It’s 2 a.m. And I’m in the emergency room. There are beads of sweat dripping from my forehead. One of my nurses comments that I just don’t look quite right. I can feel the urge to vomit and know where the nearest trash can is at all times.
I’m clearly sick. Febrile. Shouldn’t be working. But it’s the middle of a night shift, and I’ve got patients to see. I place …
Doctors shouldn’t feel guilty about sick days
I wanted to go the extra mile for my patient. The resistance I found was unexpected.
She was young. Her life — an incredible journey in diplomatic circles — was crippled too soon by a recurring disease that would ultimately prevail. Day after day, I’d round on her in what seemed like a pointless exercise, waiting for the inevitable to come. Another round of chemotherapy would have to wait for her …
Doing extra for a patient or overstepping boundaries?
There are certain paradoxes of life that are beyond the realm of rational explanation. To me, one of such is that a country that figured out how to defy gravity and conquered the cosmos has time and time again proven to be incapable of taking care of the most basic human need, namely: a commonsense health care delivery system.
U.S. spending on health care in 2016 was estimated at about 17.2 …
Corporate games have ruined the health care system
As a fourth-year orthopaedic surgery resident, we had some surgical autonomy. Always at arm’s length from the attending oversight, this was just enough to push us past our comfort zones.
My problem was I loved my comfort zone.
The single most influential day in my career happened late one evening as a PGY-4. I was about to start a complex ankle fracture by myself. The ankle fracture involved the fibula and the …
Why intangible skills are so important for surgeons
I found this note waiting for me this morning in the kitchen.
It was from my daughter, who is home for the holiday week from New York. I made her a cup of coffee yesterday morning, and it was waiting for her on the table when she woke up and meandered sleepily into the kitchen.
Seeing the warm and happy …
An excerpt from Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery.
As a young child’s heart rhythm faded to a stop, I walked off the hospital floor and got in my car with a plan to end my own life. …
A physician’s story of addiction, depression, hope, and recovery
Graduation from my residency program was a bittersweet experience. At the time, my specialty was suffering from a crippling job shortage, so our futures were uncertain, and a dark mood had come to permeate my radiology residency. We were disgruntled with the specialty, with the system, and with medicine in general. I attended my graduation without any guests and only stayed long enough to receive my certificate.
I was, however, honored …
The sad demise of an idealistic family physician
I work in the ER. It’s not an easy job. Not glamorous either. At least not as glamorous as my mother-in-law used to think.
Years ago, when I declared I was going into emergency, she looked at me askance. She didn’t ask why. She looked at me with her wise old eyes. “Let me tell you about ER,” she said. “I know all about it. I watch every show.”
She was politely dismissive …
What’s the hardest part of a physician’s job?
Everything in life starts as a dream. Big or small. My dream was to become a physician since I was quite young — the first one in my family to walk the path. I wanted to understand the science of the human body and help the sick. Heal with my skills, knowledge, and empathy. Hold my patients’ hands with care and confidence. My work was to be like none other. …
A guest column by the American College of Physicians, exclusive to KevinMD.com.
In many ways, the patient-physician relationship is seen as being mostly one-sided, with doctors possessing medical knowledge and wisdom, and patients with less medical information being in a position where they need a physician’s help and guidance in managing their health issues. Consequently, …
What doctors can (and should) learn from patients
Imagine if your bank handled all your online transactions for free but charged you only when you visited your local branch — and then kept pestering you to come in, pay money and chat with them every three months or at least once a year if you wanted to keep your accounts active.
Of course, that’s not how banks operate. There are small ongoing charges (or margins off the interest they …
Most medical offices are hopelessly old fashioned
An excerpt from Fallible: A Memoir of a Young Physician’s Struggle with Mental Illness.
Jason had an entire group of voices in his head that he called “the committee.” They talked nearly constantly, sometimes in a flat roar but often escalating to shouting. He described it as …
How your mind can turn against you
As a practicing surgeon that has one foot in the world of teaching and the other in corporate health care delivery, I enjoy speaking to students and residents about the future. We often discuss topics like the shift from volume to value, consolidation, insurance models, and specialization.
Often this information is new to them, and overwhelmingly they ask some form of the question: “How will this affect my career?” The following …
5 tips on choosing the right medical specialty for you
Here are eight things to do as a new attending that I didn’t learn as a resident (and wish I had).
Establish a budget
There are two times when a budget is a very important tool: when you are struggling financially and when you have a large income or expense change. Now that you have graduated to your new attending income, it’s important to intentionally decide how you will invest, save, pay …
8 things to do as a new attending that I didn’t learn as a resident
What seems like a tidal wave of pages washes over you. Drowning in a torrential sea of order clarification, bowel regimens, and vital sign deviations — you struggle to stay afloat. Medical school did not prepare you for this. Patients and nurses are calling you, “doctor,” you wish to return to that minimal responsibility role as a medical student.
Welcome to your first on-call weekend.
These first few days, weeks, and months …
The intern who knows everything
I’m an ER doc, and I spent my last two decades in the house of medicine. First, training to become a doctor. Then, trying to be a better doctor. No matter how hard I tried, I’ve never been the “perfect doctor.” I started wondering: what makes one a “perfect doctor”?
The perfect doctor lives in the moment, focusing on the here and now: This patient. This case. This encounter. They devote …
What makes the perfect doctor?
In the wake of the opioid epidemic, benzodiazepines have been called “our other prescription drug problem” and “the next U.S. drug crisis.” Prescriptions are on the rise, with over 30 million Americans reporting benzodiazepine use in the previous year. This is alarming, as benzodiazepines are implicated in at least 30% …
Stop cutting patients off their prescribed benzodiazepines
The standard business model around which our world revolves has no place in the “business” of human life, which is what the commercialized industry of health care has become. To be the most successful, businesses work to optimize profits by minimizing their operating costs, which include material resources and all the steps involved in distributing their product. This business model, in some form, is applied universally from the manufacturing and …
Is health care just legal human trafficking?
At kitchen tables everywhere, ordinary Americans have been grappling with the arcane language of deductibles and co-pays as they’ve struggled to select a health insurance plan during open enrollment season.
Unfortunately, critical information that could literally spell the difference between life and death is conspicuously absent from the glossy brochures and eye-catching websites.
Which plan will arrange a consultation with top-tier oncologists if I’m diagnosed with a complex …
The hidden benefits of your health insurance plan can save your life
“Let me order some labs, and then we’ll discuss where we go from there once I have the results.”
I walk out of the patient’s room and right into one of my nurses. “Zoe, can we start that lady on pressors like we talked about? Her blood pressure is still low after the fluids. I need you to put the order in so the pharmacy can send it up.”
I smile my …
The difference between shallow and deep work in medicine
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