“How many lives did you save today, Dad?”
That is what my kids would ask me, rather sarcastically, many years ago, when they were young and when I arrived home late, missing our game of backyard basketball. They knew I was a neurologist. And, of course, they knew I didn’t exactly save lives since, as I had explained to them many times, my job consisted of giving folks lots of medications …
Where does the joy and meaning in medicine dwell?
An excerpt from Becoming Doctors 25 Years Later: Twenty five physicians sharing the journey from medical student to retirement.
I’ve been out of med school for twenty-five years now. Somehow, I thought by now I would be the beloved owner of my own practice, my name on the lips of every family in town … or a full professor sitting comfortably …
It was a cold day in Durban. Sixteen degrees Celsius is cold for us on the East Coast of sub-tropical Africa.
I had made a trip through the suburbs to drop something off for my theatre scrub sister. The roadblocks are manned by community commandos, most of who are my patients and it’s easy to pass through.
On the way back to the hospital, I passed a queue of cars more than …
The medical team is at a breaking point
“Code blue!” the overhead speaker blared.
I had just started my shift in the pediatric emergency department. “This will be good for you to see,” the off-service junior resident said to me, as she sprang up from her chair in Pavlovian fashion. With a surge of adrenaline, I blindly followed a group of nurses and physicians towards the trauma case that had just rolled in.
I eventually ended up in a crowded …
Trauma: Encountering the past in the present
“It’s rare for anyone to try and tally the precise cost of unnecessary care. But when they do, the estimates are staggering. The Washington Health Alliance, a nonprofit dedicated to making care safe and affordable, analyzed insurance claims from 1.3 million patients who received one of 47 tests or services …
Marshall Allen on how to contest hospital bills and avoid treatment you don’t need [PODCAST]
Our country is seventeen months into a pandemic that we have an effective vaccine for, and yet, COVID-19 cases are still rising at an alarming rate. Currently, this dramatic acceleration in cases is evident in several states. Furthermore, these areas with high numbers of COVID-19 case rates are associated with low vaccination rates.
These unfortunate statistics lead one to reflect on the multitude of reasons that Americans are abstaining from vaccination. …
Education is the key to moving past the pandemic
When it comes to running, I am 100 percent pure-bred, authentically average. I love to run, but I don’t ever expect any record-breaking times. Did that woman in a hot-dog costume just pass me on the course? Sure did! As the Olympic games are upon us and we watch and admire the best-of-the-best, I challenge us to recognize and celebrate the Everyday Olympians among us: the “average” who always show …
Celebrating everyday Olympians: The “average” among us who always show up
In June, the FDA approved aducanumab (Aduhelm) to treat patients with Alzheimer’s disease using the agency’s accelerated approval pathway, despite significant concerns about the evidence regarding the drug’s safety and effectiveness. The agency’s approval decision contradicted the recommendations of its own advisory committee, which voted overwhelmingly against the evidence presented in support of the drug. Soon after approval, three members of the committee resigned in protest. …
Should Medicare pay for Aduhelm?
It was the first day of my third year of medical school. I was assigned to an outpatient OB/GYN clinic. I woke up early, had only a coffee for breakfast that I would later regret, hesitantly wrapped a stethoscope around my neck, unsure if this specialty required such a tool, and punched the address into Google Maps. After almost 16 months of virtual med school, I was walking into uncharted …
Medical school is more than practice problems
“A sad truth is this: Most everywhere, health care is a low-margin industry that lacks resources to invest in leadership development. Although our business’s central, sacred function is caring for our fellow human beings, many who move up in the health care hierarchy do so without possessing the so-called ‘soft …
How physicians can be better medical leaders [PODCAST]
Life is full of hierarchies — whether you are the older brother in the family, the supervisor in a company, a chief resident in medicine. There is always a hierarchy. It is a pecking order that keeps our society organized. You know where to look for guidance. Who is the person above your title that can help you with a challenge you are facing?
Even within surgical specialties, there is a …
Let’s talk about hierarchy and priorities in medicine
He was in his ICU bed without movement or brain stem involvement. His weight was down to 90 pounds.
His six-foot frame and skeletal body made me gasp.
After countless sessions with the patient’s daughter to make her 92-year-old dad “comfort care,” the intensivist sadly hung his head down low.
The daughter insisted on doing everything for her daddy.
It was my night shift, and I knew what was to be expected. Another endless …
The horror of keeping a loved one alive at all costs
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You are more likely to be struck by lightning than be born with cri du chat syndrome and OCD. The chances of becoming a performer with these diagnoses are even smaller, and yet, what a show Tanner performed.
His performance is meticulously planned out. Pump soap dispenser twice. Rub hands three times. Wash quickly. Create bubble! As the first bubble emerges, the kids take notice.
Pushing her wheelchair forward, Maria pops the …
Advocating for people with disabilities: People First Language
Earlier this year, a federal rule that requires clinical information such as doctors’ notes and lab and imaging results to be made immediately available to patients took effect. A little more than three months out from implementation, there are mixed reviews as to how well the so-called “Open Notes” rule is actually improving patient care.
Patient advocates and even many physicians have supported the concept of electronic health information …
Is Open Notes as good in practice as it is in theory?
One of the leading reasons for provider frustration is prior authorizations. The insurance companies initially created prior authorization (prior auth) to keep down the cost of care when a service fee was the primary payment method for payers. However, it has become a hindrance for providers and staff as they spend hours waiting for authorization to provide medical care.
In the past, hospital organizations needed approval (prior authorization) from an insurance …
Prior authorization reform for health care coverage takes center stage
“During my medical school clerkships, an attending recognized a truth within me that I’d hidden for many years. Just a few hours into my pediatrics rotation, the attending asked me, ‘You had a rough childhood, didn’t you?’
I was astonished. How had he known? I asked him, needing to know …
How a homeless teen became a physician [PODCAST]
When watching the news or reading articles about COVID-19, the physicians who contribute are often in internal medicine, epidemiology, emergency medicine, etc. You do not typically see psychiatrists contributing to discussions on the virus itself but more about the mental health ramifications of COVID-19.
Psychiatrists are also not often considered integral in the role of vaccine educators. But I argue that they, in fact, play a vital role in educating a …
Psychiatrists can be valuable vaccine educators
Singing during the years around menopause can bring unforeseen challenges for some women. To Elaine, a 56-year-old professional singer and voice teacher, her voice has felt like a mystery for the last few years. Her vibrato was wider than it used to be, her usual songs didn’t feel good anymore, and her flexibility and agility had decreased.
On top of that, the vocal transition, or break, between her high and low …
Menopause changes women’s singing voices
Caring for patients is not only a clinical endeavor, it is also an ethical one. Patient care and ethics are woven together as an integral part of every doctor-patient encounter. Medical schools have traditionally taught students the principle-based ethics approach of autonomy, beneficence, non-malfeasance, and justice. These abstract principles are often applied to “big” patient care situations, such as physician-assisted suicide, organ transplantation, and withholding/withdrawing treatment. The life and death …
Doing right in the everyday care of patients
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