I recently spoke with a colleague who transitioned out of the military in the last year. He was previously excited about his new job opportunity, but now a year later, he tells me, “I hate civilian medicine.”
I was surprised because he had been excited about the opportunity to teach in a residency program again. He said, “I love teaching, and I love the residents. …
9 hacks that will increase your clinical efficiency immediately
Before direct-to-consumer ads, physicians tried to reassure patients they were probably fine. Today, drug ads and online symptom checkers do just the opposite. The most insidious are “unbranded” ads that scare people about a disease without mentioning the drug they are trying to sell. Notable unbranded disease campaigns sell the obscure exocrine pancreatic insufficiency, shift work sleep disorder, and non-24-hour, sleep-wake disorder. Unbranded advertising is designed to appear like a …
Drugmakers discover tardive dyskinesia. And they profit in it.
Stock photos of “health care workers” who attend patients — physicians are no longer distinguishable — usually feature a stethoscope draped around the neck.
But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”
The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence and the rubber tubes by sophisticated …
The stethoscope is not just a prop
You were strong in college
You were strong enough to get through weed-out classes in undergrad. You were strong enough to balance the extra-curricular activities and clinical shadowing expected of you while crushing a 21-hour semester. You were strong enough to say, “no, I have to study” when friends wanted to go out because you had a dream of becoming a doctor someday.
You were strong enough to pay for the applications, …
Doctor: You were strong. You are still strong today.
I paced in the hallway outside of the patient’s room, going over my mental checklist of items to do during the history and physical examination. Bringing in a paper list was discouraged; we were meant to “flow” through the exam “naturally.”
I stuffed my hands into the pockets of the white coat I’d received three weeks earlier, during the White Coat Ceremony for first-year medical students. Feeling around the deep pockets …
The first lesson in medical school: Say you’re sorry
I recently returned from my second extended stay in New Zealand with my family. The entire experience was wonderful, but perhaps our most memorable day began with our three teenage sons waking up early to surf in the South Pacific Ocean. Once we had our fill of tropical paradise, we jumped in the car and drove a few hours to the local ski resort, where we found 10 feet of …
The secret to travel doctor success? Bring your family.
Why do so many of us (meaning me) need to be reminded to act with kindness? Why can’t we “just do it”?
Yesterday, a friend asked me why we don’t celebrate World Kindness Day every day. I believe that’s a wonderful idea. But in practice, it’s not so easy. So, I got to thinking about why that is.
If we want to spread the ripple effects of kindness — to our families, …
7 reasons why it’s hard to be kind
OK, quick — word association time.
I say “doctor,” and you think what? “Smart,” right?
And it’s true. Doctors are smart. But before you buy into the myth that every doctor has breezed through school and could fall out of bed with a #2 pencil and crush an exam without thinking about it, consider that over 1,100 internal medicine doctors fail their board exam every year.
And that’s just one medical specialty. When …
3 reasons why smart doctors fail big exams
When I graduated from residency, I was too worried about killing my first few patients to examine the meaning of being an attending physician. An early patient, a 97-year-old retired doc, brought it to my attention.
“Being an attending physician means you attend. When you attend me, all I want you to do is show up. You do not have to do anything. Keep the people with needles, knives, and nonsense away from …
The key to being an attending physician
Embarrassment is a feeling of awkward self-consciousness or shame. It manifests as a sense of discomfort or even foolishness around others. Feeling embarrassed is emotionally painful because it means you feel uncomfortable with yourself.
The problem with embarrassment is that it adds a layer of mental suffering to the difficulties you’re already facing with your health. Here are four reasons why those of us who are chronically ill feel embarrassed at …
What to do when chronic illness is a source of embarrassment
“Words Kill” is a brilliant song about the perils of texting and driving. Spread the message.
Courtesy of The Fever Breakers, a band made up of hospital employees. Their socially conscious songs are crafted in the basement of the hospital using a piano used for cancer patient music therapy and subsequently recorded in a studio.
A brilliant song about the perils of texting and driving
As a young medical student, in my early 20s, I was still too inexperienced to know how a physician was “supposed to” act.
But I took the model of stoicism that I learned from my East Indian father and applied it to the medical model. Lectures on “professional detachment” reinforced this. I remember being told that it was the doctor’s job to keep a professional distance from a patient. By getting …
It’s OK to cry when a patient dies
Think studying abroad doesn’t fit with your future plans? Think again.
Since the day I applied to university, I had been researching how I could incorporate global learning into my undergraduate degree program, while also thinking about my future goals for getting into medical school. When I was accepted to do a Bachelor of Science with a double major in chemistry and biology, I surprisingly still found time for extracurricular activities …
How studying abroad helped get me into medicine
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old man is evaluated for a carotid bruit detected on routine medical examination. He reports no history of previous focal neurologic symptoms or visual loss. He has type 2 diabetes mellitus and hyperlipidemia treated with metformin, moderate-intensity pravastatin, and aspirin.
On physical examination, blood pressure is 128/64 mm Hg, …
MKSAP: 67-year-old man with a carotid bruit
I enjoy a fairly small private practice and a manageable telepsychiatry side job with good support staff. But even the small scale of my outpatient clinical practice doesn’t fully insulate me from the pain of unnecessary practices that I wish would become obsolete.
1. Preauthorization. The dance of preauthorization starts with the naivety on my part that I decide what medication my patient should be on. I spend precious time crafting …
Stop telling doctors what to do
When I was accepted to medical school, I debated — hard — whether or not to attend.
Out of the physicians I shadowed and interviewed, 19 out of 20 advised me not to become a physician.
Their dissatisfaction was rampant.
Over and over, I was told, “Don’t be a doctor. Medicine’s not what it used to be.”
They spoke of concerns ranging from unreasonable work expectations to inhumane conditions. They described insurmountable pressure, decreasing …
Medicine’s not what it used to be
A recent article was published in the Atlantic about Americans being the worst patients.
Americans are part of a broken and dysfunctional health care system with exorbitant costs, a maelstrom of bureaucratic red tape, and insurance coverage that barely covers what most people need.
But are they contributing to this system by being such bad patients?
The article in the Atlantic seems to imply that this is the case. The …
Are Americans really the worst patients?
Next in a series.
In prior posts, I described my Healthcare Incentives Framework. If you haven’t read those, I recommend you check them out first to have the full context for this post. But here’s a refresher of the main points of the framework without re-explaining all the rationale:
The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating …
What would an optimal libertarian health care system look like?
Like all doctors, I’m a lousy patient. My doctor is a lovely man, but going to see him? That’s right there with weighing myself, getting a flu shot and doing my taxes, and behind celebrating Thanksgiving with the in-laws and getting a root canal.
And I’m not the only one. If I had a dollar for every patient who told me they hate doctors (no offense), I’d be long retired.
If you’re …
Janelle had overdosed 32 times.
Fentanyl coursed through her veins as she was given naloxone (Narcan) for the 32nd time in the ER, from the police, from a bystander. She could never get off of fentanyl. It had made her feel warm and numbed her from the trauma and horrors she had grown accustomed to. When she would wake up in the hospital, sore and discombobulated, she would beg for help. She …
A call to increase the availability of the Butrans patch
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