At nearly every stage in our education and training, we find “our people.” Maybe it’s your table-mate in kindergarten, or the kid with the really cool light-up sneakers in preschool who becomes your best friend. Maybe it’s your next-door neighbor who you play with after school or a coworker from your first job in high school. These people become part of our squad — even if their membership is only …
How to find your squad in residency
I remember lying in my bed after my second delivery in severe pain. With my first delivery, I had already endured a C-section. Four years later, I wanted to experience a “natural” delivery. I opted for a vaginal delivery after C-section (VBAC).
The VBAC quickly turned into an emergency where the maternal-fetal medicine (MFM) physician gave me two options: Get this baby out now or emergent C-section.
My mind flashed back to …
Confessions of a bed-sharing pediatrician mom
“I have a riddle,” Paul says, as the dining room falls silent.
“You’re at the bottom of the stairs. And on the wall, there are three light switches labeled one, two, and three. There’s a room upstairs with three lamps, labeled X, Y, and Z.
You can turn on and off as many switches as you want while you’re downstairs, but you can only go upstairs once. And once you’re upstairs, you …
The art of diagnosis is like a riddle
It was my first week of internal medicine rotation. A newly-minted third-year, I was rotating on the wards back in the spring, when I met a 90-something-year-old gentleman. He had come in for confusion after a fall.
There were no relatives or friends in the waiting room.
I was assigned to follow him. During his stay, his words were few; it was often difficult to engage him in conversation. Whenever I pre-rounded, …
Here’s why you should get a chaplain for your patient
“What diagnosis do you want to use for those ear drops you sent on Mr. Johnson,” Jenn texted me. “ICD-L21.8 for seborrheic dermatitis?”
Sigh. Welcome to prior-authorization hell.
These are generic ear drops I ordered for presumed fungal infection of the external ear. The cash price for the drops is $15 for a 10-milliliter bottle (I checked before prescribing them). “No,” I responded, “it would be ICD-B36.9 for otomycosis.” (translation: ear fungus)
Jenn …
Welcome to prior-authorization hell
The best teacher of medicine I ever had was during my medical residency. He was a tough, old-school physician, trained at one of the premier institutions in the country, and specialized in pulmonology and intensive care. Before I had even rotated through the ICU, I had seen him around on the medical floors—and must admit I didn’t like him very much at first. He seemed extremely serious, not particularly friendly to any …
The best teacher of medicine I ever had
Working in urgent care, I’ve started supervising some of the other providers at sites other than my own — 19 sites in all in Pennsylvania and Delaware — so I hear about a lot of patient situations.
The urgent care site where I work is in an affluent area. Most of our patients are employed or retired and have health insurance, though I have certainly encountered a number of patients …
Urgent care is emblematic of problems in our health system
A surgery resident from halfway around the world emailed me the other day looking for advice as she was nearing graduation. She confessed, “I am beginning to question myself if I am good enough … what is ‘good enough’ anyway?”
I had absolutely no idea how to answer the question – what is “good enough” for a surgeon?
First, I tried Google.
“Am … I … Good … Enough”?
2.5 billion hits and some …
What is “good enough” for a surgeon?
As I enter the exam room, I hear, “Don’t get old honey!”
As a physician caring for a large population of geriatric patients in Florida, I hear this approximately five times a day. To this statement, I always reply, “There’s no alternative, though!” I also try not to get offended by repeatedly being called “honey.” Although I am waiting to someday state; “it’s Doctor Honey.” Usually, my level is offense is …
Why I love caring for geriatric patients
Brain surgery is getting smarter. The journal Nature Medicine recently published a study that found a new imaging technique that allows pathologists to diagnose brain tumors faster and more accurately than ever before.
The study focused on Invenio Imaging technology’s use of artificial intelligence (AI) in making accurate diagnoses. So, will computers replace doctors? That’s unlikely. Treating the human brain requires a human approach. But AI is …
How artificial intelligence will affect brain surgery
Gun violence has become a public health epidemic. Despite countless deaths in mass shootings over the last two decades, the Dickey Amendment—a provision inserted into the 1996 spending bill which blocked federal funding for research on gun violence—remains on the books. While every politician, media pundit, and policy expert “know” the solution, the answers are not that simple.
In reality, the factors which have fueled the rise in gun violence across …
The impact of economic inequality on the incidence of mass shootings
Protecting your lifestyle starts with protecting your income. Disability insurance provides a solid foundation for your financial future by providing you income when you’re unable to work due to an illness or injury. When most people hear the word “disability,” they immediately think of accidents. But the reality is that 90 percent of disabilities are actually caused by illnesses.
Disability insurance is more complex than other types of insurance. We recommend …
What is the application process for physician long-term disability insurance?
Spiraling costs, poor quality outcomes, and inequities in access to care are driving significant and long overdue changes to the way health care is administered and managed in the United States.
And while the U.S. spends more on health care per person than other wealthy countries, its health outcomes are no better than those in other developed countries. In fact, it performs worse in several health metrics, including life expectancy, infant …
5 disruptive trends transforming health care
Let’s talk about the doctor who is excessively defensive.
I divide this kind of communication blocker into two varieties: physician personality and physician mode of practice. The physician with a defensive personality is one who interprets questions from parents as questioning of her medical judgment. Unlike the supremely egotistical doctor, who is often sufficiently secure in her image of herself that she is magnanimous toward parents who ask questions, the overly …
What to do with the extremely defensive doctor
I recently wrote about my new type 1 diabetes diagnosis, the quest for affordable meds and supplies, and the subsequent financial savings found through transparent pricing outside of my insurance plan. I summarized that health care “coverage” is very expensive, whereas medical services may be found much more affordably.
My next step was to establish an ongoing primary care physician relationship.
I contacted one of the large medical …
Why direct primary care is the future
Ever since the publication of the infamous 2016 BMJ opinion piece claiming medical error should be considered the third leading cause of death in the U.S., the debate on the true incidence of deaths caused by medical error has been raging. Many, including me, felt the estimate of 251,000 deaths per year from medical error was grossly inflated. For example, the paper extrapolated the number of deaths from …
Medical error is not the third leading cause of death
In my very first job as a doctor — working in a London hospital in the 1980s. I always took a ridiculously detailed past medical history for every patient I saw. I started to notice how many elderly women had had septicemia, a life-threatening infection in which enormous amounts of bacteria enter the bloodstream.
The neighborhood surrounding the hospital had once been the worst slum in London. And it didn’t take …
What happens when abortion services aren’t available
Our local newspaper recently ran an article on the top of its front page, stating that our monopoly health system is now “expanding health care cost discounts.” The article was actually a press release – free advertising on the front page. As a primary care physician who refers patients to this health system, I wanted to know what these discounts really meant.
So, I asked the newspaper in an editorial, “what …
What do hospital discounts really mean?
Recently, my mother waited for over an hour for what turned out to be a 5-minute visit with her primary care doctor. Her doctor seemed rushed and stressed, her questions perfunctory, the management plan hurried. And then she was gone. “It’s like she didn’t even know I was there,” my mom relayed to me.
This is a physician who is thoughtful, intelligent, and kind, with excellent clinical instincts. After this visit, …
On my final day of work before beginning my self-imposed burnout sabbatical, a colleague asked, “Why don’t you just get on medication?” I remember thinking, “What am I medicating? I feel nothing.” I was in the vice grip of burnout, overwhelmed, and physically and emotionally exhausted. But mostly, I was numb.
But in reality, I have always self-medicated – with work. As a professional ballet dancer turned doctor, my life has …
Numb: How I survived as a physician
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