And an insurrection in Washington, DC.
On the fourth day of …
The Bishwa Ijtema meaning “global congregation” is an annual gathering of millions of Muslims in Tongi, by the banks of the Turag river, just north of Dhaka, in Bangladesh. Bangladesh is predominantly a Muslim nation. This yearly “BI” is one of the largest peaceful gatherings in the world. The Ijtema is a prayer meeting spread over three days, usually in January during which attending devotees perform daily prayers while listening …
Life along the railway lines in Bangladesh during Bishwa Ijtema: a physician’s photojournal
“My practice consisted of patients who suffered from serious injuries and illnesses. Concerning the latter, a significant number had cancer, especially breast cancer. The issue all patient groups have in common to a certain degree is protein calorie malnutrition (PCM). The most dramatically affected are those stricken with a malignancy. …
Protein calorie malnutrition is devastating for patients [PODCAST]
Health care requires forward progression in the chase for quality, safety, and sustainability. When considering how far we have come collectively, success is often celebrated. Be it a new vaccine to curb a pandemic, an advanced diagnostic tool to expedite diagnoses or process alteration to achieve sustained quality, advancement is paramount in both length and quality of life and care delivery. Retrospectively, one can look with ease on the way …
Disrupt health care with blockchain
I first heard about Sir William Osler (1849-1919) through my primary care physician. His biography stated: “I practice family medicine because every day I get to meet new people from all over the world. I get to hear their stories, meet their families, and help them heal. In some cases, I get to see them again and again, building trust and respect while forming meaningful relationships. To me, there is …
Osler and the doctor-patient relationship
Second in a series. Please read part 1.
The business of health care delivery differs markedly from other consumer and service industries in many ways. First and foremost, the economics differ. Specifically, the payers of medical care are often different from the customers, the government and third-party insurers are the primary payers, demand is inelastic, quality metrics are typically unavailable, and the industry consists largely …
“To better meet the needs of patients, providers can improve access to treatment and offer more immediate solutions through the use of prescription digital therapeutics (PDTs). With technology, providers can now deliver programming aligned with proven mental health treatment methods, such as cognitive-behavioral therapy, and connect teens and young adults …
How digital therapeutics can improve behavioral health [PODCAST]
An excerpt from Yankee Doctor in the Bible Belt: A Memoir.
Doctors like to solve puzzles. These are ideally diagnostic puzzles. The following is a story about a patient whose illness was unsolvable: the pieces of the puzzle did not fit together. No matter how you tried to force a diagnosis out of the disparate pieces of data, it did not …
Could you solve this medical puzzle?
Musings of a primary care triage nurse:
1. “Isolation means you aren’t around others. No, you shouldn’t be eating dinner with your family or watching TV with them.”
2. “You’ve been sick for the past week but didn’t get tested. Yes, COVID can just be symptoms like a cold or that sinus thing you get each year.”
3. “The majority of those that are hospitalized are unvaccinated. I know ‘someone’ told you that’s …
10 things this nurse is f-ing tired of saying
Your income doesn’t matter. What you do for a living doesn’t matter. If you want to keep from being broke, none of these things matter except for this: When you’re dealing with money, you’ve got to understand how to do simple math.
I hear stories about people that don’t understand what broke means. It could be the person that recent graduates from dental school with $400K in debt that buys the $80K BMW for instant …
How not to be a broke doctor (5 ways)
“Many of us suffer in silence for myriad reasons. Being a physician with infertility presents a perfect storm of stress, anxiety, guilt, and shame – all of which we know don’t contribute to managing any medical problem.
Consider what it’s like to undergo a typical cycle of in vitro fertilization. …
Women physicians with infertility [PODCAST]
Once upon a time, in a magical land of Whoville, lived the Whos. They were a group of little humans who loved Christmas with passion. But not too far from their beloved town and in a place called Mount Crumpet, inhabited the Grinch, a grouchy creature that hated Christmas. During that time of the year, the Grinch would watch people of Whoville adorn their houses and buildings in bright colors …
What Dr. Seuss reminds us about Christmas
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