The physician is the ultimate patient advocate

Physician
July 13, 2015

“Only one rule in medical ethics need concern you — that action on your part which best conserves the interests of your patient.”
– Dr. Martin H. Fischer, German-American Physician and Author

“A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”
– Principles of Medical Ethics, American Medical Association

“I pledge to pursue the practice of surgery with honesty and to place the welfare and the rights of …

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A quiet day in the doctor’s office: And that’s the way it’s supposed to be

Physician
July 10, 2015

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It’s been a very slow week in my office.  Today we almost pitched a no-hitter, having only one patient come in toward the end of the day.  Overall, we’ve been quiet in nearly every way: few phone calls, few patients stopping by, few appointments, few secure messages.

What’s wrong?

That was a trick question.  This is exactly what should be happening when things are going …

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A neurosurgery case that this medical student won’t forget

Education
July 10, 2015

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After the last elective case of the day, the neurosurgeon I was shadowing told me that he was on overnight call that evening, and that I could stick around to observe more surgeries if I wanted to. “Yes,” I responded. “Absolutely yes.”

My fascination with surgery stems from its ability to provide immediate results to a patient by cutting out, repairing, reshaping, or …

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10 thoughts on the transition to a third-year med student

Education
July 10, 2015

The transition between the basic science years and the clinical years in medical school are jarring, mystifying, exhilarating and thought-provoking. Recently, I did an hour conference with approximately 30 medical students. About half started their clinical year five weeks ago, while the remainder have only three weeks left before they finish the year. They gave me permission to share our discussion. We focused on their (and my) observations about the …

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There are only 3 ways to allocate health care resources

Policy
July 8, 2015

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Manny Alvarez is a 23-year-old college student with the misfortune of having not just a devastating cancer — but the wrong devastating cancer. The chemotherapeutic agents shown to be highly active against his specific tumor cells are FDA approved for the treatment of leukemia, but not for the stunningly rare kind of sarcoma with which Manny has been diagnosed. Nothing is …

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Poker face: The complex psychology of the patient-doctor interaction

Physician
July 6, 2015

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Patient-doctor communication often has many facets, wrinkles, and twists.  Medical school prepares a doctor minimally for the ups and downs of these patient interactions.  There is no mannequin who can train each medical student how to deal with every personality, response, or even outburst by each patient.  On the job training is sine qua non.

During and after medical school, it took …

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There is no shame in honest work, no matter what the job description is

Physician
July 6, 2015

When my sister, Jessica, was a nurse anesthetist student at the University of New England, she had the opportunity to rotate at Johns Hopkins, and she seized it. She was young and fairly new to the medical world and so she did not recognize at first the name of the neurosurgeon with whom she would be working — Dr. Ben Carson. After receiving multiple comments from numerous people about how great it …

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An inappropriate use of medical jargon: Words do matter to patients

Physician
July 6, 2015

My patient had suffered a terrible, crushing injury to his chest leaving many ribs and his sternum fractured, his lungs and heart badly bruised and his body on the edge between life and death. He was on a ventilator, the tube through his mouth into his windpipe pushed air into lungs that couldn’t draw for themselves. He was on constant medications for pain and to sedate him while we used …

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Mad Libs for medicine. Do you think you can use these?

Physician
July 5, 2015

Do you remember Mad Libs from when you were a child? A story is filled with blanks, and as you fill them in with inappropriate and ridiculous words, you laugh until you can’t see straight. You laugh until you can’t breathe, and your parents beg you to stop! Let’s be children again. Share these with the nurses, and give the shift a little levity.

Pain medication. You see, doctor, my pain specialist …

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A physician enters rehab. What happens next should disturb you.

Physician
July 4, 2015

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I’m a physician, and I’m adrift. I am pretty much lost at sea. I’ve often thought of writing this column, but afraid I’d be recognized, I’ve hesitated for years. Even now, I’ll most likely remain anonymous, because I’m in a vulnerable position. Let me preface my remarks with the reassurance that I’m not a bad person.

I developed dependence on opioids several …

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The darker side of being a doctor

Physician
July 2, 2015

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I recently read an article written by a human physician about her personal feelings and other people’s reactions to her decision to quit practicing medicine.

The author frames the article around how her choice was made after she recognized how detrimental her career was to her own health. The irony of a doctor abandoning her profession because it was causing …

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Can a surgeon operate while sitting down?

Physician
June 30, 2015

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A loyal reader alerted me to news of a lawsuit brought by an obstetrician in South Carolina who is suing a hospital for suspending his privileges. He had performed a cesarean section while sitting on a stool because he had a foot fracture secondary to diabetes. Several witnesses said that the doctor “had been unable to properly view the surgical field, …

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A psychiatrist is burnt out and depressed. Here’s what she did about it.

Physician
June 30, 2015

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I noticed that my writing and conversations with others convey far less emotion than usual.  My reserve for tolerating stress had reached maximum capacity, which I realized upon my first day back at work from vacation three weeks ago as exhaustion immediately erased any sense of relaxation from my trip.  Perhaps I should have requested two weeks off instead of one?  Either way, …

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The best places for a doctor to practice: It’s more than money

Physician
June 30, 2015

I would think that when physicians decide where to set up practice, there are things that they would want to think about other than how much money they’ll make.  Yet if one reads Medscape’s current list of the best and worst places to practice, it would appear that money trumps everything else (although Medscape said it also considered factors like “cultural attractions”). What Medscape apparently did not consider …

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Indian radiologists have more to worry about than teleradiology

Physician
June 29, 2015

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Teleradiology has the same effect on radiologists as Lord Voldemort has on Muggles. It’s the feared end point of the commoditization of imaging, with Rajeev in Bangalore outpricing Rajeev in Chicago for reading follow-up CTs for lung nodules.

But despite the fears of U.S. radiologists, their counterparts in India have more pressing things on their mind.

“U.S. radiologists think that Indian radiologists are …

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Idioms and axioms provide a glimpse into medical culture

Physician
June 28, 2015

Idioms are expressions everyone understands as something other than what the literal words say.  For example, when I talk about “putting all of my eggs in one basket,” everyone knows I’m not really talking about eggs.

We say things like:

It’s raining cats and dogs.

It was a piece of cake!

I heard it straight from the horse’s mouth.

We have a few idioms in medicine, too.  If I talk about “hanging crepe” in a …

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A letter to parents hesitant about vaccines

Conditions
June 28, 2015

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Below is a letter I have written to parents who are hesitant about giving vaccinations to their children.  I don’t know how many it will convince, but I needed a respectful and informative way to follow up with parents who expressed concerns or declined vaccinations, and this is what I now share with them after such visits.  This is written not …

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