How to raise a doctor
An excerpt from 
I know what you’re thinking, I thought this book was about how to raise a doctor, and now this guy is telling me not to raise a doctor! That’s exactly right. I’m telling you to not …
My first objective structured clinical examination
After a semester of studying and taking written exams, we had our first OSCE in medical school. An OSCE — or an objective structured clinical examination — is the real deal. Instead of filling out multiple choice boxes, we instead work with a real human being, which for me is a welcome change.
The actor is given a script with their unique condition and story — it’s a simulation of what …
My first objective structured clinical examination
6 things this physician learned after retiring
In February 2017, I saw my last patient and left clinical medicine. Most people would say I retired. I have chosen to say I have repurposed. I no longer see patients, but I still work. I am writing the Doctors Guide series of books, keeping up a blog and working with physicians who need help with a financial makeover, usually to eliminate their debt, set themselves up for retirement or …
6 things this physician learned after retiring
A medical intern’s 3 greatest fears
A 76-year-old gentleman with a history of kidney failure, myasthenia gravis and recently diagnosed with esophageal cancer presented for evaluation of melena and hypotension.
The patient was my first admission to the medicine team as an intern, and he was as near to an ICU admission without actually being admitted to the ICU as one could come. After examining the patient, I briefly staffed with the busy attending physician, placed the …
A medical intern’s 3 greatest fears
How physicians can start lazy side hustles
How do I start a side hustle?
I have heard this plea so often, It is no wonder there are many how to blog posts trying to answer this exact question. As helpful as they may be, most of the ideas espoused are both time and energy-consuming. For instance, starting a blog is great! But if you want to truly make money, be prepared to put in full-time hours. Or Read more…
How physicians can start lazy side hustles
An awkward encounter with a hypochondriac
A warning about examining your friend’s medical condition. Brad Nieder is a physician and comedian and can be reached at the Healthy Humorist.
An awkward encounter with a hypochondriac
Here’s what’s wrong with time-based billing in the hospital
Consider this hypothetical addendum to a hospital discharge summary:
”ADDENDUM @10:56 a.m: In considering the accurate billable discharge time involved in this case (as I have recently been instructed by hospital coders that I must record the exact time required for a patient discharge, rather than simply “greater than 30 minutes” or “less than 30 minutes”), I feel I have stumbled upon a troubling quandary, having failed to note the exact …
Here’s what’s wrong with time-based billing in the hospital
Independent practice: Nurse practitioners respond
Shortly after the publication of “Independent practice: Both nurse practitioners and physicians should be outraged,” the nurse practitioner (NP) leadership responded with a press release, denouncing the concerns that were cited, calling them “rhetoric.”
But in contrast to this criticism from the political end of the NP spectrum, I was inundated by emails from working NPs across the country in support …
Independent practice: Nurse practitioners respond
The human touch in medicine: good or bad?
Humans need human touch
Patients sometimes need a shoulder to cry on. When I say that, I normally mean it on a completely figurative level.
However, at times, it needs to be interpreted differently. There are instances in a medical encounter where an actual shoulder could be of service — a physical crutch that takes off an emotional load — and that’s when the popular adage can be beneficially carried out in …
The human touch in medicine: good or bad?
The fall of the digital rectal exam
For almost 20 years, the value of the digital rectal exam (DRE), a long time staple of the complete examination of the trauma patient, has been questioned. Performing a rectal examination on all trauma patients is no longer advocated except for a few specific indications.
As recently as two months ago, trauma surgeon Michael McGonigal blogging at the Trauma Pro reinforced the message. Because a rectal examination is so uncomfortable …
The fall of the digital rectal exam
Sexual assault in the emergency department: What can you do?
It has been documented that 1 in 3 women will experience rape in her lifetime, and this is most common in women under the age of 25. Over 95 percent of victims of sexual assault are women worldwide, while in North America estimates place that at 85 percent. These are the assaults we know about — generous estimates say that, at most, 10 percent of rapes are reported to police …
Sexual assault in the emergency department: What can you do?
Reflections on school violence: a psychodynamic perspective
The mental health community must increase its clinical acumen regarding complex psycho-pathology consisting of the avoidant personality, social impotence, and related rage. School violence has taken on epidemic proportions since two disturbed adolescents masterminded Columbine and became role models for the mentally ill young men who drive the new culture of school shootings.
While the profile of the school shooter has evolved over the last couple of decades, it’s worth considering …
Reflections on school violence: a psychodynamic perspective
Emergency physicians are glorified secretaries with medical degrees
We had a pretty busy shop when I was in residency. So busy, in fact, that we had three secretaries working simultaneously — one for paging, one for order entry, and one for admissions. I haven’t been back there in a long time, but I hope the secretarial staff has grown commensurately with the volume and acuity of the ED. But from what I’ve seen around the country in my …
Emergency physicians are glorified secretaries with medical degrees
11 physician finance lessons from The Greatest Showman
I love movies. Not the artsy types that win awards; I most enjoy the big, expensive popcorn blockbusters that take you away to a different time and place. However, as our income and wealth has grown, we’ve maintained a few of our “cheapskate” habits from when we were poor. One of these is we see almost all of our movies at the “dollar theater,” a second-run theater where the entire …
11 physician finance lessons from The Greatest Showman
America leads the world in high tech care and health care costs
Why is U.S. health care so costly compared to other developed countries? A recently published report provides some insights.
In a study of 11 countries, Harvard researchers found that while the United States has the highest health costs relative to its GDP, its use of services is average. More specifically, the U.S. ranks lower than nearly every other country in doctors’ visits, hospitalizations, hospital days, and consultative services.
The difference is …
America leads the world in high tech care and health care costs
Push back on toxic behaviors from other doctors
“Don’t get tired! Don’t f*cking move! Don’t you f*cking move, or I’ll f*cking die!”
That’s an excerpt from an OR in St. Louis on March 12th. This is just one of the outbursts that was reported from a single, multi-hour surgery — an attending’s toxic mandate to her resident, who was poised in a precarious situation under the drapes. The rest of the OR staff caught plenty of its own abusive …
Push back on toxic behaviors from other doctors
Physicians and medical students: Unlearn helplessness
Learned helplessness. It’s a psychological concept marked by a perceived loss of power, and it’s prevalent in medicine. We are taught early on how little we are in this colossal world. We are told what to do, when to do it, and what we will get for it. Our objections go unheard or—worse—ignored.
Let me quote a paragraph from The Paradox of Choice by Barry Schwartz:
They were conducting a series of experiments on basic …
Physicians and medical students: Unlearn helplessness
Do whatever it takes to have fun and spend time with your family before it is too late
Recently I had three important events happen during a three day period that reminded me of the brevity of our life and the need to live life to the fullest every day.
On July 4th, having planned celebratory events that day with friends and family, a CRNA in my home town awoke feeling poorly just before sun up. He was in great health the day before and lived a very active …
Do whatever it takes to have fun and spend time with your family before it is too late
Financial independence: the story of the 3 brothers
There was once three brothers who set off on the journey of a lifetime by embarking on three separate roads. Each brother was uniquely different, and quickly these roads diverged.
It was believed that the eldest brother was most wise because his path was clear and straight.
The middle brother was a strong walker but easily distracted. It was hard to keep him concentrated on the task at hand.
And finally, the youngest …
Financial independence: the story of the 3 brothers
How physicians dress matters. Here’s why.
Anybody who has ever been to Europe, knows that fashion trends and the way people dress are very different from the United States, and generally more formal and fashion conscious (not to make a generalization — but it’s true). Growing up in England, every school has a uniform from an early age. (There are pictures of me wearing a tiny little shirt, tie, blazer, and hat to preschool when I …
How physicians dress matters. Here’s why.
Past Week
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Rethinking the role of family physicians vs. specialists
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A humorous parody of medical specialties and the modern patient
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Administrative burden is driving severe physician burnout
-
Pharmacy closures threaten our entire public health system
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Clinicians are failing at value-based care because no one taught them the system [PODCAST]
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How an international medical graduate fought workplace retaliation
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Past 6 Months
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The controversy over Maintenance of Certification for grandfathered physicians
-
Why clinicians fail at writing expert reports
-
Rethinking the role of family physicians vs. specialists
-
How hindsight bias distorts clinical medicine
-
The cost of time constraints in primary care: Why doctors feel rushed
-
Health insurance incentives and alternatives to opioids for chronic pain
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Recent Posts
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Clinicians are failing at value-based care because no one taught them the system [PODCAST]
-
Why listening is the core of patient-centered care
-
What to expect at your first gynecologic visit
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Why relationship-centered care matters in medicine
-
The quiet hospital financial crisis threatening health care
-
Why I would never compromise on withdrawing care until I saw it firsthand [PODCAST]
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Past Week
-
Rethinking the role of family physicians vs. specialists
-
A humorous parody of medical specialties and the modern patient
-
Administrative burden is driving severe physician burnout
-
Pharmacy closures threaten our entire public health system
-
Clinicians are failing at value-based care because no one taught them the system [PODCAST]
-
How an international medical graduate fought workplace retaliation
-
Past 6 Months
-
The controversy over Maintenance of Certification for grandfathered physicians
-
Why clinicians fail at writing expert reports
-
Rethinking the role of family physicians vs. specialists
-
How hindsight bias distorts clinical medicine
-
The cost of time constraints in primary care: Why doctors feel rushed
-
Health insurance incentives and alternatives to opioids for chronic pain
-
Recent Posts
-
Clinicians are failing at value-based care because no one taught them the system [PODCAST]
-
Why listening is the core of patient-centered care
-
What to expect at your first gynecologic visit
-
Why relationship-centered care matters in medicine
-
The quiet hospital financial crisis threatening health care
-
Why I would never compromise on withdrawing care until I saw it firsthand [PODCAST]
-
