I practice gastroenterology in Cleveland in the dark shadow of a large medical institution whose name contains the name of our city. They are a world class medical institution whose reputation is largely derived from its cardiovascular department. Presumably, these practitioners, like all doctors, advise patients who smoke that cigarettes have deleterious health effects. The entire campus is smoke-free, as …
Recently, a jury awarded a young California resident $28.2 million for a delayed diagnosis of a pelvic tumor. The jury found Kaiser Permanente (KP) negligent. Doctors in the system, touted to be one of the finest systems by the president, allegedly refused an immediate MRI for back pain in a 17 year old. The patient eventually received an MRI three months after …
My interns started the term with mixed career aspirations. One wanted to do interventional radiology, the other, “not sure.” Now, in their last few weeks of our term, they’re thinking about a surgical career. Which I think is great. I’ve been lucky enough to have had some great advice over the years, and I’ve nutted a few things out myself along the …
Mr. U* came to the hospital overnight with severe heart failure. His breathing was supported by a ventilator and he was sedated. Thus, our primary means of communication was via his daughter. His daughter, distraught, stayed awake through most of the night. She appeared suspicious about her father’s care, immediately asking my credentials when I entered the room and demanding that we discuss treatment decisions with her alone. The next …
I was asked by one of my readers recently to write a post on how I maintain work-life balance during the all-consuming intern year of medical training. I love this idea because keeping myself sane while spending 80 percent of my time in the hospital has proven to be a constantly challenging task, and I’ve come up with a few ways …
A couple of weeks ago I was on-call and had to go down to the emergency room to see a patient. Before I entered the room, I was told that the patient was accompanied by her long-time physician who was a bit “crazy and old school.”
“Hmm … that’s strange … why would her physician be in the room with her?” I …
While working at small rural hospital I was once again faced with the emergency physician’s dilemma. Admitting a patient and being told to write holding orders. In the midst of a very busy department, I sat with a nurse who guided me through the ridiculously complex and counterintuitive electronic orders system. All this so that the admitting doctor wouldn’t have to log onto the computer, from home mind you, and trouble …
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 …
What does patient safety mean to you?
I believe patients get the safest care when
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 …
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 …
“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 …
An excerpt from The Real Doctor Will See You Shortly. Warning: Contains explicit language.
It started with a banana peel.
After years of quiet study in the libraries, laboratories, and lecture halls of Harvard Medical School, I finally made the tectonic shift to hospital life in the summer of 2006. The third year of medical school marks a …
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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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 …
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 …
As a fellow in cardiology, you sign up to be part of a specialty that can involve emergencies.
As a first-year fellow, usually you are running things by other senior fellows and attendings, and typically you are not the first person to make a decision on a plan. At times, though, there can be an exception to that rule, and it is …
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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 …
As a sleep physician, I spend a lot of time educating patients about what sleep is and how it works. Sleep, as I often explain, is not simply the lack of being awake; any more than landing a plane is simply the lack of flying. It’s becoming increasingly understood that sleep is an actively generated state, created by a series of …
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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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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