Mr. Williams is a 52-year old male who has been following me for some time. He has just been started on metformin for newly diagnosed diabetes. Lisinopril is his only other medication for high blood pressure. When he had his yearly physical, he was also found to have a high LDL “bad” cholesterol of 150. His BMI is 29, significantly overweight and touching obesity levels.
I sat down with him for …
The dream patient that makes a doctor very happy
I am a former chief of surgery and a scientific entrepreneur.
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. PCM leads to increased morbidity, mortality, …
Protein calorie malnutrition is devastating for patients
“Frontline workers may have temporarily experienced a heightened sense of personal success and gratification, but I doubt many of us are still able to feel satisfied at this point, after all the repeated moral injuries and losing so many patients. COVID-19 assuredly changed me. The virus changed my residency …
Carry on, my weary one: Persevering in the aftermath [PODCAST]
About 4 months after emergency medicine physician Jessica (a pseudonym used out of fear of retaliation from her employer) joined a Michigan hospital in 2014, the department’s staffing group was bought out by TeamHealth, a staffing firm backed by the private-equity behemoth Blackstone.
Ever since Emergency Medicine Specialists (EMS) — which touts itself as one of the oldest emergency physician groups in Michigan — was acquired by TeamHealth, “it’s been …
Why private equity is a dangerous employer
At the very start of the pandemic last year, I met with a couple of patients in the office while we wore masks. Based on that limited experience, I quickly concluded that seeing each other’s faces was of paramount importance, even if over video. That, plus the infection risk, led me to close my office to in-person appointments. For more than a year, I exclusively conducted …
Which is better: Psychotherapy using video or in-person while wearing masks?
Remember the dark days of the pandemic, when the true risk of caring for COVID patients started to become clear? Remember when you could be censured by a nursing supervisor or administrator for wearing a mask in public areas lest you frighten patients or visitors?
Right around then, a third-year resident at UCLA decided to wear a mask wherever he went in the hospital, as testing wasn’t readily …
Why it may be time for doctors to unionize
“As a mother, a physician, and an educator, I refuse to accept this as normal. It is not! What should we tell the parents of these young physicians? How do we explain to them that their dream of being a doctor became a nightmare with a tragic ending? What do …
Physician suicide: Where are the leaders? [PODCAST]
An article in the New England Journal of Medicine in 2018 noted the sad milestone that firearms were causing 15% of all deaths in children and adolescents. Somewhat encouraging, a later study showed states with stricter firearm laws correlated with lower numbers of firearm deaths in children. The relationship was quite linear, as you can see below. The authors had specific criteria for weak vs. strong gun laws: if …
The success of Australian firearms regulation: What it could mean for children
Over the last 32 years, I have been following the literature concerning money, investing, and debt. In the last few years, I started writing about the topic as well as sharing my knowledge with other physicians through one-on-one financial coaching. Through the years, I have seen many people make the same mistakes when projecting financial goals, and they make them year after year.
When all of the answers are at our …
4 money mistakes everyone makes
Recently, I solved a medical dilemma by changing the medication that seemed to have nothing to do with my patient’s problem.
Ethan Blake is a thin-boned, soft-spoken man with atrial fibrillation and a history of high blood pressure. He lives alone and prefers to shovel his own driveway. He also loves to walk his springer spaniel in the woods behind his house. He is in great physical shape.
At his routine follow-up …
Thinking like a plumber when adjusting medications
“Provider organizations may look at their budgets and think the traditional model of fax machines and landlines is serving their entity in optimizing revenue streams. They may even look at their providers’ full schedules and believe there isn’t a patient population that still needs care. But this would be …
Why clinicians can’t keep ignoring care coordination [PODCAST]
Ni cta ni akohikon: That hurts me.
Carol pe ntamici: Carol, come see me.
Ni taci sa micta mackikikatakoiin: They are overdosing me on drugs.
Wipatc tca: Do it quickly.
Those were the chilling words of Joyce Echaquan, broadcasting live from Facebook on September 28, 2020 at 10:27 am (English translation provided).
On September 26, 2020, Joyce Echaquan went to De Lanaudière Hospital in Joliette, Quebec. She was suffering from severe stomach pain. …
Systemic racism and Indigenous deaths in health care
When I decided to leave practice and explore non-clinical career options, I found no shortage of opportunities, ranging from the pharmaceutical industry to the health insurance industry and many points in between. I chose to work in the health insurance industry because jobs were plentiful, and the focus of work remained on the patient.
A typical entry-level job in the health insurance industry is that of utilization …
For doctors leaving clinical practice: Do not consider utilization review jobs
My Tuesday out of clinic started off like any other Tuesday. I got up (sluggish, still chronically sleep-deprived), scrubbed my face and brushed my teeth, slipped into workout clothes then set to getting my two girls ready for school. After packing lunches, brushing hair, and waiving to the bus, I sat down to do what most of us do on our days out of clinic: check the dreaded inbox. Who …
I’m your primary care doctor. May I take your order?
“During COVID, the medical training system had to adapt because people couldn’t meet in person and even those that could didn’t have access to patients or facilities in the same capacity. However, the explosion of remote training tools that became available make this hybrid training method as good in many …
Technology’s impact on dermatology [PODCAST]
The COVID-19 public health emergency (PHE) has been an amplifier and catalyst for numerous issues. The pandemic has impacted health care delivery significantly, and inequities for the Black community are more apparent. Federal and state rules for telehealth compliance/reimbursement were relaxed to preserve health care access during the PHE. While we are still in the data collection and observation phase, some concepts are clear: Telehealth positively impacts health care access, …
Expanding health care access and equity through telehealth
“As you wait, you have a lot of time to think. You comb through the past in search of something you might have missed. If we had acted sooner on the signs of his illness—had the cancer been diagnosed earlier—would Lee have had a better chance? You think about your …
A son’s brain cancer. A father’s story. [PODCAST]
We have been walking down a long hallway for many, many months. We left the room we resided in pre-COVID, but we have not yet found a room to rest. We are in the liminal space of COVID. This is unsettling and unnerving — liminal space often is.
Liminal space in architecture is the area between discrete, functional spaces, a way of passage, but not the place where beds are placed, …
Crossing the liminal space of the pandemic
Shellee Cohen defines “stratified reproduction” as the practice in which society assigns value to offspring and, therefore reproductive capacity of different groups of people. While commonly race or socioeconomically based, this can be based on any category we can divide people. This concept is ever-present in medicine, even in the most progressive environments. This became most evident when I was sitting at my desk in an outpatient gynecology office, clicking …
Stratified reproduction in medicine
“Last March, I was working in a small primary care practice on the west side of Denver. COVID-19 came to town. On Thursday, March 12, we were told the schools would be closing. On Friday, we were told that clinic staff had to wear masks — and the clinic had …
I was thinking about retiring, and COVID-19 gave me a push [PODCAST]
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