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
When my obstetrician told me I was not going back to my clinic that afternoon due to severe preeclampsia, I was so indoctrinated that my first thought was of the inconvenience to my patients who would need to be rescheduled. Only a few minutes later did it register that I would be giving birth sooner than I had anticipated, and my new life as “working mother” would begin.
I was due …
Choosing family over medicine: Why I decided to leave clinical medicine
Health care is big business, with medical practices vying for contracts, hospitals undergoing facelifts in order to cater to patient experiences, and insurance companies making deals with pharmacies. Some of these arrangements are negotiated in the name of reducing health care spending, but there has to be some skepticism when for-profit entities are implicated. Physician salaries aren’t exactly growing with inflation—some fields have had massive cuts in spending over the …
The problem with reducing physician salaries
In the current health care system, patient outcomes, and patient satisfaction are increasingly important. With the hospital value-based purchasing program, Medicare adjusts payments to hospitals based on the quality of patient care they provide. Hospital consumer assessment of health care providers and systems scores are tied to Medicare reimbursements. Under the hospital-acquired condition reduction program, hospitals in the highest quartile of hospital-acquired conditions are subject to a 1 percent payment …
3 things every hospital should invest in
It’s difficult to imagine a world now without Google and the internet. It’s also strange to think that most people alive right now received the bulk of their education in the pre-internet era. I remember in the United Kingdom, where I went to medical school, Google only became a thing perhaps midway through university. Since then, of course, the internet has exploded and penetrated every facet of our lives. And …
Don’t judge patients for researching their health issues
Just before I induced anesthesia, he said, “Doc, I want to apologize beforehand. I am incontinent due to a previous surgery so I might wet the sheets.”
I told him not to worry and that we understood and that “these things do happen.” His response has stuck with me: “Doc, but there is still some shame.”
I nodded, told him not to worry since he was going to get a catheter anyway, …
Don’t forget to manage your patients’ dignity
I am a middle-aged, full-time emergency physician, and part-time law student. Usually, I practice medicine during the day and attend law classes in the evening. Sometimes I have law classes in the afternoon or early evening then work in the emergency department all night.
So, what’s harder: medical school or law school?
Absolutely the most common question I am asked by physicians, attorneys, and students at all levels of training.
The other most …
Doctor by day, law student by night
Dear lawyers:
You got it right. Your operations make sense. I know this is wrong for me to say — doctors and lawyers are often at odds with one another — but I have to tip my cap here. I have this unsettling feeling that — from a professional standpoint — your billing practices make sense. And the way you do your documentation also makes sense. Your delegation and hierarchy make …
Lawyers have figured out what doctors haven’t
One of my favorite scenes in the recent Apollo 11 IMAX film was a dramatic panning shot of mission control moments before lift-off. Row after row of mission specialists, engineers, astronauts, communications technicians — all looking ahead in silent, unbreakable focus. All 100 percent dedicated to the three men about to lift-off into history. It was a truly mesmerizing portrait of teamwork.
While astronaut safety is the focus of every individual …
From a neurosurgeon: You need a family doctor
I recently read an article called “Inefficiency and luxury” in which the author stated that he has never tried to get any frequent flyer rewards, and in fact doesn’t even have a frequent flyer number. This statement left me a bit confused when I first read it. I’m not one who likes to leave money lying on the table. Then he …
A physician’s guide to frequent flyer rewards
What is your gut reaction when you hear the words “hospital chaplain?” Maybe it’s an eye roll or confused stare about what you believe to be an incoming attempt at religious conversion. As a family member anxious about a loved one in the hospital, maybe it’s a sigh of relief. As a patient, maybe it’s an overwhelming fear of incoming bad news. Health care chaplaincy is chronically misunderstood, beginning with …
It’s time to stop being skeptical of hospital chaplains
Residents and fellows around the country have bought into the “medical training myth.” The myth states: “Life will get so much better when I finish residency/fellowship.”
Sadly, too many house staff buy into this false belief and experience tremendous letdown when they graduate.
Residents often see their attending stroll into the team room with a cup of coffee at 8 a.m., ready to round. Meanwhile, they think, “I’ve been …
Debunking the myth that life gets easier once you finish medical training
Get free updates delivered free to your inbox.
