That slippery bowel wants to be everywhere

Physician
April 29, 2013

Next in a continuing series.

Inside the belly, everything is slippery. The peritoneum is a glistening layer of self-moistening plastic wrap, enveloping the surfaces of all the organs, and the inner aspect of the abdominal wall. Undisturbed, the intestines coil and slither, reptilian. Watching waves of peristalsis makes me smile: there’s something always entertaining about those moving contractions, following one upon another, gurgling, surprisingly tight bands of tension moving …

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The ethical shortcomings of selling supplements

Meds
April 28, 2013

A crunchy friend of mine on Facebook re-posted something from an even crunchier friend of hers who was shocked to find that many naturopaths sell supplements. Actually, she feels that selling them is okay; so is prescribing them. But selling what they prescribe apparently tips her ethics meter over into “unacceptable”.

As I read her screed against  the ND who conducted a cursory history and exam before checking off $750 worth …

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Practical advice for the parent of a pre-med

Education
April 27, 2013

For over a decade, I have advised pre-meds on how to maximize their chances of getting into medical school. During this time, as I witnessed thousands of anxiety-ridden pre-meds wade doggedly through the murky waters of medical school admissions, I have noticed pre-med difficulties often pale in comparison to those of pre-meds parents. It’s often much easier to be the athlete on the field than the coach on the sidelines. …

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Treating the enemy still requires respect and professionalism

Physician
April 26, 2013

A city is free. A town is celebrating.

I sat and watched the local news station announce that the second suspect in the 2013 Boston Marathon bombings had been taken into custody and was being transported to a nearby hospital.

I am relieved. And thankful.

Then I wonder. I wonder about the hospital that this suspect is being transferred to, and I wonder about my colleagues. What are the nurses, the doctors, and …

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How my geriatric practice works

Physician
April 22, 2013

A little over a year ago, I found myself burning out and realized that my worklife was unsustainable.

I’d been working at an FQHC clinic, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our …

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As an oncologist, I hate running late

Physician
April 22, 2013

Yesterday I had office hours: 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day.  However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve.  I really hate it when patients are late.

Now, I have to admit this is a unique …

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Radiation therapy: Don’t let me talk you into it

Physician
April 20, 2013

When I was young and foolish and just starting out in my career, I found it very hard to take “no” for an answer.  If a patient needed radiation therapy, and he or she didn’t want to have it, I did my very best to talk that patient into it.   I have always been a very persuasive person—if I didn’t get the go ahead on the first formal consultation, there …

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The locked inpatient psychiatry unit: What’s it really like?

Physician
April 19, 2013

As I walk onto any one of the locked psychiatric units at our hospital I am immediately struck by the hum of intense activity. It’s like the startling feeling of stepping out of an air-conditioned apartment into the steamy height of a New Haven summer. Across from the nurses’ station, a psychologist interviews a patient retelling the story of constant childhood molestation as rivulets of mascara run down her cheeks. …

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Anesthesiologists are victims of their own success

Physician
April 18, 2013

New research just out in the journal Psychology and Aging says pessimists live longer and healthier lives. If this is true, then contemplating the future of anesthesiology ought to make us immortal, because our professional prospects don’t look bright.  As we teach residents to do what we’ve always done, shouldn’t we ask ourselves honestly if we’re training them for a future that doesn’t exist?

Especially here in California, it seems …

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So your partner wants to remove your pubic hair

Physician
April 16, 2013

A divorced friend of mine who recently started dating was shocked to find that the complete absence of female pubic hair seemed to be an expectation among her potential partners. I’m not surprised, when I was in the dating pool a couple of years back there were men who actually listed full clamscaping required among the personal attributes they were seeking in a girlfriend (and here I was looking for …

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The rise of ultimatums in medicine: Do they work?

Physician
April 15, 2013

Has anyone else noticed the growing presence of ultimatums in medicine today?

The New England Journal of Medicine published a discussion of the ethics of not hiring smokers.  My hospital adopted this policy six months ago, and they are not alone.   There is a tobacco blood test that new employees have to pass.  If they fail, they can look for a job elsewhere.  I do not know the exact details, but …

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Why doctors should use their real name on Twitter

Social media
April 14, 2013

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The General Medical Council (UK) published new guidelines that state, “If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely.”  This has …

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8 surprising thoughts about patient wait times

Physician
April 14, 2013

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Every one of us feels a high level of anxiety when we are made to wait.  In grocery stores, we jockey back and forth to the line we perceive is moving the fastest and easily get frustrated when we choose the “wrong” line.  When driving, we will swerve across multiple lanes of traffic to avoid a line at a toll booth or …

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The patient experience can be dehumanizing

Physician
April 12, 2013

Being a clinical student is not a walk in the park. When we get together for “Reflections on Clerkship” days every two months in our small groups, students let the floodgates open about the hardships they have been facing on rotations. I am no exception. Transitioning to a strict schedule in the hierarchical world of academic medicine has been no small feat. In fact I was planning earlier this morning …

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The male gynecologist: Tips to connect with female patients

Physician
April 12, 2013

With all due respect to the many caring, compassionate, and skilled male OB/GYN physicians out there, we’d be amiss in ignoring the research showing a near majority of younger women preferring a female gynecologist. Some call this reverse discrimination in gynecology.  I’d more simply call it patient preference. The bigger question is, “Where does this leave the male gynecologist?”, especially in a current marketing climate promoting the “female only” OB/GYN …

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Increasing the role of nurse practitioners in the inpatient setting

Physician
April 12, 2013

We are fortunate in our country to have the best medical technology in the world. Unfortunately, delivery of this technology, reflected in a worldwide healthcare ranking of 37th, is a disservice to the American people and must be rectified especially when Cuba is ranked 39th.

As provisions of the Affordable Care Act are put in place, a daunting factor is the shortage of doctors who will be needed to provide this …

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Beauty in surgery: Traction and counter-traction

Physician
April 11, 2013

Next in a continuing series.

Traction and counter-traction: along with maintaining excellent exposure, that is one of the fundamental principles of operating. It’s Newtonian: equal and opposite. In nearly all forms of surgical dissection, there’s a need for some pull in the opposing direction: tissues that are a little stretched-out, that are under some tension, fall open more easily when dissected. Plus, it’s a form of stabilization, another obligatory …

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A memorable introduction to the family

Physician
April 10, 2013

Although I rarely get sick with the numerous strains of “bugs” that seem to go around our community this time of year, the week prior to my return to work for my next scheduled string of four shifts was spent mainly in bed, coughing and aching and whining about how miserable I felt. Fully recovered, though, I was excited to return to the emergency department to do my fair share …

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The real reason to be cautious about Z-Paks and azithromycin

Meds
April 10, 2013

The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide.

What’s the hubbub about?

Azithromycin is in a family of antibiotics called macrolides, which also includes erythromycin and clarithromycin (Biaxin). Erythromycin and clarithromycin have long been known to very rarely cause fatal abnormal heart rhythms. It …

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