There’s an interesting article in the Journal of Hospital Medicine on what to do when a patient wants to leave the hospital against medical advice. After reading and rereading it, I had to disagree with the conclusion, but it took me a bit to get there because the article, with its confusing use of terms, is a masterpiece of obfuscation. The most obvious example is the oxymoronic use of the term “AMA …
We’re going to address the most common question I see. Should you pay off debt or use your money to invest? Over and over again it is asked, always with slightly different details. 95% of the time, the answer is a simple “It depends.” So today, we’re going to talk about what it depends on. I’ve written about this topic before, but it has been six years. I …
As a private practice specialist in an affluent metropolitan area, I am often inundated with requests for consultation by local residents and primary physicians. That’s fine — it’s what I do, and it’s what I enjoy doing. Hey, it pays the bills, and I won’t complain about that.
Concierge medicine has taken a foothold locally, and this means more referrals directly from doctors who insist we take care of their patients …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 75-year-old man is seen for routine follow-up for very severe COPD. He has constant dyspnea and air hunger and spends most of the day in a chair. He has had no change in baseline cough and sputum production. He has had multiple COPD exacerbations that required ICU admission and intubation. He …
I spent considerable time after college working in academic labs being indoctrinated with the theory that publication is the currency of academic value and that researchers should always want to have their work printed in the journal most cited by other journals. You are supposed to be impressed when somebody claims that he or she is from a highly ranked university or institution, as these well-regarded institutions are synonymous with high achievement.
That all changed for me during residency when I met …
I feel the mountain in my bones. The methodical plodding of feet over uneven terrain, a meditation, the grace of a single forward path, with no decisions, no guilt or what-ifs, no fear. Just forward movement, forward momentum. I hear Mary Oliver’s words at my core: “I don’t know exactly what a prayer is. I do know how to pay attention … how to be idle and blessed.” It’s taken …
“Are you a left-sider or a right-sider?” my classmate asked with a puzzled look during an end-of-the-year dinner among first-year medical students. I was confused. He repeated himself then answered. “Do you sit on the left or the right side in class … that’s right; you sit on the right.” He then mentioned that everyone present was a “right-sider.” Nearly everyone was white.
For the past 18 months, we sat in …
Physician training is an extremely high stakes business, not only for the patients that will be under the care of the eventual independent, fully-trained, board-certified doctor, but for the trainee herself. The financial and time costs of the entire training process are enormous. To become derailed from the board certification path can have significant and permanent career consequences. With so much at stake, what does a resident do when she …
A few months ago, I hired a contractor for a home improvement project. He didn’t know that I was a physician at the time, and we came to a mutually agreeable price.
Fast forward a few weeks, when we realized that we needed an extra, seemingly small, addition to our project. By this point, we’d gotten to talking, and he’d learned that my husband and I were both physicians.
To my surprise, …
Have you ever come out of an interview feeling like you spent an hour (or more) talking about yourself but learning absolutely nothing about your potential employer? I certainly have.
Sure, interviews are a chance for potential employers to see if you are a good fit, but after way too many one-sided interviews, I came to a realization. Interviews are also the best way to find out if this medical institution …
I am pediatrician who has been practicing for almost twenty years. During my career, I have been employed by two different free-standing children’s hospitals, a non-profit community-based health center, and now I own my own practice. In every setting, I have had to generate coding and billing for my work even when my salary was independent of that billing.
There is no other profession that would dutifully learn the “rules” of …
Doctors at some of the largest U.S. hospital chains admit they went overboard with opioids to make people as pain-free as possible, and now they shoulder part of the blame for the nation’s opioid crisis. In an effort to be part of the cure, they’ve begun to issue an uncomfortable warning to patients: You’re going to feel some pain.
Even for people who’ve never struggled with drug abuse, studies …
Life insurance is one of the key foundations of a good financial plan. In this article, we will discuss the basics of life insurance.
Why life insurance?
While you might feel invincible and 100% healthy, as physicians we all know patients or colleagues who were diagnosed with terminal cancer or died suddenly because of an accident or health condition.
If someone is dependent on your income (usually your spouse or children), then life …
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Someone who I care about deeply messaged me today: “I think I’m done with surgery.”
This person, a surgeon, feels like his potential is elsewhere. There are more opportunities, different challenges, and fulfilling experiences in other places and he is ready to explore.
I told him that he inspires me.
But I am in medical school. So how could someone leaving the medical field be inspiring to me?
Because inspiration does not come from a job description or a fancy …
College
I went to a fairly expensive college, George Washington University. I think at the time (1998) it actually was one of the, if not the most expensive schools. Why did I decide to go there? Well, my brother was attending the school and living in Washington, DC seemed amazing to a suburban boy from Tennessee. Sure, I had gotten into University of Tennessee with a scholarship, but adventure won over …
Walking up to the admissions desk I knew the routine. I stretched out my arm for my hospital band. A name, a number, and a doctor were what defined me during my many hospital stays. It was simple; my brain was too large for my skull. Brain surgery after brain surgery has occupied my life for many years, all while I have been studying to become a doctor.
I …
In my last post, I told my story of how I got out of medical school with only $18,000 of debt. By the time I left residency, I had that whittled down to $6,000 at 3% interest. Then during the next three years after starting my practice, I had accumulated almost $500,000 of new debt.
Initially, I didn’t think anything of this new large debt, after all, I …
It was a long December.
A few years ago, my husband of 37 years got his death sentence: recurrence of liver cancer with mets to his lungs and lymph nodes.
He had a “Whipple” — a surgical procedure for pancreatic cancer — on Dec 24, 2015, and the surgeon discovered liver cancer too. So it was a 16-hour surgery. We were told he might die on the table.
His eyes haunted me as …
I am an emergency medicine physician.
I save lives.
As an ER physician, my job is frequently misunderstood. A common question that patients ask is, “What specialty are you hoping to go into?” The misconception is that emergency rooms are staffed by cardiologists, internists, etc., who are trying to make extra income. That’s likely not the case anymore. Some also believe that we can take the place of their family doctor. Or …
These are tumultuous times for practicing physicians. The health care landscape is changing at breathtaking pace and less and less of our time is spent doing what we were actually trained to do: taking care of patients. I absolutely love the patient care part of my job, do everything possible to always remember why I went to medical school in the first place, and maintain focus on the aspects of …
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