Should patients order their own lab tests?

Physician
February 16, 2017

Knowledge is power. Increasingly, patients are demanding and receiving access to levers in the medical machine that would have been unthinkable a generation ago. The informed consent process, which I support, can overwhelm ordinary patients and families with conflicting and bewildering options.

Television and the airwaves routinely advertise prescription drugs directly to the public. Consider the strategy of direct-to-consumer drug marketing when millions of dollars are spent advertising a drug that …

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Patients are unique with individual needs. That is the art of medicine.

Physician
February 15, 2017

On a busy day in the office, a patient was added to my schedule for “bleeding, early pregnancy.” She was one of my partner’s patients, but he was not in the office that day. We talked for a minute, then I examined her and did an ultrasound. As I expected, she was in the process of a miscarriage. Unfortunately, I, who wasn’t her regular doctor, had to give her this …

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The blame game: It’s not alright to blame the patient

Physician
February 14, 2017

Most of the lawsuits I deal with have more than one named defendant. For example, the plaintiff (typically a deceased patient’s next of kin) might sue a hospital, a nursing home, and the attending physician at each facility. Sometimes they go a bit further and may even include the administrator, the director of nursing, and individual HCPs, such as the wound care nurse or the registered dietitian nutritionist.

When a lawsuit …

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4 reasons why being a doctor is worth it

Physician
February 14, 2017

2016 closed around a continued effort to “salvage” the medical profession’s reputation, but the notion that it’s broken continues to be counterproductive.

The brightest students, for example, question the long journey and delayed gratification being a physician entails. They do the math and continue to engage in other professions that are medical but not specifically Medical Doctorate degrees or Doctor of Osteopathic degrees. These same students conclude there is no longer …

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Words of wisdom for new nurses

Education
February 13, 2017

Welcome to the land of happiness, sadness, confusion, self-doubt, defeat and heroism. You have only just begun. This is not an easy job. And countless times you will say, “What was I thinking?” Or “Why did I do this?”

But it’s not really a job. It is a lifelong sentence. It can be insanely gratifying, or you can throw in the towel.

But be patient. It will consume you, and you will …

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The Physician’s Bill of Rights

Physician
February 10, 2017

I love teaching my children about history, and in the process, I often see a clearer perspective of events I learned about at a young age when I had less life experience under my belt.

As I have been revisiting the evolution of our country, the formation and restructuring of our society, and the emergence of periods of oppression, rebellion, and social change, I have been struck by the concept that …

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Are you asking students questions or “pimping?”

Education
February 10, 2017

One of the most respected and skilled clinician-educators — of course, he is an infectious diseases specialist — at our institute came into my office, sat down and immediately starting eating pretzels. “Let me know what you think about this,” he said between bites. He went on to recapitulate a recent interaction he had with the members of the internal medicine team (medical students, house staff and the attending physician) …

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How to navigate the language barrier with patients

Education
February 10, 2017

William Osler once said, “Listen to your patient; he is telling you the diagnosis.”  Anybody who practices medicine knows that is easier said than done. The ability to take a skillful history takes years to develop. There are many nuances in a medical history and physicians must know the right questions to ask. The next step is to avoid asking the wrong questions and the wrong wording of the right …

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This doctor is a pro-choice physician. Which means she promotes life.

Physician
February 9, 2017

To my friends who view abortion as a betrayal of their religious values: I want you to know that I love you for who you are and understand where you are coming from.

I grew up with many friends for whom the church was an important part of family and community. I was, perhaps unwittingly, towed along to vacation bible camp” at said friends’ churches and for several summers in high …

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Hospital color codes, and what they mean

Physician
February 9, 2017

Hospitals have lots of codes. The most famous one is Code Blue (medical emergency), but it turns out there are lots of color-based codes. This can be confusing, as the connection between the code colors and the situations they represent are usually tenuous at best. Today we explore all of the types of codes, and shed some light these arcane medical euphemisms.

Code Blue

What it sounds like it means: Aggressively-scented cologne from Armani.

What it actually means: …

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Should we stop burping babies?

Conditions
February 7, 2017

One evening this past week, after my wife finished feeding our 5-week-old daughter, I took over baby duty. I sat her up on my lap and gave her a few thumps on the back. Not hard enough to hurt, obviously, but just to make her burp.

She didn’t burp. So I gave her a couple more gentle-but-firm whacks, still without a result.

And then I remembered the phone call I got a …

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Should we treat anti-vaxxers with more respect?

Physician
February 7, 2017

Years ago, when I was less flexible, I took up Pilates. My instructor, Jim, a charming chap with an infectious laughter, was a 9/11 truther. I’d egg him on to hear about his conspiracy theories. Jim believed that 9/11 was concocted by Bush and Halliburton so that the U.S. could invade Iraq to capture their oil. He thought that United Flight 93 never took off. Whatever happened after 9/11 became …

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How running marathons helped prepare me for medical training

Education
February 5, 2017

It’s not a sprint, it’s a marathon.

You often hear this analogy about the medical training process, but, having run a few marathons myself, I think it’s particularly apt. I’m working my way through my fourth and final year of residency now, and I can attest that running marathons was one of the better things that prepared me mentally for the challenges of med school and beyond.

26.2 miles is no trivial …

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The doctor fired for having cancer speaks up

Physician
February 3, 2017

I recently reported on Stephanie Waggel, the doctor fired by a prestigious U.S. hospital for getting cancer (story also the Washington Post). In a transcription of her whistleblower video, Stephanie describes how she nearly died due to obstruction of medical care:

It started during my intern year of residency. Which, bizarrely, was the happiest year of my life. And all my friends are …

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Have a mean patient? Don’t take it personally.

Physician
February 3, 2017

My brother-in-law, Ron, was a curmudgeon; grumpy, sullen, even downright mean at times.

By blood, he and my husband Bill were cousins. In the 1950s, when Bill was just a child, his mother died unexpectedly, and Ron’s mother took Bill in to live with her and her four children. They were an African-American family living in the midst of a middle-class, predominantly white Connecticut township. Their home, located on a wealthy …

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A physician’s first code. See how it turned out.

Physician
February 2, 2017

“CODE BLUE, 7 SOUTH. CODE BLUE, 7 SOUTH.” I’m up and out of my call room bed before fully regaining consciousness from my light sleep. It’s 4 AM. I should feel ready: I’ve trained with simulations labs, mock codes, and test questions. I passed my CPR and ACLS courses. I’ve done chest compressions as an intern. But this is different. I’m the resident on call, and if I get there first, I’ll be running the …

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A letter from doctors to our patients

Physician
February 1, 2017

Dear patients,

We are happy to have you in our lives.  We came into medicine to take care of you.  Some of us because we wanted to help you to win the fight against cancer.  Others of us because we love delivering your babies.   Others because we wanted to have the skill to make sure you survive that heart attack or that terrible accident.  Others because we wanted to do our …

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The curious case of a swollen scrotum

Conditions
February 1, 2017

It’s almost 7 p.m., and I’m handed the chart of a man in his sixties. “Can you see this one first,” the nurse says, “he needs an ultrasound.” I skim the triage note, which is often like reading the blurb at the back of the DVD. If it says “pain all over for eight months,” it’s not likely to be a hot new rental.

Frank Martin (name changed) has been sent from a walk-in …

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The story of a rare, serious complication of mononucleosis

Conditions
January 31, 2017

Thirteen years ago, I received a call from the mother of a college freshman who was concerned because her son had been diagnosed with mononucleosis during finals week.  She felt something was not quite right and asked me for advice.

“Trust your instinct, go get him, and bring him home.”

She brought him to my clinic the following day.  He looked mildly ill.  His vitals were stable; he was fatigued, slightly dehydrated, …

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Medicine is not destroying your marriage

Physician
January 29, 2017

Every medical couple knows that the lifestyle and career choice brings with it adjustments and sacrifices. Physician spouses and partners often take on more housework and childcare to accommodate long working hours. Physicians may work unusual hours that lead to late-night arrivals, missed bedtime tuck-ins, and less face-to-face time. This can lead many couples to blame medicine for their struggling relationship.

Take the example of a resident who has been working …

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