After finishing medical school and my residency in internal medicine, I undertook an additional year of training in a field called palliative care. Patients who notice my background sometimes ask me what exactly palliative care means. It’s really a simple concept. Palliative care is helping people with a serious illness have the best possible quality of life. It’s enabling sick patients to make the most of the time they have left …
Three years ago, in the midst of all that was happening with health care reform, I thought about if I’d ever recommend medicine to my daughter. I thought and thought about that issue and looked deep inside myself for reasons one might still choose this profession, then penned “The Top Ten Reasons to Be a Doctor.” It is, by far, the most popular post on my blog, having been …
In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.
On the bike path where Jha took his initial tumble, people went out of their way to …
An orthopedic surgeon from New York reportedly has 261 malpractice suits against him. He has been accused of performing “phantom” and unnecessary operations. In one case, he supposedly performed a knee reconstruction, and the patient died of a pulmonary embolism the same day. A post-mortem examination allegedly showed no evidence of a reconstructed knee.
There is also said to be evidence showing that in one day he was doing as many …
So what exactly do we want a patient-centered medical record to look like?
What is the point of a patient’s medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be.
If a healthcare provider from one or two generations ago were to look into a patient’s chart today, would they recognize what they saw? Would they …
There’s something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it’s a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying.
Stark and …
Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.
Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, …
Recently we have learned that 15 patients in New England were exposed to a rare infection called Creutzfeldt-Jakob disease (CJD) when neurosurgical instruments contaminated with the infection were used in their care. Each had undergone a brain or spinal surgery in early 2013, and now their future was uncertain.
Creutzfeldt-Jakob disease is caused by an infectious agent called a prion — as is “mad cow disease.” Originally discovered in the brain-eating Fore cannibals of Papua New …
Necrotizing fasciitis is a rare but life-threatening soft tissue infection. Its presentation is characterized by rapidly spreading inflammation and resultant death both of the surrounding soft tissue and fascial planes. Prompt recognition and aggressive treatment is paramount in order to avoid fatality. Often times, symptoms may overlap in their presentations so one must maintain a high index of suspicion and a multidisciplinary approach facilitated appropriate imaging studies and resulted in a …
She was the first Michigan Wolverine I met who taught me their college fight song “Hail to the Victors,”and demonstrated their rabid pride anytime football or basketball season rolled around. (If you know people from the University of Michigan, you know what I mean). She was also one of the smartest and hardest working doctors in our family medicine residency program and one of our two chief residents.
So …
A friend delivered twins early. One is in the NICU, one died. What can I say or do?
This question was sent to me via Twitter. The person who added my name to the tweet knew that I might have something to offer because 10 years ago I was that friend. I entered the hospital with ruptured membranes at 22 1/2 weeks, pregnant with triplets. My son Aidan died at birth …
One would never guess that a frequent activity in the OR is painting. I’m not referring to the application of paint to the walls of a room or house. The painting I’ve seen is limited to the patient and his or her body parts.
I suppose the first application of “paint” would be the initial scribble placed by the surgeon, marking the surgical site. This is a relatively new requirement and …
It’s no secret that America is suffering from a huge crisis in healthcare. As we watch the sun rise on Obamacare, doctors, patients, insurance executives, hospitals, small businesses and legislators alike stand agape. No one seems to have found a simple, logical solution.
The solution is in fact very simple. It’s so ridiculously simple, it might make one laugh. And, believe it or not, it’s also amazingly cheap.
But because of its …
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Cancer screening is of little benefit in persons with dementia but can cause very serious harms. Older persons with dementia have limited life expectancies which makes any benefit from cancer screening very unlikely. This is because cancer screening works by identifying a cancer many years (generally at least 5-10 years) before it would threaten health.
But cancer screening tests cause lots of burdens when given to persons with dementia. The …
In 2008, the state legislature of Washington passed what was called the Death with Dignity Act, a law that legalized physician assisted suicide. Under the law, terminally ill patients (predicted to have less than six months to live) can request prescriptions for lethal medications from their physicians, under a series of safeguards: multiple requests for example, determination of competency, and the like. Then, if the patients so choose, they can ingest …
We gastroenterologists are regularly summoned to bring light into dark places. We are the enlightened ones who illuminate anatomical shadows. Sure, we have tunnel vision, but we like to believe that we can think broadly and creatively as well.
We are the scope doctors.
We are commonly consulted by primary care physicians and hospitalists to perform colonoscopies, upper endoscopies (EGDs) of the esophagus and stomach and other gastrointestinal delights. We deliver a …
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We all know that physician-patient communication is important. Poor communication, not deficient clinical skill, is the primary driver of malpractice suits; conversely, good clinical communication alone can improve patient outcomes. For example, patients of physicians with superior communication skills have been shown to have superior blood pressure control. Fortunately, physicians generally recognize the significance of good communication, and often take the time to ensure that it happens. Yet there …
In 2007, I published a story in my local paper in which I confessed to having made a medical error years earlier. I’d mistakenly prescribed an antibiotic for a patient whose chart indicated an allergy to the drug.
Thankfully, the story had a happy ending. My patient recovered and took no legal action after I explained to her what had happened. I ended my article vowing to take greater care to prevent errors …
This year my wife and I decided to compile a list of all of the holidays we’ve had since we had kids. Its a nice list and we’re lucky to have traveled as well as we have.
I always get excited about going. There’s the anticipation of downtime away from work (and other peoples’ problems), time for relaxation, sleeping, eating, reading, and some quality time with my family. Life is just …
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Today in clinic, I interviewed a formerly morbidly obese woman. She has lost almost 300 pounds since undergoing gastric bypass surgery a few years ago, a presentation that has become increasingly common. She was here to see the plastic surgeon for her four week follow up appointment, status post abdominal skin flap removal.
See, after losing a ton of weight, loose skin remains, especially in places like the arms and abdomen. …
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