Boarded to death: When will testing for doctors ever end?

Education
April 2, 2015

I am relieved and proud to report that I passed my boards: I am officially a diplomate of the American Board of Obstetrics and Gynecology. While the oddly formal “diplomate” is a term in common use with physicians, I didn’t understand what “diplomate” and its sister phrase “board-certified physician” meant until I undertook my own board preparation.

The Medical College Admission Test (MCAT) is a memorably stressful element of applying to …

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This is what patient safety means to me

Physician
April 1, 2015

What does patient safety mean to you?

I believe patients get the safest care when

  1. The patient is known as an individual.
  2. The health care team gives the patient their undivided attention.
  3. The team is well-supported with efficient workflows and organized, easily accessible information.
  4. The health professionals find joy in their work.

By being “known” I mean, that the nurses and physicians know the patient as a real person, what their life is like, who are their …

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Capturing moments of innuendo in the emergency department

Physician
April 1, 2015

Although I pride myself on catching the obscure snapshots of typical life moments that occur daily while dealing with patients and their families in the emergency department, occasionally there are times when I am so focused on the task at hand that I completely fail to see a glaring moment of obvious humor, sadness, or tenderness. At times like this, then, I am glad to have our hard-working nurses and …

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As a doctor, I need to understand power, trust, and pain

Education
March 31, 2015

“You have the nurse hand you the equipment, that way she doesn’t just stand and stare like a chaperone,” my doctoring mentor explained to me before we entered the room to do a pap smear on a young, 35-year-old woman. My doctoring mentor is a middle-aged, 6-foot-5, exceptionally hairy, broad-shouldered man that carries a warm, jovial presence. Yet the reality of the fallen world is that no matter how sweet, happily …

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Can introverts survive in medicine?

Education
March 27, 2015

Does the profession of medicine favor certain personality types over others?

When I was younger, it seemed like all of my doctors were gregarious, self-confident, and humorous, leaving me to wonder if one can “make it” in medicine without being outgoing. This seemed a natural consequence of the fact that so much of medicine is team-based and demands constant interpersonal interaction with colleagues and patients. For many introverts, a career in …

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Patient refuses ED discharge: Admitted to the hospital against medical advice

Physician
March 27, 2015

The following article is satire.

In the first application of a new “reverse AMA” system put into place to improve patient satisfaction, a patient was admitted to the hospital for the first time against the wishes of her treating ED physician.  Constance Dolor, a 37-year-old morbidly obese patient with chronic unexplained pain and a frequent visitor to the emergency department, became the first person in known history to be admitted the …

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I’m not apologizing for my part-time role in medicine

Physician
March 26, 2015

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Over the course of pre-professional and professional education, my colleagues and I have had numerous moments of self-doubt.  Would the next organic chemistry exam eliminate my 3.99 GPA?  Would the MCAT decide what medical schools would immediately ignore me without ever meeting me?  Would the sheer volume of material weed out the persons sitting next to me in medical school or …

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The last breath can be seen as a the passage into eternity

Physician
March 24, 2015

Eonia I Mnimi (Eternal Memory) 
– Greek Orthodox Funeral Blessing

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.

***

My uncle had been declining for several years with Lewy …

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Are cardiac risk calculators accurate?

Conditions
March 23, 2015

After more than a decade of titrating medications to low density lipoprotein cholesterol targets, family physicians who have transitioned to the 2013 American College of Cardiology / American Heart Association cholesterol treatment guideline now base treatment decisions on a patient’s estimated 10-year risk for a cardiovascular event. Although it endorsed the ACC/AHA guideline last year, the American Academy of Family Physicians expressed concern that the guideline’s new risk calculator had not been validated in …

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What does it mean to live in the age of Abilify? 

Meds
March 23, 2015

I learned recently that the antipsychotic Abilify is the biggest selling prescription drug in the U.S.  To be a top seller, a drug has to be expensive and also widely used.  Abilify is both.  It’s the 14th most prescribed brand-name medication, and it retails for about $30 a pill.  Annual sales are over $7 billion, nearly a billion more than the next runner-up.

Yes, you read that right: $30 a pill.  A little more …

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Heart-wrenching photo of a doctor crying goes viral. Here’s why.

Physician
March 20, 2015

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Outside of a Southern California hospital, an ER doctor is crouched down against a concrete wall grieving the loss of his 19-year-old patient. A paramedic snaps a photo of the tender scene. His coworker, a close friend of the doctor, posts the photo (with permission) online. Minutes after the photograph, the doctor returns to work “holding his head high.”

Thousands of people have …

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Eulogy for the doctor

Physician
March 17, 2015

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No physician, however conscientious or careful, can tell what day or hour he may not be the object of some undeserved attack, malicious accusation, blackmail or suit for damages  … “
– Assaults Upon Medical Men. Journal of the American Medical Association, 1892

It’s happened again: A well-liked doctor is killed by his patient. Last year’s horrific death of a physician in our community, a …

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3 myths and 3 truths about hospice

Physician
March 17, 2015

As I travel around speaking about preparing for peace at the end of life, I have found that there are three pervasive myths about hospice that might cause you to inadvertently rob yourself or your family of a peace-filled end-of-life experience.

So, I am taking on the job of myth-buster to clear the air. Here goes:

Myth #1: Hospice is a place. While hospice can be a place, it is primarily a service. …

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Surprise! When it comes to a vaginal hysterectomy, this insurance company gets it right.

Conditions
March 16, 2015

The preferred route for a hysterectomy is vaginal. This means the entire surgery is done through the vagina with no incisions in the abdomen of any kind. The joke among surgeons is that it is a bit like taking a car apart through the muffler. While doing surgery entirely through the vagina may sound highly complex, it’s really just like any surgery. A vaginal hysterectomy done correctly it is an …

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We are overprescribing statin medications for high cholesterol. Here’s why.

Meds
March 16, 2015

The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins.

One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication …

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