Are surgical residents really doing the cases they scrub on?

Education
December 25, 2016

According to the Residency Review Committee for Surgery, “A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative care, selection, and accomplishment of the appropriate operative procedure, and direction of the postoperative care.”

In nearly all instances, resident “determination or confirmation of the diagnosis, provision of preoperative …

Read more…

How an oncologist used Pac-Man to teach his patient

Conditions
December 20, 2016

The most exciting and difficult part of my job is keeping up with all the rapid changes occurring in the field of cancer treatments.  It is amazing how each day there seems to be a breakthrough treatment coming along, shifting old cancer paradigms.  Although this is a good problem to have, finding time to stay current is easier said than done.  Even more difficult is making sure we can explain these …

Read more…

Essentialism for health care professionals

Physician
December 18, 2016

An excerpt from Physician—Time to Invest in Yourself: Work-Life Balance, the Needs of the Patient, and Medical-Legal Risk Management.

What is an essentialist? What is an essentialist lifestyle? Essentialism focuses on identifying the important signals in life and eliminating the noise. The noises are the distractions that add no value to your life and frequently monopolize time and meaning. When you assume the role of an essentialist you will discover that you …

Read more…

Listen to your patient’s story: It’s their diagnosis

Physician
December 14, 2016

Sir William Osler wasn’t exactly wrong when he said, “Listen to your patient, he is telling you the diagnosis.” But he didn’t mean it literally. His patients did not offer up esoteric and complete medical diagnoses on a silver platter. They left him clues in plain language that he listened to carefully in order to make the correct diagnosis.

He penned his words in an era when medical information was scarce …

Read more…

Telemedicine: What could go wrong? A lot.

Physician
December 14, 2016

Someday, we may miss the quaint idea of going to see your doctor for your medical concerns.

I realize taking your children to see their doc is a pain. So is taking your car into the mechanic, waiting for the cable guy or going out for groceries. There are other things you’d rather be doing with your time. Can a quick phone call substitute for a doctor visit?

At least one huge …

Read more…

Is there a difference between a good and bad prognosis? It depends.

Physician
December 14, 2016

It was recently pointed out that one of my partners had made an error in a patient’s electronic hospital chart. Did I want to correct the mistake? Curious, I looked at the computer screen. There in 12-point-black-on-white Cambria was the culprit documentation. The words were:

“Our therapy goal is palliative. Prognosis is good.”

Now, this was clearly not what the author had intended. In common practice when someone is so sick that …

Read more…

Please tell me what a “mommy-friendly” medical career is

Physician
December 13, 2016

I had a familiar conversation the other day with yet another female medical student.

“I really loved surgery!” she said, “but I was concerned about the lifestyle, so I decided on ______.”

Lifestyle — it turns out — almost always seems to be code for having a family.

Maybe it’s just the kind of students who seek me out. I have yet to encounter someone concerned that a surgical career will hamper their …

Read more…

Medical students can make a difference in health care

Education
December 12, 2016

I recently read an article that my future in medicine would be mediocre.  It made me reflect on some things.  Like the author of that article, I am a fourth-year medical student waiting to graduate and start my training in residency, the training that will prepare me for a successful career as a physician.

Like the author of the article, I decided to become a doctor with the hope …

Read more…

This resident works 100+ hours per week, but is still a poorly trained surgeon

Education
December 11, 2016

I am forced to write anonymously because of gross neglect by my residency program regarding standard ACGME duty-hour rules. If my name were published, it would identify my program.

As a PGY-2, I worked 100+ hours per week on average last year while taking primary call for my urology department. (Admittedly, the PGY-2 is the historic “worst year” for any urology resident.) On a quarterly basis (depending on manpower), we take …

Read more…

10 questions to frame the health care debate

Policy
December 10, 2016

We are at a watershed moment for health care, both nationally and in Massachusetts.

Massachusetts, the state that first piloted the model, “Romneycare” in 2006, that was disseminated to the nation as “Obamacare” is now going full steam ahead with ACO models under the newly approved 1115 waiver, that received the CMS green light in early November. Having expanded to near universal coverage in 2006, now, at the end of 2016, we are taking on …

Read more…

My experience as a patient has made me a better physician. Here’s how.

Physician
December 9, 2016

The medical assistant swabbed my nose and my throat multiple times. Pricked my finger too. Then, the phlebotomist (or vampire?) drew bottles and bottles of my blood. Along with the physical discomfort, there was emotional discomfort too. What would the test results show? If they were all negative, would I be satisfied without having an answer?

Being a patient can be extremely vulnerable. Not only do you often divulge to a …

Read more…

End-of-life decisions aren’t any easier for a doctor

Physician
December 9, 2016

As an internist and geriatrician, I deal with elderly patients all the time. We always end up talking about end-of-life issues:

“Should I be resuscitated if my heart stops and I stop breathing?”

“Do I want a feeding tube or gastrostomy tube if I stop eating and require nutrition?”

“Should I be kept alive on machines and for how long if there is no reasonable hope of recovery?”

“When should we refuse tests for …

Read more…

What does a doctor’s white coat really mean?

Physician
December 8, 2016

For a century, the white coat has been the symbol of the medical doctor. Today, the vast majority of medical schools in the U.S. begin with a white coat ceremony. There, the fledgling, future doctors stand together and recite a modified version of the Hippocratic Oath before being called up one-by-one to receive the white coats that they will wear throughout the upcoming trials and adventures of medical school. The …

Read more…

ADVERTISEMENT

Why this physician chose internal medicine

Physician
December 7, 2016

On November 1973, I had an epiphany.  My first week on my internal medicine clerkship, I realized that I had found my specialty: internal medicine.

Prior to medical school, I had worked with emotionally disturbed children in an inpatient hospital.  I really enjoyed the experience, and learned a great deal.  During my first two miserable years in medical school (I disliked how they taught the basic sciences and even more how …

Read more…

I never want to be a government-employed physician. Here’s why.

Policy
December 6, 2016

Every health care system in the world is facing its fair share of challenges. Aging populations, the exponential increase in chronic diseases such as heart disease and diabetes, expensive new treatments—all at a time when most countries desperately need to curtail rising health care costs to save their economies. At the two extremes, we have fully public-funded (socialized) medicine versus entirely free-market (private) health care delivery systems. I’ve written previously …

Read more…

Give the outside hospital the respect it deserves

Physician
December 4, 2016

OSH, or “outside hospital,” is one of those abbreviations that has crept into the lexicon of hospital jargon that merits additional scrutiny.

What are the implications of calling another health care facility “outside”; does that make your hospital the “inside” hospital? I suspect that it is, as many patient-related conditions are described, multifactorial. Or, if you like the band Fort Minor, “Remember the Name” (apologies to the band):

This is ten percent …

Read more…

ADVERTISEMENT

Atheist doctors must come out of the closet

Physician
December 2, 2016

Reading about the opening of the Noah’s Ark Theme Park in Kentucky brings to mind the days when I worked as a physician in that state. I had moved from an academic position in Colorado and joined a large group of private practice cardiologists in Louisville. I found that people in Kentucky were different from those in Colorado. They were much more overtly religious.

As an interventional electrophysiologist, I would meet …

Read more…

When should you talk to your teenage daughter about sex?

Physician
December 2, 2016

So, have you talked to your teenage daughter about sex?

Have you really talked to her about sex?

I’m not talking about the superficial birds and the bees conversation; I’m talking about using words like vagina, penis, and condom. Yes, those words!

As an obstetrician-gynecologist and a mother of girls, I know the challenges that our daughters face as they navigate their teenage years. I know how critical it is to have real …

Read more…

This is one of the most difficult tasks that physicians perform

Physician
November 30, 2016

“It’s strange how the worst day of your life often starts just like any other.”
– Joanna Cannon

I prepare for each clinic by reviewing the tests and scans of the patients who will be seen that day. Today, I am dismayed as I read a report for a longstanding patient. The news is not good; his scan shows that his cancer has returned.

Twenty years ago on a day like today, I …

Read more…

ADVERTISEMENT

What’s the real reason women remove their pubic hair?

Conditions
November 28, 2016

A study published in JAMA Dermatology regarding women’s pubic hair grooming practices has people abuzz. This cosmetic act needs a formal medical name because “clamscaping” just doesn’t work on grant applications. Although why the authors couldn’t go with hair removal, I don’t know. The study wasn’t about styling, it was about removal. The study even made it into the New York Times. And yes, my first …

Read more…

542
pages