A stage IV lung cancer survivor story

Conditions
January 23, 2019

I want to share how the era of immunotherapy, specifically immune-checkpoint-inhibitors, has changed the landscape of community oncology practice in metastatic non-small-cell lung cancer, for oncologists and, more importantly, patients.

I want to tell you the story of Joe. A stage IV lung cancer survivor story. (Name and details changed to protect anonymity.)

In 2015, Joe was diagnosed with stage IV non-small-cell lung cancer (NSCLC), adenocarcinoma. He had multiple metastases to other organs. …

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To my mentor: Thank you. I didn’t know how much I needed you.

Physician
January 23, 2019

I never really had a true mentor. Or role model. I wasn’t sure if they were the same thing, or what the difference was, so I gave up. Sometime in middle school, I remember a teacher encouraging us to find someone we looked up to and develop a mentor relationship. I was 12, looked at my teachers who I thought were old, and ignored that advice.

In high school, I thought …

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How this student took care of his severe depression in medical school

Education
January 22, 2019

We learn about it in school as a formula. There is a checklist that we are given, and we ask our patients these eight questions and then calculate whether or not they have depression. It’s so simple. Anyone can do it! I never once thought that I would be calculating my own score at the prime of my education.

I entered medical school full of hope after years of failures and …

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I had just witnessed my first patient die

Physician
January 22, 2019

Stepping into a hospital for the first time as a clinical medical student is a strange dichotomy. There is still so much you have to learn before you will become a physician, but you are quickly thrust into life-and-death situations. One of my early rotations was in the emergency room. As a student, you have no actual authority and must be closely monitored at all times. Many times you will …

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Why did it take over a week for doctors to initiate treatment?

Conditions
January 22, 2019

Part 3 of a series.

Patients with advanced cancer are particularly vulnerable to infection due to a compromised immune system. Moreover, the typical symptoms of serious infection, such as fever and chills, may be absent in cancer patients. If not identified and treated early, infection can lead to sepsis, a life-threatening reaction of the immune system that causes organ failure, shock, and death, as …

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It’s OK to care more about things outside of medicine

Physician
January 21, 2019

It seems like natural human tendency to explain ourselves.  When we are late to a meeting, we come up with an excuse in case anyone asks.  When our kid starts throwing a temper tantrum at the store, people stare at us expecting an apology.  In the same way, when we decide that there are things outside of medicine that are more important to us than the job – an explanation …

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5 powerful tips for women in medicine

Physician
January 21, 2019

As a woman in medicine, where the odds for pay, promotion, and leadership are stacked against me, I feel obligated to light the path for younger women who come behind me.  It has taken me a while to be comfortable with my style of leadership, own my own voice, be able to regroup after rejection, and tolerate feeling on display and yet often invisible.

I wish someone would have told me the following …

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How should salespeople sell to doctors?

Physician
January 21, 2019

Two device salesmen recently came unannounced to our small private gastroenterology practice. They were hawking a product that could quickly and non-invasively determine how much scar tissue had formed in a patient’s liver, a useful tool for assessing patients with hepatitis and many other liver conditions.

We are physicians, not entrepreneurs. We do not regard the colonoscope as a capitalist tool. Yet, these two salesmen were barraging us with facts and …

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A reflection on the last day of residency

Physician
January 20, 2019

I entered residency self-assured, if not in my scholarly achievements, at least in who I am as a person.

I left slightly broken.

Something happens to you in residency, and you don’t realize the transformation as it occurs. It may be the loss of a patient who died on your watch, or the realization that you have not changed the world. It could be the constant fear of failure or punishment by …

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An orthopedic surgeon’s bone broth journey

Physician
January 19, 2019

Many cooks traditionally use broth derived from simmered bones of fish, fowl, or four-footed critters to flavor soups and sauces. Recently, bone-broth bars have popped up around the country and serve a non-caffeinated, nutritious alternative to tea or coffee. In some of these health-conscious establishments, the owners claim that these drinks also have filling, cleansing, and detoxing capabilities.

I decided to see if a daily cup of bone broth should be …

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Don’t judge when trainees use dating apps in the hospital

Social media
January 17, 2019

During rounds, in between seeing patients, the medical student pulls out his phone and scans a dating app for new matches. In the team room, a resident opens Facebook before responding to a non-urgent page. Each of these instances may seem trivial enough, but I’ve seen both lead to poor evaluations, reprimands, or others whispering terms like “unprofessional.”

In the medical world, there’s an implicit understanding that while you’re at work, …

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The old days of medicine are gone

Physician
January 17, 2019

In the last decade, specifically in the last five to six years, we have seen the gradual disempowerment of America’s physicians as well as their unfortunate patients.

Starting with health management organizations, managed care, all the way to the insurance exchange, doctoring has been forcefully wrestled away from physicians only to be placed into the hands of large insurers, administrators and the United States government.

The common denominator was never about improving …

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For residents unsure about their choice of specialty

Physician
January 16, 2019

About halfway through the internal medicine residency, there comes a time when a resident must decide on what he or she plans to do after three years of training. We may come across a second-year resident saying: What should I do next? Should I become a hospitalist or plan for a fellowship? But in what? Cardiology and gastroenterology are fascinating careers, but is my resume ready for a competitive match? …

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10 tips for non-traditional medical school applicants

Education
January 16, 2019

I would like to offer some words of encouragement to what many call the “non-traditional” students pursuing medicine.

The term encompasses people in different aspects in their lives. It may be someone in a different line of work looking at medicine as a second career or another just getting started that didn’t take the traditional path in undergrad.

My own journey

I started medical school at 28 after spending six years as a …

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Why is Medicaid reimbursement below sustainability?

Policy
January 15, 2019

Recently, a child was on a waitlist for five months to get into my practice. For this article, I will call him Tiny Tim.

Tiny Tim, now five years old, has a skin condition known as eczema or atopic dermatitis. When we first met, virtuously every area of his body was covered with wounds from constant scratching. Skin that breaks easily and heals poorly can give bacteria access to other parts …

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A divided house always falls: Why doctors lost control of health care

Physician
January 15, 2019

I recently met an old friend of mine for the evening in New York City. He’s a talented young orthopedic surgeon, who has already, in the short amount of time since finishing residency, experienced so many of the problems our health care system faces.

The topic of conversation quickly turned to the current state of medical practice, the dramatic swing to corporate medicine, and the consequential loss of autonomy suffered by …

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A call for the end of routine opioid use after wisdom tooth removal

Meds
January 15, 2019

We are writing as a parent and a dentist to spread a message to parents and dental health care providers across Canada: there are alternatives to prescribing opioids after wisdom tooth removal.

Removing wisdom teeth is considered by many as a rite of passage for teenagers. It is one of the most common surgical procedures done in young people aged 16 to 24.

Amy’s 16-year-old son, Felix recently had his wisdom teeth …

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The fallacy of work-life balance in medicine

Physician
January 15, 2019

Physician well-being, burnout, and “work-life balance” are pretty common topics in training.  We start at intern orientation, discussing how to work 80 hours a week, eat, sleep, exercise, and still have some semblance of social life.  It’s like we’ve forgotten the origins of our job title: “resident” or “house staff” — implying that, until recently (and even now, in places outside of North America), we, the physicians-in-training, lived at the hospital.  …

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Peanut allergies: What is the best policy for schools?

Conditions
January 14, 2019

Peanut allergies can be a serious problem, and many exposures happen when our kids are at school. On average, there are probably about 5 peanut-allergic children in each of our nation’s 100,000 school buildings. What’s the best policy for schools to use to help protect these kids from potentially fatal reactions?

Different schools have taken different approaches, and as far as I can tell there is no authoritative national guideline …

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