I keep thinking about the dichotomy between covering a lot of ground and getting to the point.
The other day I saw my bosses at one of my clinics stop in their tracks when I suggested that a lot of the things we are measured on as physicians could be turned into standing orders and simply get shifted off my plate. I have just created a letter that anybody can send …
Physicians are problem solvers and artists
How doctors treat patients’ need for information has changed significantly over the past decades. Sixty years ago medical practice was much more paternalistic than it is now, although some would say it continues to be so in important ways. Still, not too long ago it was common for doctors to tell patients or their families next to nothing about what was going on. The presumption always was: the doctor knows …
What to do with physicians who don’t explain
I’ve known Pat McCann (identifying information changed) for many years. He carries a diagnosis of COPD and has a preventative and a rescue inhaler, but he has never really had any serious flare-ups.
He fell and broke his hip. Then he went to skilled rehab, one of a half dozen near Cityside Hospital. His stay turned longer than expected because he fell, luckily didn’t break anything, but had to go back …
A diagnosis of pneumonia in a rehab facility: We can do better
If you’re done with your residency or fellowship, you’ve paid your dues. And I am excited for you. Life is about to get better. A lot better.
If you read my prior article about going unmatched, you know that things have not always gone smoothly for me. But now, after a reasonably good first year out of training, I feel compelled to reflect on why things are going well, and also—to offer any …
10 tips for success after you finish residency
A piece of advice I would give to any younger physician, especially one who is just graduating residency, would be to expect a whirlwind ride into the realities of frontline medical practice. It’s something that you are totally not prepared for in the controlled environment of education and residency training. A steep learning curve awaits you once you start practicing medicine. And one of the biggest things you will have …
Physicians: Do not be intimidated by administrators
Global climate change is reaching a critical mass.
Since the advent of the industrial revolution, we have seen the global mean temperatures increase by 1°C (1.8°F), and significant steps must be taken by 2030 to mitigate an even larger global temperature increase of 1.5 to 3C as predicted by 2030. In other words, we are in dire need of change.
This change is not only reliant on governmental policy change but is …
How climate change affects your skin
I’ve finally stopped thinking about the process of getting into medical school. But with friends going through the application cycle, waiting on and making decisions, I’ve been reflecting on my process and remembering just how terrible the whole thing felt. To offer some support to those going through it, I wanted to confess a few things. These confessions feel silly and small in retrospect, but I hope they’ll help at least one …
5 confessions of a medical student
“At least seven children are known to have died in immigration custody since last year,” according to a NBC News report last month.
I recently spent a Saturday working with amnesty-seekers that had been detained at California detention centers in the desert. They were dropped off at bus and train stations in the desert in Southern California, most with no money and no ability to …
A physician volunteers with migrants. Here’s what she saw.
I recently graduated from medical school and will soon start residency. Yay! Although I’m happy with my decision to become a doctor, I can’t help but notice that there are several ways that going to medical school and becoming a physician helped — and hurt — my ability to build wealth.
Ways it helped me build wealth:
1. I will have a high income. Most of us doctors will make at least …
How becoming a doctor can help and hurt the ability to build wealth
My husband and I are nearing the completion of a fifth and final year of residency. I say “we” because, as all residents know, the training years involve the entire family. As I reflect on the struggles and successes over the past five years, there are a few things that I know have helped us cope with the challenges, and one of those things has been travel.
We made significant life …
Travel during residency: perspective of a resident’s spouse
Yesterday, I went into an exam room to print out some orders for a patient who needed to get his labs done at an outside facility.
Due to his insurance, he cannot get his labs drawn in our office during a scheduled appointment, but must do it at one of the laboratories that his insurer has contracted with.
Not a terribly big …
Medicine is the last bastion of faxes and printers
The incidence of brain trauma has been rising in recent years. According to the Centers for Disease Control and Prevention (CDC), emergency department visits related to traumatic brain injury (TBI) increased by 53 percent in the U.S. from 2006 to 2014. For 2014 alone, the CDC reported about 2.87 million TBI-related visits, hospitalizations, and deaths. Reports of concussions in high school athletes have also increased in recent …
Concussion treatment centers: 5 red flags to watch for
We’re all gonna die.
It’s a simple truth that an astounding number of people neglect to acknowledge or accept. Some people die sudden, unexpected deaths, but most eventually fall victim to chronic or terminal conditions like COPD, heart failure or cancer. As a palliative care physician, I often meet patients who have had conversations with their families about their end of life wishes and have completed supporting legal documents.
While I appreciate …
How to have an exciting death: 5 tips from a palliative care physician
An excerpt from Human Rights Violations in Medicine: A-to-Z Action Guide.
From sex trafficking to censorship, the range of human rights violations is immense, some more heinous than others. Abuse may be perpetrated by dictators in war-torn countries and administrators in first-world hospitals. Inside this action guide are the top …
Our doctors are suffering from human rights violations in medicine
Words have meaning. And when it comes to cancer, especially advanced cancer, there aren’t many words that have more meaning than the word “cure.” It is that very word and concept that is top of mind for some of us these days.
We clinicians are guilty as charged when it comes to reluctance declaring those who have had a remarkable response to treatments for advanced cancer “cured.” Experience has taught us …
What should a cure for cancer look like?
Whenever I tell people outside of medicine how bad doctors are with money, they are always shocked. Almost universally, they wonder why we don’t save enough money. They understand that – to become a doctor – you must be hardworking, intelligent, and dedicated to the cause. These are the same attributes – when they are applied correctly – that result in financial success. How in the world can …
4 reasons why doctors are bad with money
The common practice in this country (although not everywhere — Europe, for example) has long been to treat all acute middle ear infections (otitis media) with antibiotics. This is not necessarily needed. We now know that for many children another reasonable approach is to wait a day or so to see if the symptoms get better on their own without antibiotics. Parents have an important role in making this choice. …
Are antibiotics needed for your child with an ear infection?
A patient walks into the doctor’s office and says:
I hate feeling this way. Yes, I know it’s not cancer and it won’t kill me, but this shaking has made me a different person. I can’t sign my name. I drop and spill things all the time. I’m afraid to pick up my baby grandson. I don’t go out anymore because I’m embarrassed. And I don’t know what can be done. …
Steadying patients’ fears about shaking hands
To my residency class:
The clock is ticking, its hands spinning around its face faster and faster until I feel dizzy and disoriented. The remainder of the academic year can be measured in days, even hours for some. The carousel is slowing down to let some off, some on. Some, like me, will remain in the saddles of their brightly painted ponies. The cheerful calliope melody becomes distorted with the change …
Words of wisdom to a residency’s graduating class
A patient groans in agony lying atop a rigid spine board, carried by paramedics into the ER, his neck in a protective collar. The paramedics shout a summary of the accident. Monitors are attached to the man, flashing and beeping the cadence of vital signs. Nurses and physicians swarm. Gloved hands comb through brown hair for bumps or lacerations. They remove his clothes, feeling for pulses in the neck and …
Fasting for Ramadan and being the on-call orthopedic trauma resident
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