Investing in the stock market is like playing that game of rock-paper-scissors

Finance
January 11, 2019

Rock-paper-scissors is a game that nearly all of us played as children.

It is a game with incredible opportunities to play mind games with your opponent.

There is no luck in rock-paper-scissors as with card games.

The game does not have complex rules like chess.

You simply have to figure out the patterns of your opponent (or induce patterns into them) and take advantage accordingly.

Can you beat the New York Times computer bot?

Back in …

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A financial checklist for the pregnant woman physician

Finance
January 11, 2019

Women physicians are disheartened when they discover the financial implications of having children. Most of us will not get paid leave. Many of us are the breadwinning partner. And most of us will not become stay at home moms so we will need to pay for high-quality childcare or have a stay at home spouse.

Certain things should be in place prior to becoming pregnant. So even if you’re single, I …

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10 surprising things you need to know about the hospital

Physician
January 11, 2019

1. Very little revolves around the patient. For a place dedicated to healing, the hospital does a poor job accommodating patients. Labs are drawn in the middle of the night, so the doctor has them early in the morning. There is no standard rounding time, so the patient is constantly awakened throughout the day. Vitals must be measured every few hours. Patients often comment about being happy to be discharged …

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Treating sleep apnea without CPAP

Conditions
January 11, 2019

It was 4:00 a.m. when I made it to my parents’ home. My mother called me to say that my father was having a hard time breathing. I could hear him struggling in the background. I ran inside to see my mother cradling my father on the floor — not breathing. I performed CPR on the man that gave me life! CPR on the person who just three months earlier …

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The discrimination against nurse practitioners must stop

Physician
January 10, 2019

I have been a neonatologist for 30-plus years. Throughout my career, nurses and neonatal nurse practitioners (NNPs) have guided me, assisted me and comforted me through difficult patient care issues that arose. Even more importantly, they allowed me to leave the neonatal intensive care unit (NICU) without worrying about how my patients were being taken care of.

I am writing this because our profession (MDs and DOs) continue to devalue these …

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Your first 24-hour shift

Physician
January 10, 2019

How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the ordeal.

When I get to work, full of nervous energy, I am relieved to find out …

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10 essential questions to ask when diagnosed with bladder cancer

Conditions
January 9, 2019

Over 80,000 new cases of bladder cancer are diagnosed every year. Of the new cases, over 62,000 are men, and over 18,000 are women. Whites have higher incidence rates than blacks, although black patients have higher mortality rates, particularly black women. The majority of cases are found with painless gross hematuria (although most patients with gross painless hematuria don’t have bladder cancer). Nearly 80 percent of patients diagnosed with bladder …

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Here’s what caregiving taught me

Conditions
January 9, 2019

Caregiving is often described as a sacrifice. One individual bears a burden to care for another. There’s a connotation of drainage, evocations of burned-out batteries and tired limbs.

I was a premedical student. I was aggressive in pursuing an MD. I wanted to be the best doctor I could be. I did not realize that required me to become a much a better person.

I left school to care for my grandmother. …

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Residency training, and training in residency

Education
January 8, 2019

Exhausted. Aching. Hungry. Slightly delirious.

Mile twenty-four of a marathon? Or hour twenty-four of a twenty-eight-hour shift?

I am a resident. I am a runner. I am also a rather tired human since, as I type these words, I’m both post-call and post-run. However, this post-call/run state of body and mind is one I have learned to love and embrace during this residency whirlwind.

I’m not myself unless I’m wearing scrubs or running clothes. …

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How near-death experiences profoundly change lives

Conditions
January 7, 2019

An excerpt from The Science of Near-Death Experiences.

Near-death experiences are an ancient and very common phenomenon that spans from ancient philosophy, religion, and healing to the most modern clinical practice of medicine.

Modern advances in medical knowledge make it possible to revive patients from increasingly severe, life-threatening injuries and illnesses, including cardiac arrest.  Upon being revived, …

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A medical student’s letter to her parents

Education
January 7, 2019

Dear Mom and Dad,

I love you, and thank you. The rest of this letter is an attempt to write something more eloquent and thoughtful, but those are the best and truest words I can ever speak to you. I made the decision to enter the medical field when the rest of our family is from a business and finance background. Despite being unfamiliar with the different hurdles of application cycles, …

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Physician gives in to police pressure to conduct a forced invasive rectal exam

Physician
January 7, 2019

Recently, news broke about a disturbing act of medical battery carried out by doctors at St. Joe’s Medical Center in Syracuse, New York. The case began when police officers conducted a pretext stop and elected to harass their victim about a small amount of marijuana.

As the situation escalated, the cops took the man to St. Joe’s Medical Center for him to be searched for …

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Net promoter scoring needs to be tweaked for medicine

Physician
January 6, 2019

Net promoter scoring (NPS) measures customer experience and predicts business growth. Recently it is becoming more common for health networks to adopt NPS. The word “customer” should be a red flag. In medicine, we do not have customers; we have patients.

It is common practice for a patient to receive a text message after they leave an office asking them to rate their experience. It generally looks something like this, “How likely …

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An approach to prior authorization insurance denials

Policy
January 6, 2019

Patient access to care is a high priority for all neurosurgeons. Unfortunately, many of our practices are thwarted in these efforts from unwarranted insurance denials. Know, you are not alone. Take this common scenario:

When Ms. Mary Smith (not the patient’s real name) started her new job several years ago, she purchased the premium insurance policy that her company provided. Recently, she developed severe neck and left arm pain. Imaging of …

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How to transfer residency programs

Physician
January 6, 2019

Even though physicians do not talk about transferring residencies, it is more common than is often believed. According to the AAMC website, about 30 percent of residents do not finish the initial program they started. Quantifying that number further, the ACGME recently reported 1,044 residents transferring from their program.

There are a variety of reasons for transferring residencies: A spouse being accepted for …

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Stop shoving metrics down nurses’ throats

Policy
January 5, 2019

One time, I applied for an emergency department (ED) nurse manager position. I thought I had the job locked up until I was asked during the interview how I would “enforce metrics.”

“Enforce.”

My holistic, qualitative research-based response to this authoritarian-style question was: “I’ll find more organic ways to achieve your metrics without shoving numbers down their throats.”

I didn’t get the job. Someone told me I wasn’t “MBA enough.”

Yet, I stand by …

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Non-therapeutic relationship or human kindness?

Physician
January 4, 2019

About two months ago, a 15-year-old Native American male was riding around in a stolen car on the reservation. “M” and the driver were drinking. And somehow, after he exited the vehicle at 4 a.m., the car struck him. Hours later, it became clear that something was wrong. M was transferred to our pediatric hospital as a trauma and was found to have an unstable vertebral fracture. Conservative treatment with …

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What’s the biggest problem with medical education?

Education
January 4, 2019

There has been a profound deterioration in the education of our medical students. I only make this contention after having taught over a hundred medical students across five continents, often one-on-one and for extended periods. Although the majority of those I’ve taught have been students educated at international medical institutions, a substantial number have been those from U.S. medical schools. While I do recognize that those that find their way …

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What’s barbaric in medicine?

Education
January 3, 2019

Late one evening, I received a text from my oldest daughter.

“What in medicine, that we do now, will we think is barbaric in 50 years?”

Wow. They play more provocative bar games now than they played when I was in my 20s.

I promptly texted back my knee-jerk response: “chemotherapy.” As we are on the brink of precision medicine, what will the next generation think of our “slash, burn and poison” paradigm …

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