It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry …
Am I the cold and detached physician?
Where I practice, the process of referring a patient suffering a mental illness is quite infuriating. The wait to get in to see a psychiatrist or psychologist can be months all the while patients are suffering. Worse yet, with certain insurances, there are just no mental health providers available for any of their covered patients. The failure of treating mental health disease in the U.S. is glaring.
In the U.S., approximately …
The U.S. is failing at mental health care
1. You sleep when you can. Despite what medical television dramas portray, call room beds are for sleeping. Period. As you curl up into the bed you have no idea whether you are about to get a couple hours of sleep or a couple of minutes, but in that moment of sheer exhaustion, the drab hospital cot or bunk suddenly transforms into a luxurious sleeping pad. Bonus if you can …
After a semester of medical school, I returned home to the Antelope Valley in California, an area CNN coined, “health care’s nowhere land” because of low health insurance rates and limited provider networks that force residents to travel far for care. I wanted to help my family and neighbors by using the physical exam skills I learned during my first few months as a medical student, but …
Identifying social determinants of health is critical to the patient interview
It seems like everywhere I look these days people are talking about passive income streams: why you should start them, which ones you could start, how they can change your life, and how much money you can make from them.
Doctors commonly look for ways to create passive income as a way of being able to work less while still maintaining the lifestyle they want or honestly to quit …
5 reasons why you can’t start passive income streams
Actual conversation heard in the hallway outside an exam room earlier this week:
Doctor: “So, we’re going try this medicine for your blood pressure; you keep checking it at home as we discussed. If the numbers remain high, we can increase the dose or add another medicine.”
Patient: “Well, what do we do if the pressure stays high; if this medicine doesn’t work?”
My partner told me later that she had explained the …
A better way to follow-up your office visit is needed
I am a first-year medical student, and just like some of you once did, the primary reason I am becoming a physician is to really make a difference for my patients by [insert x, y or z].
“Wow, that’s really great, but we’ll see how you feel about it in a few years.”
“That’s not how it works once you’re actually out there.”
“Trust me, medicine isn’t what it used to be, get …
Being idealistic is a necessary component in achieving your goals
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old man is evaluated for symptoms of dysphagia that began 2 weeks ago. When he eats, he starts coughing after the first bite of food and occasionally has nasal regurgitation.
On physical examination, blood pressure is 135/90 mm Hg, pulse rate is 78/min, and respiration rate is 12/min. Left-sided weakness is noted in both extremities, …
MKSAP: 78-year-old man with symptoms of dysphagia
Nothing troubles physicians more than an unforeseen outcome and a malpractice lawsuit. It cracks open self-doubts and assumptions about medicine and may be life-changing.
It commonly fuels burnout, loss of confidence, PTSD and early retirement. And there are links to depression and physician suicide.
There’s another side to this story, though. Like all of life’s great challenges, a patient’s unexpected loss, and professional litigation present us with huge opportunities for growth.
I am …
5 ways to live through medical malpractice lawsuits
It’s that time of year again. Over 30,000 medical residents are about to finish their training and start their first job. Many of them will make some big financial mistakes during their first year that will haunt them for years to come.
One of the biggest errors many doctors make is to buy a house right after they leave residency. Society gives us a big push to own a house, after …
New doctors shouldn’t buy houses
I made the decision to get an MD/MBA when I was still in high school. I had an interest in medicine but hated the idea of being yet another Indian doctor. How unoriginal. So when my dad introduced me to someone who had done this dual degree, it was my “aha!” moment. As far as I knew, this was something different. It could set me apart, and no one else …
Why this physician has an MD and an MBA
Seeing patients in my OB/GYN office this morning, I try to stave off the mild nervousness rumbling inside of me. My good friend Monica is having a C-section this afternoon, and I’m performing it.
We met ten years ago when I walked my three-year-old daughter into Monica’s preschool classroom for the first time. Monica sat on the floor, a child in her lap and others playing around her. Like them, I …
My patient, my friend: a sometimes stressful relationship
While infertility may be a problem affecting nearly 7.3 million women in the United States between the ages of 15-44, it is a topic that women often don’t discuss. Rather, they suffer from the emotional pain that accompanies hormone injections, multiple procedures, and sometimes miscarriage. How is it best to treat this vulnerable population that rarely gets the attention it deserves? The answer lies in a team approach to medicine.
According …
The mental health implications of infertility
What is borderline personality disorder (BPD)? According to the National Institute of Mental Health, unstable moods; impulsive and reckless behavior, and unstable or volatile relationships may be indicative of BPD. People with BPD often have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides. They often make poor life choices and take unwise risks. Thus, adults with …
Borderline personality disorder in medical practice
Having worked at both community hospitals and major medical centers, the issue of ultrasound in pregnancy has revealed itself to be more complex over the years. As a resident, I worked with an obstetrics office that only scanned their own patients who had private insurance and would send uninsured or Medicaid patients (often with a high risk of inadequate prenatal care) to the hospital late in the day to be …
The questionable ethics of ultrasound in pregnancy
Well done! Strong work! You’ve done it!
Four years (often more) of perspiration have earned you two extra letters (often more) in your name. You should be proud. Nothing should get between you and a gigantic glass of bubbly today. The world feels different. You feel different. But are you?
The thing about ceremonies that feature costumes, protocols and rituals is that they confer upon participants a sense of change. Just look …
What you need to hear at your medical school graduation
Cyberbullying is a major and growing public health problem associated with increased risk of greater psychiatric morbidity and mortality among children and adolescents. Its prevalence, varieties, associations with other forms of maltreatment, risk factors and deleterious effects in different populations are poorly understood.
Furthermore, effective, evidence-based approaches to screening and prevention in different populations are lacking. Developing such approaches is challenged by the rapidity and unpredictability with which electronic social media …
Cyberbullying and mental illness in kids
Leaving the nursing profession is bittersweet. My heart left nursing a while ago when I came to the realization that nursing left me first. It never was a two-way relationship. The profession left me without acknowledgment of work-related stress, specifically post-traumatic stress (PTS).
First responders and emergency workers often hear the phrase, “It’s just part of the job.” So we all just deal with it — or not. I’ve heard this …
On my morning commute as I read this NPR article, memories started flooding my brain. I could not control myself and had to write this.
My last name “Theetha Kariyanna” has its origin from a small village Theetha and added to it is my dad’s name Kariyanna (a local folk god). Back in my school days, the name was weird to my friends as the name …
The caste system is thriving in medicine in the U.S.
We hear all the time that maternity leave in the U.S. is in shambles. Let’s clarify: There’s no such thing as guaranteed maternity leave. Some companies are obligated to give some leave to some employees — that’s as good as it gets. No companies are obligated to give paid leave.
Medical training adds complexity to parental leave. Residents and fellows are expected to be deferential, the lowest on the totem pole …
Pregnant and in medical training? Here’s how to do it.
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