Deep extubation is a useful technique for any anesthesiologist to master

Conditions
August 1, 2017

There are two schools of thought about how to extubate patients at the conclusion of general anesthesia:

Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patient’s head bleats, “Open your eyes!  Take a deep breath!”

Or:

Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence …

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When an erythrocyte sedimentation rate leads to a serious diagnosis

Conditions
August 1, 2017

In Sweden, back when I trained, three blood tests were the “routine labs” done at most doctor visits: hemoglobin, white blood cell count, and erythrocyte sedimentation rate. I’m trying to remember, but I don’t think everyone waited an hour to see the doctor, so they must have used a modified rapid sedimentation rate.

The “sed rate,” or “sänkan” as we call it, was invented by Robin Fåhraeus, a relative of one …

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Does the public shaming of Carmen Puliafito go too far?

Physician
August 1, 2017

Recently, the Los Angeles Times broke a story that Dr. Puliafito, former Dean of the Keck School of Medicine of USC, had been abusing drugs and keeping company with a group of younger individuals who engaged in drug use and illicit activity.  Much of this activity occurred while he was dean, and it is a shocking story: A 66 year-old titan of the field of ophthalmology, renowned for inventing …

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Health reform should simplify our health system. Here are some ideas.

Policy
July 30, 2017

We are a nation divided. Our two major political parties agree on essentially nothing. Republicans cannot agree even amongst themselves how to proceed on health care reform. It is demoralizing that even though U.S. health care has sunken to last among developed nations, our elected leaders are unable to envision or agree upon any effective solutions. We could all use a win. When it comes to health care reform, administrative …

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Here’s what it’s really like when your spouse is a doctor

Physician
July 30, 2017

June 30 is a date that those in the medical world know well; it’s the official end of the medical training calendar year. July 1 represents new beginnings: beginning of the academic year, an internship, a residency, or a fellowship. This year was our tenth and final passing through the medical new year. Looking back, I realize that we never would have predicted what we were going to learn and …

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Waiting on a significant other to finish medical school? Here are some tips.

Education
July 28, 2017

My husband and I met during my graduate studies and while he was earning his bachelor’s degree. Two years after getting married, we packed our belongings and moved to a new state where he began medical school. We started our own little family a year later and welcomed an amazing daughter into our lives. After she was born, I made the personal decision to leave my job and stay at …

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Why are doctors leaving private practice?

Physician
July 28, 2017

In the U.S., approximately 30 percent of physicians work in practices that they own. This number has been dwindling down over recent years. Perhaps more surprising, the number of women doctors who are self-employed are a mere 18 percent.

Many hospitals and other corporate entities are actively looking to purchase the remaining practices. It is not just to make money from that practice; it’s to make money from services that are …

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Being Latina, a physician, a mother and a runner: by the numbers

Physician
July 28, 2017

To a runner, numbers are everything. It’s data. It’s workouts. It’s goals. It’s pace. It’s winning or losing. To a physician, numbers are everything as well. Before you get into medical school, numbers are your schedule, your GPA and your MCAT. In medical school, numbers are your grades, your board scores and your rank in the class. It goes on and on. …

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We need to talk about mental illness in the medical field

Physician
July 28, 2017

It wasn’t until I was six months into my second depressive episode that I discovered depression existed. I didn’t know it was a real disease. I didn’t know that my grandmother got electroconvulsive “shock” therapy in the 1950s. I only knew something was terribly wrong when I sat crying for 20 minutes in front of a pile of laundry one morning because the thought of choosing clothes and going through …

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5 reasons why medical students drop out

Education
July 27, 2017

I write this blog in order to prepare premedical students for the road ahead. I want you to understand common obstacles facing medical students so you can be better prepared to overcome them. Medical training is akin to a roller coaster pulling you through the highest of highs and the lowest of lows. On the one hand, medical school is extremely challenging but rest assured, it is very tough to …

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Doctors: Don’t lose your humanity

Physician
July 27, 2017

There has been much publicity recently surrounding the issue of doctor mental health after a spat of doctor suicides, and sadly not a new thing in the history of medical training. I think the crux of this issue is the idea that doctors are somehow above the concept of humanity. We are held to standards above human abilities, yet we bleed the same blood, cry the same tears and feel …

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4 tips for finding a work-life balance during intern year

Education
July 25, 2017

My wife and I were in a unique situation after graduating medical school. We had met in the first year of medical school in and became friends. During our second year we started dating, and by end of third year, we were married. By the beginning of fourth year, we were proudly expecting. By June 1st, 2016 we were fortunate enough to share our graduation from medical school with our …

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I left medicine to become an entrepreneur

Tech
July 25, 2017

I have wanted to be a pediatrician since I was eight years old. Growing up, my favorite book was the large medical encyclopedia that sat on the bookshelf in our den. My life has been planned around that singular goal, each step predetermined and in a very specific order. I have thoroughly enjoyed practicing medicine over the last 17 years — first as a primary care pediatrician, then for the …

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Doctor, we can’t read your writing

Physician
July 23, 2017

“Dr. Fraser, the pharmacy is on the phone for you. Line one.”

I answer the call, pressing the gray, rectangular button with one hand while writing in a patient’s chart with the other.

“Sarah Fraser speaking.”

“Oh, hi, Doctor, we just got in a prescription of yours, but we are not quite sure what it says.” The pharmacist is gentle in her words.

It was the first time this had happened. I’d promised myself …

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Don’t call me “Mrs.” Call me “Doctor.”

Physician
July 23, 2017

My smile freezes on my face as my patient says to me, “I’m so glad you’re back – that I get to see Mrs. Lycette today!”

He has been my patient for several years, and I am perplexed to hear him address me as “Mrs.” rather than “Doctor.” At the same time, I really do not think he means an intentional insult, so I keep my face neutral and continue with …

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The decline and fall of informed consent

Physician
July 21, 2017

Margaret Edson’s 1999 Pulitzer Prize winning play, Wit, tells the story of the final hours of Vivian Bearing, PhD, an English professor dying of cancer.  Early in the course of her disease, one of her doctors sees the value of her case from a research point of view and asks her to enroll in a clinical trial of an investigational therapy.  In the film version of the play, which stars …

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