When it comes to the review of systems, I’ve been a natural, a savant — a prodigy you might say.
During my first few weeks of medical school, I remember doing mock interviews with fake patients. This was long before I learned anything about “HPI,” “ROS,” physical exams, billing or anything medically relevant for that matter. As other students stuttered, trying to figure out what to ask a lady pretending to …
Let’s get rid of the review of systems
“OK, it is time to move on,” my professor claps his hands together and yells above the chatter. We all look up from our Netter’s anatomy books and our cadavers. The smell of formaldehyde burns my nose as the fluorescent lights flicker above.
“We have explored the chest cavity and the abdominal cavity. It is now time to move onto the extremities, starting with the arms. I want you to unwrap …
The hands tell us the most about a cadaver
“I like good strong words that mean something.”
– Louisa May Alcott
My resident and I are removing a large, recurrent cancer from the neck. Dense scar tissue is everywhere from prior surgery and radiation therapy. The going is slow. Each move is arduous, and bleeding obscures the view of the anatomy.
“Watch out,” I tell her. “The jugular vein is nearby, probably buried in that scar.”
“Yeah,” she responds. “Look at this nerve! …
What surgeons do is a violent act
During a recent internal medicine rotation, a senior resident expressed disappointment that I’ve chosen a career in family medicine. He was concerned that my talents would be wasted, because — in his words — I wouldn’t get to care for the “more complex patients” he sees in internal medicine. Although I appreciated his confidence in my abilities, I felt my heart sink, as it does each time I am faced …
No, I’m not settling for family medicine
While Muzak plays (think Kenny G covering John Mayer) and courteous expressions like “excuse me” and “thank you” are exchanged in hospital waiting rooms, behind the front desk, angry patients are firing curse words into the hallway like their mouths are assault rifles with an endless supply of ammunition. Nurses are being cussed out by patients who sound like characters in “Platoon.” And medical professionals are dropping f-bombs. All of …
Why medical professionals have potty mouths
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old man is evaluated for recurrent nephrolithiasis. Medical history is significant for Crohn disease complicated by multiple small bowel strictures requiring resection. He began developing kidney stones 3 years ago following his last bowel surgery. Analysis of the stones has consistently shown calcium oxalate, and he has been adherent to a …
MKSAP: 28-year-old man is evaluated for recurrent nephrolithiasis
A good relationship between a patient and his or her physician is the cornerstone of superb medical care. That relationship is important when you know the doctor well. It may be even more important when you don’t, say when you are in the hospital.
Growing competition for new customers is inspiring American hospitals to focus on providing …
8 traits of excellent hospital doctors
Physicians and patients are fighting a growing hypocrisy in American medicine. Examples abound, such as criticism that doctors are overprescribing antibiotics and contributing to resistance, while insurance companies simultaneously incentivize their members to use telemedicine programs or urgent cares instead of visiting their primary care physician.
My own insurance company, Cigna, recently sent me a letter notifying me that I will have a reduced co-pay if I …
This is the hypocrisy of American health care
Doctors and nurses like facts. After all, we’re evidence-based thinkers — rational scientists. Yet, we can be surprisingly superstitious.
Many of us believe in a thing called “call karma,” which is when certain doctors attract sick patients while working on call (these people are said to have bad call karma). Other doctors attract less sick patients, meaning they have good call karma.
As a medical student, I quickly learned that I fell …
It’s bad luck to say that in a hospital
One of the most challenging and difficult parts of my professional day is trying to determine if my patients are actually taking their as prescribed.
I ask my patients to bring their medications to each visit in the original pill bottles, and we count pills. I ask them to bring their medication lists as well, and we go through the time-consuming practice of reviewing each medication against the prescribing date and …
The elderly need hired professionals to administer their medications
It is not something that is taught enough in medical school, but practicing physicians quickly realize that in this business: Communication is everything. The reality of health care is that you can be the worst physician in the world clinically (not that it’s something desirable to be), display great interpersonal skills, communicating well with your patients — and they will do absolutely anything you say and put you up on …
3 communication mistakes doctors make. And how to fix them.
Recently, a nurse at Children’s Hospital Los Angeles noticed that comedian Jimmy Kimmel’s newborn baby had a murmur and was cyanotic and brought it to the newborn intensive care unit for further evaluation. That triggered a rush of activity that led to a diagnosis of a congenital heart defect and heart valve problem and surgery to save the baby’s life.
Here’s what the public doesn’t understand: Nurses do this every day. …
An ode to the nurse who saved Jimmy Kimmel’s baby
“How long have you had the bleeding?”
“About seven years,” my patient replies stoically.
Ange’s angular face no longer retains the beauty of her youth. The sharp lines around her mouth speak of a long life packed into a brief 42 years. She is well dressed, but her manner of speaking betrays the poverty in which she exists.
Ange has advanced cervical cancer — a completely preventable disease. In fact, cervical cancer can …
What’s the difference between health care in the U.S. and Haiti? Not much.
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I’ve seen a lot of social media posts or comment threads that say we don’t have any studies to prove that the CDC’s vaccine schedule is safe or effective.|
As a pediatrician, the first time I read that, I was surprised. But now, I think I know what they mean.
I think they mean that we haven’t done the best study. Those of us in the scientific and medical fields frequently demand …
The vaccine study you’ll never see
For many physicians, the term “compassion fatigue” may imply, as the words describe, that fatigue leads to the loss of ability to feel compassion for others.
After all, what physician doesn’t have a day when s/he is too tired, running on too little reserve, and feeling some degree of emotional numbness?
Many physicians may not realize, however, that compassion fatigue can go much deeper. According to the Compassion …
5 things doctors should know about compassion fatigue
As a consultant in gynecologic pathology, I receive requests for second opinions from patients who have been diagnosed with endometrial hyperplasia. My opinion is based upon correlating the relevant clinical history with a review of the patient’s pathology slides and report. In my experience, there is a difference of opinion that leads to a change in treatment in about half of the cases. 75 percent of cases with changed diagnoses …
This gynecological issue is misdiagnosed over 50 percent of the time
I’ll be honest, when I first matriculated into medical school, I didn’t even know what a USMLE Step exam or clinical clerkship was. In fact, the first time I ever heard of them was from another applicant on the interview trail. I have always been a take-it-one-step-at-a-time type of person, but eventually, I would have to succumb to the pressure and ask upperclassmen about the exam. And what did they …
Should we standardize clerkship grades?
No matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it’s some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight.
That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali …
There she was, hanging in our closet
On my first trauma shift as a fourth-year medical student, a young, disheveled man with blood-soaked pants hobbled into the emergency department. Wincing in pain, he offered me a bizarre history of being shot in the leg by a nail gun that went off after he dropped it on some stairs while helping a friend move. He lifted his right pant leg and removed the bloody, tattered bandana wrapped around …
Doctors aren’t cops: We need to change gunshot reporting
There has been much talk over the years about resident work hours. How long is a safe shift? With safety being considered for both the patient and the resident. But no one ever discusses attending work hours. If putting in a 24-hour shift is bad for a resident, isn’t it bad for an attending as well? When I was working in critical access hospitals, I usually was on call for …
Other jobs have strict rules on hours worked. So should doctors.
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