It was 4:00 a.m. when I made it to my parents’ home. My mother called me to say that my father was having a hard time breathing. I could hear him struggling in the background. I ran inside to see my mother cradling my father on the floor — not breathing. I performed CPR on the man that gave me life! CPR on the person who just three months earlier …
Treating sleep apnea without CPAP
I have been a neonatologist for 30-plus years. Throughout my career, nurses and neonatal nurse practitioners (NNPs) have guided me, assisted me and comforted me through difficult patient care issues that arose. Even more importantly, they allowed me to leave the neonatal intensive care unit (NICU) without worrying about how my patients were being taken care of.
I am writing this because our profession (MDs and DOs) continue to devalue these …
The discrimination against nurse practitioners must stop
How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the ordeal.
When I get to work, full of nervous energy, I am relieved to find out …
Over 80,000 new cases of bladder cancer are diagnosed every year. Of the new cases, over 62,000 are men, and over 18,000 are women. Whites have higher incidence rates than blacks, although black patients have higher mortality rates, particularly black women. The majority of cases are found with painless gross hematuria (although most patients with gross painless hematuria don’t have bladder cancer). Nearly 80 percent of patients diagnosed with bladder …
10 essential questions to ask when diagnosed with bladder cancer
Caregiving is often described as a sacrifice. One individual bears a burden to care for another. There’s a connotation of drainage, evocations of burned-out batteries and tired limbs.
I was a premedical student. I was aggressive in pursuing an MD. I wanted to be the best doctor I could be. I did not realize that required me to become a much a better person.
I left school to care for my grandmother. …
Here’s what caregiving taught me
Exhausted. Aching. Hungry. Slightly delirious.
Mile twenty-four of a marathon? Or hour twenty-four of a twenty-eight-hour shift?
I am a resident. I am a runner. I am also a rather tired human since, as I type these words, I’m both post-call and post-run. However, this post-call/run state of body and mind is one I have learned to love and embrace during this residency whirlwind.
I’m not myself unless I’m wearing scrubs or running clothes. …
Residency training, and training in residency
An excerpt from The Science of Near-Death Experiences.
Near-death experiences are an ancient and very common phenomenon that spans from ancient philosophy, religion, and healing to the most modern clinical practice of medicine.
Modern advances in medical knowledge make it possible to revive patients from increasingly severe, life-threatening injuries and illnesses, including cardiac arrest. Upon being revived, …
How near-death experiences profoundly change lives
Dear Mom and Dad,
I love you, and thank you. The rest of this letter is an attempt to write something more eloquent and thoughtful, but those are the best and truest words I can ever speak to you. I made the decision to enter the medical field when the rest of our family is from a business and finance background. Despite being unfamiliar with the different hurdles of application cycles, …
A medical student’s letter to her parents
Recently, news broke about a disturbing act of medical battery carried out by doctors at St. Joe’s Medical Center in Syracuse, New York. The case began when police officers conducted a pretext stop and elected to harass their victim about a small amount of marijuana.
As the situation escalated, the cops took the man to St. Joe’s Medical Center for him to be searched for …
Physician gives in to police pressure to conduct a forced invasive rectal exam
Net promoter scoring (NPS) measures customer experience and predicts business growth. Recently it is becoming more common for health networks to adopt NPS. The word “customer” should be a red flag. In medicine, we do not have customers; we have patients.
It is common practice for a patient to receive a text message after they leave an office asking them to rate their experience. It generally looks something like this, “How likely …
Net promoter scoring needs to be tweaked for medicine
Patient access to care is a high priority for all neurosurgeons. Unfortunately, many of our practices are thwarted in these efforts from unwarranted insurance denials. Know, you are not alone. Take this common scenario:
When Ms. Mary Smith (not the patient’s real name) started her new job several years ago, she purchased the premium insurance policy that her company provided. Recently, she developed severe neck and left arm pain. Imaging of …
An approach to prior authorization insurance denials
Even though physicians do not talk about transferring residencies, it is more common than is often believed. According to the AAMC website, about 30 percent of residents do not finish the initial program they started. Quantifying that number further, the ACGME recently reported 1,044 residents transferring from their program.
There are a variety of reasons for transferring residencies: A spouse being accepted for …
How to transfer residency programs
One time, I applied for an emergency department (ED) nurse manager position. I thought I had the job locked up until I was asked during the interview how I would “enforce metrics.”
“Enforce.”
My holistic, qualitative research-based response to this authoritarian-style question was: “I’ll find more organic ways to achieve your metrics without shoving numbers down their throats.”
I didn’t get the job. Someone told me I wasn’t “MBA enough.”
Yet, I stand by …
Stop shoving metrics down nurses’ throats
This article is sponsored by Careers by KevinMD.com.
Wide open spaces. Fresh, clean air. No people for miles around.
The advantages of rural living are plentiful, but there are disadvantages, too, especially when it comes to health care; being way out in the country likely means the choices for doctors, clinics and hospitals are severely limited.
According to the …
The pros and cons of practicing medicine in a rural setting
About two months ago, a 15-year-old Native American male was riding around in a stolen car on the reservation. “M” and the driver were drinking. And somehow, after he exited the vehicle at 4 a.m., the car struck him. Hours later, it became clear that something was wrong. M was transferred to our pediatric hospital as a trauma and was found to have an unstable vertebral fracture. Conservative treatment with …
Non-therapeutic relationship or human kindness?
There has been a profound deterioration in the education of our medical students. I only make this contention after having taught over a hundred medical students across five continents, often one-on-one and for extended periods. Although the majority of those I’ve taught have been students educated at international medical institutions, a substantial number have been those from U.S. medical schools. While I do recognize that those that find their way …
What’s the biggest problem with medical education?
Late one evening, I received a text from my oldest daughter.
“What in medicine, that we do now, will we think is barbaric in 50 years?”
Wow. They play more provocative bar games now than they played when I was in my 20s.
I promptly texted back my knee-jerk response: “chemotherapy.” As we are on the brink of precision medicine, what will the next generation think of our “slash, burn and poison” paradigm …
1. Murphy’s Law as it applies to the ER: If something can go bad, it will do so in a hurry. If it can’t possibly go bad, it will still find a way.
2. Clock’s First Rule: All the patients will crash at the same time. Usually when the computer system goes down.
3. Clock’s Second Rule: The sickest patients will come just before the shift change.
4. Haste’s Theorem: The healthier the …
I know what you’re thinking: She’s cold-hearted, cruel, and unkind.
But am I? Or are you?
Grandma Lilly is 87-years-old and in the ICU. She’s on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats per minute. Her blood pressure is low and Levophed and vasopressin drips are ordered.
Her family can’t talk …
Yes, med-peds is a real residency! It is a real specialty! And it is a practicing profession by many physicians today! It can open doors for so many wonderful professional opportunities. It is a discipline that can provide patients and communities extremely comprehensive medical care. People need to know more about this unique and sometimes under-recognized field. And here is why:
Like many people today, I didn’t even know what med-peds …
The myths and truths about med-peds physicians
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