DSM-5 is psychiatry’s maladaptation in the grey zone masquerading as science

Conditions
November 21, 2015

The iconoclastic psychiatrist Thomas Szasz said that mental illness was metaphorical, not real, because mental diseases lacked biological substrates. The absence of a substrate predisposes psychiatry to overdiagnosis and avoiding overdiagnosis is psychiatry’s biggest challenge. This challenge has been taken up by Allen Frances in Saving Normal. Like Szasz, Frances writes in cultured, erudite prose. Unlike Szasz, Frances believes that psychiatric illnesses are real. To save the mentally ill, to save …

Read more…

This doctor quit residency. And now she’s truly happy.

Physician
November 19, 2015

“I quit residency.”

Three words that many physicians couldn’t ever imagine coming out of their mouth, but for me, I say it all the time, usually with a smile on my face. I was a year and a half into my family medicine residency and decided it was enough. My decision mostly revolved around the birth of my son. My husband (a resident in the same program) and I planned to …

Read more…

Value to patients and value to society: How can doctors balance the tension?

Policy
November 19, 2015

Amid ongoing health care transformation, clinicians will increasingly face the tension that the late physician and health services researcher John M. Eisenberg, MD, MACP, described over 30 years ago: providing high-value care with simultaneous commitments to patients and society.

Physicians have always been charged as patient agents to advocate for patients’ best interests. Simultaneously, however, they are tasked with considering the societal good by using resources wisely. While these commitments often …

Read more…

A surgeon blogs for one year. Here’s what she learned.

Physician
November 16, 2015

“I admire anyone who has the guts to write anything at all.”
– E. B. White

“All you have to do is write one true sentence. Write the truest sentence that you know.”
– Ernest Hemingway

“Writing is easy. All you have to do is cross out the wrong words.”
– Mark Twain

“There is no greater agony than bearing an untold story inside you.”
– Maya Angelou

“There is nothing to writing. All you do is sit down at …

Read more…

Don’t make yourself look like Barbie to fit into yoga pants. Please.

Conditions
November 15, 2015

The New York Post is reporting that women in New York are getting labiaplasties to look and feel better in tight athletic wear. They quote a patient, Veronica R., as wanting to “look like Barbie.”

According to the Post, on the Upper East Side in New York there are apparently “a large number” of women who want to look “sleeker in so-called athleisure wear, made from Lycra-like fabrics that often …

Read more…

It’s time to stop comparing health care to manufacturing

Physician
November 10, 2015

From ancient times, doctors have appreciated that, for all their similarities, no two patients are exactly alike. This understanding is what made physicians act like, and earn society’s respect as, professionals.

The commercialization of health care has brought in managers from other industries and other branches of academia, and their rise to power has been predicated on their ability to treat patients and doctors not as individuals, but as small cogs …

Read more…

4 questions about Theranos that are actually worth discussing

Conditions
November 10, 2015

Combine a hot start-up valued at 9 billion dollars, an articulate Stanford drop-out CEO with celebrity-like press coverage, and a recent Wall Street Journal report that calls into question the reliability of the company’s “revolutionary” testing, and you have the perfect storm to set the internet abuzz about Theranos.

Amidst the melee of accusations, “change-the-world” start-up jargon, and anecdotes of incongruent lab results, something has been missing: an organized, …

Read more…

You have no idea what it’s like working in the ER as a pregnant physician

Physician
November 9, 2015

When I was pregnant with my first child, I worked full time as a physician in the emergency department.  I worked mostly 9-hour shifts, but some 12-hour shifts as well. Days, evenings, nights, holidays and weekends were divided up amongst the entire group of physicians. I worked my share of those shifts as well.

I have worked in the ER while pregnant twice now, and while I am proud to be …

Read more…

A physician’s life with epilepsy

Conditions
November 8, 2015

In May 2003, during my second year of pediatric residency, I had a right temporal lobectomy to remove a seizure focus in my right hippocampus.  Although the surgery proceeded without complications, I was unable to walk unsupported for several weeks after the operation.  My experiences taught me what makes an exceptional physician.

An …

Read more…

Physician, heal thyself. A reflection on physician self-care.

Physician
November 6, 2015

Another workday comes to an end. 11 a.m. rolls around and freedom from the hospital beckons after another 24-hour call is finished. In the span of the preceding day, it is likely that numerous important decisions had to be made with the expectation that all of your mental faculties would be used, irrespective of what time of day it was or how much sleep was obtained. It is a day …

Read more…

Here are 10 patient suggestions for hospitals. Let’s make them happen.

Physician
November 5, 2015

Since undergoing a double-lung transplant at the Johns Hopkins Hospital in December 2011, Podge Reed Jr. has had four medical admissions, two surgical admissions, eight outpatient procedures requiring anesthesia, more than 100 outpatient appointments, and 700 labs and other tests. He’s amassed enough experiences with the health care system to write a book. So far, though, he’s mostly kept it to two letters, totaling 12 pages, to our patient relations …

Read more…

An emergency physician goes to the ER, and is shocked at the care she receives

Physician
November 2, 2015

I  have lately been discussing the state of health care with a lot of doctors. I’m a doctor, and I’m also a consumer of health care services.

Imagine my surprise when I visited a local ER on a three day weekend, hoping to get some advice from someone who might be able to use the panoply of diagnostic tools available in the ED to help me mitigate the pain of a …

Read more…

A physician’s open letter to Medicare patients

Physician
November 1, 2015

Dear patients,

This is a hard letter to write, but it is important that you know about a major change that is coming for both of us in 2017, just a short year away.

As you recall, last year I left a large hospital group practice and opened my own office, and I want to thank you for your faithfulness in following me to my new location.  With the newfound freedom of …

Read more…

ADVERTISEMENT

What creates a toxic hospital culture?

Physician
October 28, 2015

Hospital culture is largely influenced by the relationship between administrative and clinical staff leaders. In the “old days” the clinical staff (and physicians in particular) held most of the sway over patient care. Nowadays, the approach to patient care is significantly constricted by administrative rules, largely created by non-clinicians. An excellent description of what can result (i.e., disenfranchisement of medical staff, burn out, and joyless medical care) is presented Read more…

Will your anesthesiologist leave the OR? Patients deserve to know.

Physician
October 27, 2015

“For some must watch, while some must sleep.”
– William Shakespeare, Hamlet

I admit, I was taken aback at the headline that ran in the Houston Press today: “Going under:  What can happen if your anesthesiologist leaves the room during an operation.”

It’s bound to make the curious reader wonder why the anesthesiologist would leave the operating room in the first place.

Of course, reporter Dianna Wray explains that in many hospitals, one …

Read more…

Why do never events occur? It’s because of the human factor.

Physician
October 26, 2015

Wrong procedure, wrong side/site, wrong implant, retained foreign object: big problem.  No patient should ever have to undergo these types of events, and they are therefore called never events. However, these events do occur and when they do they not only jeopardize patient safety but they also breach the trust between patient and practitioner, have financial implications, and reflect negatively on the entire health care system.

The good news is never events …

Read more…

ADVERTISEMENT

Open your eyes. Look at each other. And make the connection.

Physician
October 25, 2015

shutterstock_255266638

We’re not imagining it: We really are losing our connections to each other. It’s a huge problem. In fact, it’s life-threatening.

A recent Wall Street Journal article discussed the Brigham Young University study that found that social isolation increases our risk of death by 32 percent.

Duke University and the University of Arizona have been watching our connections go down the …

Read more…

Life and death are in God’s hands, and we are merely his instruments

Physician
October 25, 2015

I lost a very dear friend about a week ago.  She was my nurse, office manager, and friend. She was Ginny. Ginny came into my life about eight years ago as I assumed the responsibility of medical director for a multi-location clinic. I spent about as much time with her as I did my family, she was my “work wife.”

About nine months ago I became concerned with her rapid loss in …

Read more…

Should doctors be allowed to concealed carry at work?

Physician
October 24, 2015

One word: gun. That is all it takes to spark a debate between two very different camps. One end of the spectrum feels guns are an evil haunting the nation by their mere existence, and they need to be dealt with by restricting (or even eliminating) everyone’s ability to possess them. The other end believes it is a core right to keep and use firearms for sport, personal defense, collecting, etc., and that no …

Read more…

ADVERTISEMENT

Is it time to take out your skeleton in the closet? 

Education
October 24, 2015

I have a skeleton in the closet.  I really do.  It is a human skeleton that I acquired when as a first-year medical student at the University of Sydney in 1981.

Back then, just about every medical student would own a half or full skeleton. They had to be real human bones as the quality of plastic models at that time were as good as useless as they often lacked many …

Read more…

540
pages