It’s always kind of a surprise when you read a patient’s chart, and you see an examination of a body part they just don’t have.
Just the other day, I was reading a consult note on a patient of mine who had been seen by a subspecialist for evaluation of a serious issue, and I received back a long detailed office …
Just because EMRs can document everything doesn’t mean they should
The money was so good in the beginning, and it seemed it might gush forever, right through tiny country hospitals in Missouri, Oklahoma, Tennessee and into the coffers of companies controlled by Jorge A. Perez, his family, and business partners.
It was his “secret sauce,” the rotund Miami entrepreneur would smilingly tell people in their no-stoplight towns. The money-making ventures he proposed sounded complicated, sure, but he said they would bring …
The story of a hospital collapse and how small towns were devastated
“You’re 27-and-a-half weeks pregnant.”
As I lay on the exam table, time froze.
How can this be? I wondered dazedly. I’m a second-year medical student. I’ve just completed a course in female reproduction and endocrinology. How could I have missed the signs?
I attribute my obliviousness to the surgery I’d gone through only months before: the removal of a 27-pound, mucus-filled ovarian cyst. My lack of menstrual periods was nothing new; they’d been …
A surprise pregnancy in medical school
Over the last three decades, surgery has slowly but steadily evolved towards a minimally invasive technique. The standard of care for appendicitis now involves creating three half-inch incisions and using a laparoscopic technique to remove the appendix. This technique uses a camera to see inside the body via a large screen. Instruments that are over a foot long are used. Sufficient research has shown that this minimally invasive technique leads …
The decision to undergo robotic surgery is a more than just about the length of the scar
The science of complexity lays a conceptual foundation for understanding “complex adaptive systems.” What all complex adaptive systems have in common is that they are all bound by the same set of physical laws. Their “behavior,” i.e., growth, maintenance, and death, can all be described using the same set of mathematical relationships. These systems (animals, plants, ecosystems, etc.) are the most productive and functionally effective systems known to man.
Unfortunately, our …
What role does the science of complexity play in medicine?
One question I get asked a lot lately is this: “Is it OK for me to use CBD oil?”
First of all, CBD oil and associated preparations are types of alternative medications, medicines that might not be mainstream or readily prescribed by doctors, but are nevertheless used by many people on their own. Alcohol and marijuana are two substances that are often used as “medicines” by those that think they function …
Considering CBD oil? This psychiatrist suggests these questions to ask first.
What has the medical community, once thought of as the “ultimate team,” finally come down to in 2019? The “back in my day” sigh I often hear from more senior physicians has inspired me to read several books about the history of medicine. As I devoured them from cover to cover, the excitement of medical discovery, the anticipation of the near-miracles that were about to be revealed, and most importantly, …
Should physicians yearn for the nostalgic ideals of their predecessors?
Back in 2006, I settled into my career as an emergency room physician. It was then when I started working in multiple hospital groups in several cities in Arizona and Texas to maximize my earning potential.
The strategy worked. I was able to make enough money to service my medical school debt as well as dabble in commercial real estate, buying some duplexes in Central Texas then single-family homes and larger …
Haven’t thought about investing in group homes? You should.
I was a 22-year-old intern, just about to finish my public health internship. I had an ambitious career ahead of me. I was trained as a public health educator. I was doing wellness fairs, writing newsletters, and excited to get to the next stage of my life. I wasn’t yet certified, however, so when all of a sudden a job opportunity presented itself to me and gave me a chance …
I’m a residency program coordinator. My role has changed over the years.
“I just don’t know what to do, how to help.” My patient’s wife was slumped in the plastic chair by her husband’s side, fatigued and beleaguered. She had been there for hours, days, as we waited for antibiotics to start fighting back against the infection that had overwhelmed his body.
“What sort of music does he like to listen to?”
“Depends on what he’s doing. Zeppelin to work on the car. Jazz …
The changes that have occurred in health care over the last few years represent a sea change from the autonomy and clout that physicians once had. It’s no great secret to anybody working in medicine that most of these changes to practice — including the push towards employment instead of private practice, and the need to now spend the majority of the day clicking boxes on a computer screen — have …
Physicians need to stop being so nice
I just did my first telemedicine video visit.
The concept seems so strange, the idea of carrying out an “office visit” without the patient actually being in the office.
Right now we have it structured so that when a patient calls up requesting to see me on a day when I am already fully booked (or, as is usually the case, overbooked), …
A physician’s first telemedicine video visit
A debate highlighting gender discrimination in medicine currently rages within the pediatric hospitalist medicine community.
The debate centers on the board certification process for “grandfathering” for the new pediatric hospitalist subspecialty which effectively excludes women on the basis of motherhood.
For those not familiar with “grandfathering in,” this is the process by which a new subspecialty may grant board certification to physicians who have been practicing in the specialty. The alternative option …
Don’t make me choose between motherhood and my career
The emergency room is an interesting place to work. It’s controlled chaos. Walk through the hallways, and you’ll hear people screaming, see others crying, and others wincing in pain.
Over time, you get a unique perspective on the human condition. In my years of training and practice, I’ve seen so much. People experiencing their worst days. Others receiving news that will change everything. Some lives ending. Others returning from the brink.
Certainly, …
5 lessons from an emergency physician
I made my 10:20 a.m. patient wait while I told my support staff about my day off.
“I was getting an ice cream when I saw a car accident. By the time I got there, it was clear that there were no serious injuries and all I did was to distract the passenger so she wouldn’t panic while we waited for EMS. Her husband hit a tree with their van, and …
Asking patients the right questions isn’t as easy as you think
Some radiologists perceive teleradiology as the “dark side” of our profession. I may have counted myself among those skeptics, but I now see the light and am happy to share a place among the converts.
Most of my career has been in traditional private practice, but there’s not a great deal of difference in how they operate versus a teleradiology practice. Both organizations exist to provide clinicians and patients with diagnostic …
4 reasons why this radiologist loves practicing teleradiology
The one thing doctors want to avoid like the plague is a lawsuit — a medical malpractice lawsuit.
To be sued means the doctor loses precious time from work, endures emotional personal and family distress and is unable to fully invest oneself in providing the very best medical care possible. It is a dark cloud that hovers over the majority of physicians at least once in their lives. Some medical specialties, …
10 reasons why doctors get sued
People often compare internship to drinking from a fire hose. Overwhelmed by new information and workflow, interns (especially international) usually do not have a clear direction about how to optimize their working/learning experience. Here are some tips for interns to smooth their transition from a newbie into a high-functioning intern in the setting of medicine inpatient wards.
Success leaves clues
Don’t explore yourself, specifically ask your upper-level resident about the most productive …
4 actionable tips for new medical interns
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman is evaluated in the emergency department for chest pain after a belted motor vehicle accident. She is pregnant at approximately 23 weeks’ gestation. She reports no additional symptoms and is otherwise well. Her only medication is a prenatal vitamin.
On physical examination, the patient is afebrile, blood …
MKSAP: 25-year-old woman with chest pain after a motor vehicle accident
Jeffrey Epstein’s apparent suicide while in custody at a Manhattan detention facility has focused intense media scrutiny into jail suicide prevention procedures. Suicide is the biggest cause of death in jails in the U.S. — by far. Because of this, all jails (including the facility where Epstein was housed) have a suicide prevention policy. Since the process was an epic …
I’m a jail physician. Here’s what likely happened to Jeffrey Epstein.
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