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
Most physicians receive a budget for CME expenses, and many of those expire on December 31. It’s important to take action now – if you have funds left, there’s a good chance they will be disappear when 2021 ends, and you will then be spending your 2022 CME allowance.
It’s unfortunate that CME budgets typically expire on December 31. This is an incredibly busy time of year, and most of us …
CME budgets expire soon: Use it or lose it
A few months back, I read about a two-year-old child with a terminal cardiac condition who has spent her life in a hospital bed attached to multiple devices that maintained her survival. At the staff’s request, the institution’s ethics committee reviewed the child’s history and prognosis and decided that the equipment could be disconnected. Her mother repeatedly blocked this option, insisting that the child, although frequently sedated, had a “bubbly …
Is life more than breathing and a heartbeat?
Trying to match into residency or fellowship can be stressful. I’ve gone through the match once for residency, and I’m currently going through it a second time for fellowship, so I understand your plight if you are going through it too. There are many variables that are out of our control. As much as we may desire to match our desired specialty at our desired location, this uncertainty can lead …
Healthy ways to reduce stress during match season
“Patients communicate immense amounts of information through body language. The primary understood, universal body language is choking. Anywhere in the world you go, if someone is choking, they use both hands to grab their throats. No matter what country you are in or what language is spoken, you can recognize …
Listening to patients with our eyes [PODCAST]
During my 30 years in medicine, and especially as I began leading medical missions in 2005 to the poorest countries in the world, I have seen much need, tragedy, and heartbreak. It is overwhelming. Despite our best efforts medically to help, we fail. What do you do when all else fails? What do you do when someone has lost all hope and feels you have nothing else to offer?
In his …
Are you willing to shed tears for your patients?
Physicians prioritize patient needs above all other considerations. To advance that mission, the AMA works tirelessly to improve access to quality, affordable health coverage for everyone, which includes protecting patients from the financial harm posed by unanticipated medical bills that can be generated through out-of-network care.
That is why the AMA has joined the American Hospital Association in asking the courts to …
Key change are needed to make the No Surprises Act work as Congress intended
Over the last several years, there has been an increasing recognition that burnout is rising exponentially among health care workers – and there has been a positive shift in the public understanding of burnout and other mental health issues in general. Unfortunately, the policy response from governments, health care institutions, and policy-makers has been woefully inadequate.
Instead of addressing the root causes of burnout and mental distress among our health care …
The trouble with resiliency: It’s time to get to the root causes of health care worker burnout
“Medicine is not a business
You fools.
Healing is your blueprint, activated
to complete itself.
A doctor does not broker it,
The best anyone can do is align you
With what you should be,
And stay out of the way.
(Like a teenager setting off an illegal firecracker.)
Mostly, you pay the doctor for the alignment,
And the nurse
To …
Innovation insight and poetry from a physician-technologist [PODCAST]
The white coat ceremony marks the beginning of a new chapter in the lives of medical students. An academic ritual steeped in symbolism, the ceremony calls on new medical students to reflect upon and adhere to the values that guide the profession. The honor of graduating medical school returns these soon-to-be-doctors to the ideals of medicine. They must take an oath to avoid harm, build trust, and …
Educating for the oath: a medical student’s lived experience with the hidden curriculum
Attention-grabbing headlines suggest that our crucial COVID-19 pandemic tools—monoclonal antibodies and vaccines—are incompatible. Beyond the controversy rests an evidence-based reality: monoclonal antibodies and vaccines are complementary aspects of patient care. Both are powerful interventions that can prevent hospitalizations and deaths from this virus. After weeks of declining cases and hospitalizations, the United States is experiencing another surge of new infections likely due to multiple factors, including relaxed mask use in …
COVID-19 monoclonal antibodies are a bridge to vaccination
Diabetes is a complex yet common disease that impacts over 34 million Americans. Blood glucose is just the tip of the iceberg; related complications include neuropathy, eye disease, ketoacidosis, kidney disease, cardiovascular disease and more. In fact, it could be said that diabetes is a “whole body” disease, in the sense that it spirals out to cause devastating problems that impact many regions of the body, including …
Diabetes impacts the whole body, but the foot can’t be forgotten
“The holiday season is rapidly approaching, and it is not uncommon for us to gain up to 10 pounds between Thanksgiving and Valentine’s Day. But what if we do not want to put on some insulation? What can we do? I specialize in medical weight loss, and my first recommendation …
Don’t let the holidays sabotage your weight loss goals [PODCAST]
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