“The journey to becoming a physician is generally a linear path. Sure — there are exceptions, but for the most part, you can accurately predict what you will be doing in the future. For example, when you are in high school, the next step is college, then medical school, residency, possibly a fellowship, …
How to navigate residency probation [PODCAST]
“You do not rise to the level of your goals. You fall to the level of your systems.”
– James Clear, Atomic Habits
I had a bit of a revelation recently when I brought my dog in for grooming. Some background: My dog is ten years old and has a double coat from hell (although very pretty). She also had a spinal cord injury in November 2019 and has residual weakness in …
Groomers at PetSmart have more autonomy than physicians
Their absence makes me feel sad,
I look around at my peers, envious and curious,
Obsessing over when they will show up.
When they do, they never seem to live up to expectations,
Too small, too uneven, but what’s sure is it’s a sign I’m no longer a child.
It adds to my wardrobe in a hushed way,
I don’t know whether to be proud or embarrassed that they’re finally here.
I look at magazines; should I …
There is no other body part that has filled me with such a roller coaster of emotion
The holiday season was notorious for causing loneliness, sadness, anxiety, and a sense of loss even before adding the COVID-19 pandemic to the mix. The pandemic has only served to magnify many of these feelings, as gatherings with loved ones are postponed or canceled. The stress of getting everything done on time and navigating family dynamics can lead to struggles that can benefit from support and self-care. In 2021, support …
Sustaining mental health during the holidays and starting strong in 2022
“I love stories, either told, written, or listened to. Songs tell stories, as does art. Blogs such as the rich content open so many doors for rich conversations. Telling stories is part of who I am. My father loved to tell them, as did my grandfather, whose name I took. …
Why storytelling is critical in medicine [PODCAST]
One of the most dramatic changes from my training to the present is the nearly complete disappearance of elective ulcer surgery. (Reminder: as I’ve said before, “elective” means non-emergent, as opposed to unnecessary.) The revolution began with the advent of drugs that effectively reduce gastric acid production and settled in for real when the relationship between ulcer formation and the bacterium known as H. pylori was worked out. I have to …
A reflection on stomach surgery
“Mom, every time I look in the mirror, I see something different. Sometimes it’s good, and I feel good about myself. But, sometimes it’s not.”
It was well after dinner, and my nine-year-old daughter was perched on the kitchen counter, nibbling on apple slices while I made tea. Her eyes were fixed on her reflection in the mirror across the room, her expression critical.
I leaned forward. “Let me share something with …
Leaving academic medicine was a matter of self-respect
“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
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