5 essential concepts to know about code status

Conditions
April 3, 2013

Full Code.  Do not resuscitate.  Do not intubate.

Ask anyone without a personal or family history of a hospitalization on the implication of these terms and you’d likely get a blank stare in response.

Unfortunately, this incomprehension often rings true with those who need to know it most: the hospitalized patients themselves.

Many clinical reports (see here and here) have demonstrated that most physicians are not only inadequate in discussing code status with …

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Writing your medical school personal statement: Tips and myths

Education
April 2, 2013

“I have no idea what to write.”

“I want to stand out.”

“I want to be different.”

“I want to have a theme.”

These are all comments I hear from medical school applicants as they start thinking about what topics to include in their medical school personal statement. I find that applicants often feel pressured to be unique and to write something the medical school admissions officer has never read before. But if you …

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Questions to ask when considering new medical technology

Tech
April 2, 2013

“Hey doctor, what do you think about this product/solution/service?”

These days, I look at a lot of websites describing some kind of product or solution related to the healthcare of older adults. Sometimes it’s because I have a clinical problem I’m trying to solve. (Can any of these sleep gadgets provide data — sleep latency, nighttime awakenings, total sleep time — on my elderly patient’s sleep complaints?)

In other cases, it’s because …

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Are physicians more afraid of death than the general population?

Physician
April 1, 2013

The cavernous hospital amphitheater in Tel Aviv, normally used to screen videos and new surgical procedures, was illuminated only by tea candles floating in decorative dishes of water on a recent Wednesday in January. Hundreds of doctors, nurses and other medical personnel filled the seats, as usual. But we had not come to learn the latest life-saving technique.

Dr. Ofira Ben-Tal, one of Israel’s leading hematologists, had lost her battle with …

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Am I smart enough for family medicine?

Education
April 1, 2013

I’m not sure why my parents were surprised when I told them that I was applying to go into family medicine. It seemed like a logical transition after spending six years working in public health and primary care before medical school, but from the perspective of Taiwanese immigrant parents, I couldn’t have made a more absurd career choice. I was confronted with comments such as, “Most people choose careers to make …

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Clinical pearls that you don’t learn during medical training

Physician
March 29, 2013

Al Franken, the humorist-turned-senator, once published a book that was titled “Oh, the Things I Know!” Indeed, by the time we reach parenthood, it is truly amazing what we keep up there in that attic of a brain.

Here is a brief selection of things about the practice of medicine that I have had to discover for myself or never quite figured out, including clinical pearls, aphorisms, dictums, platitudes, mysteries and …

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Where can doctors publish literary writing?

Physician
March 29, 2013

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There are many ways to write about health, medicine, and health care. And there are many people – patients, caregivers, policymakers, pundits, thought leaders, and health professionals – in a position to do so.

Fortunately, the world also offers a similar and growing diversity of places in which to publish this sort of work.

My focus today is more, well, literary.

I know the word “literary” often …

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Why coroners should fill out death certificates

Physician
March 27, 2013

I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they are being “burdened” with hundreds of extra cases every year that they must handle. And if other doctors don’t sign off on the cause of death, sometimes it takes two …

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How can you tell if adjuvant chemotherapy works?

Conditions
March 25, 2013

Think you know something about oncology?  Ok then, pop quiz: If you are giving chemotherapy to a patient who does not have cancer, how can you tell if it works?  Ridiculous question?  Not at all.  The answer to that question is; “hopefully, we will never know,” and it is at the core of modern cancer care.

In the 1960s, breast cancer surgeons had a serious problem.  They were doing large complex …

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8 reasons why your practice needs to stay open during lunch

Physician
March 24, 2013

Most professional business enterprises nationwide understand that they could never expect to compete in the marketplace if they shut down their phones 20 – 25% of important business hours every day. Yet that is exactly what your medical practice is doing if you are shutting your phones down for a “lunch break”.

You might be wondering how important can this really be for a medical practice? Can’t patients just wait an …

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Measuring quality: What doctors and teachers have in common

Policy
March 21, 2013

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I was watching Jon Stewart recently, and he had Michelle Rhee on.  For anyone who doesn’t know her, she’s the superintendent of schools in Washington D.C. who made a bunch of reforms that caused some controversy and resulted in her being one of the main spokespersons for education reform in this country.  Her conversation with Jon made me realize the similarities between …

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Medical malpractice stress syndrome: The ignored side of litigation

Physician
March 21, 2013

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In March 2008, prominent Denver business owner Leslie Fishbein suffered cardiac arrest and died after receiving trigger point injections with bupivacaine for chronic neck pain.  Ms. Fishbein owned a chain of high-end furniture stores.  She was well known within the community because of her starring role in television commercials promoting her business.  Her death drew tremendous media attention and heavy scrutiny for …

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I’m a part time physician, and I’m not sorry

Physician
March 20, 2013

I began the medical school application process 10 years ago.  I was 23, single and most of my role models worked full time.  I had no idea that a part-time medical career lay in my future.  Quite a bit has changed since the days of hoping and praying and crossing my fingers for a medical school acceptance letter.   In the past 10 years I have, at varying times, declared …

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Questions to ask before your CT scan

Physician
March 18, 2013

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The United States is higher in its use of computed tomography (CT) scans than any other industrialized country. There were about 3 million scans done in the U.S. in 1980. By 2007 that number had risen to 70 million. A number of articles published in medical journals over the past few years have reported that excess radiation delivered by these scans will …

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Violence and severe mental illness: 6 questions to ask

Physician
March 17, 2013

Recently one of our readers posted this comment:

“If any Shrink Rapper ever has the time and inclination it would be interesting to read about what you would do to fix the mental health system, particularly the issue of involuntary hospitalization, if you had unlimited funds and political resources. You’ve been in the trenches, it would be great to hear your thoughts.”

Over on Peter Earley’s blog I see that …

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How to avoid becoming a gunner in medical school

Education
March 15, 2013

gunner: a pre-med or medical student who is ambitious to a fault. They often throw other students under the bus, put their accomplishments and grades on display, and generally make life miserable for any student who they perceive to be a threat to their own success. In short, they are what Hermione would be if she was a Slytherin.

On my blog, I am fairly vocal about my disdain for gunners. They …

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Doctors: Pronounce the names of your patients correctly

Physician
March 13, 2013

I have it on good authority that it’s not easy being green. But I’m willing to wager that it’s a whole lot easier when you have a lovable name like “Kermit.” Imagine being green (or brown) with a name like “Ramachandran”? Growing up with a name like mine certainly had its disadvantages. While most neighborhoods have a local bully who kicks ass and takes names, in my case, he would …

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