A guest column by the American College of Physicians, exclusive to KevinMD.com.
I recently saw a 35-year-old patient of mine who came into clinic requesting brain imaging. Although she had no specific symptoms, she had a friend who was diagnosed with a brain tumor several months ago and is concerned about the possibility that she …
The challenge of the worried well
As a boy growing up in a small town in Pennsylvania, I never gave much thought to the concept of a kiss. My family gave and received kisses without hesitation. I continue to give and receive kisses from my wife and kids in the same nonchalant manner.
Until one night — on shift.
I work in the ER of a medium-sized town in southern Oregon. It was late into my shift. The …
A kiss changed this doctor’s life
I am a physician in recovery and just celebrated my fifth-year anniversary on October 11, 2017.
While in active addiction, my drugs of choice were benzodiazepines and opioids that I washed down with top-shelf alcohol. Near the end of my usage, I was diverting scheduled drugs in order to feed my addiction. After an unsuccessful suicide attempt, I finally admitted myself for treatment.
As part of the treatment process, I enrolled with …
What’s the cost of being a doctor in recovery?
Early this month, Joanna Gaines, co-host of HGTV’s popular Fixer Upper, shared her pregnancy news with the world via a baby bump photo and an ultrasound, both posted to Instagram. The congratulations began pouring in from excited fans. But the conversation took a dark turn when a physician commented that the ultrasound appeared to …
An ultrasound posted on Instagram. Does a physician have a duty to warn?
Doctors are intelligent people, but are we good thinkers? And how should we think?
There are two basic kinds of thinking: analytic and intuitive. (And maybe good and bad, so that’s four.) Within medicine, analytic thinking can perhaps be best exemplified in the evidence-based movement, which began in the early 1990’s. It was a gilded age, full of promise, and bolstered by the reality that computers would give physicians instant access to the …
How doctors should think: Heuristic thinking isn’t heretical
We all know that life is unpredictable. In fact, the only thing that’s certain is that things will be uncertain. Despite this, or perhaps because of it, I think the majority of people are risk-averse. We’re concerned about future and its potential for unfortunate circumstances. If we weren’t, there would be no such thing as insurance–and there’s insurance for just about everything.
While it’s important to think optimistically, knowing you have …
Have you set up the safety nets in your life?
I work as a pediatrician in a bustling metropolis, in an outpatient setting of a world-renowned academic center. One of those non-profit hospitals you see in television ads. For the last three years, our outpatient encounters have plummeted, and the mothership has put all efforts into recuperating financial losses. Meanwhile, our office phones are ringing off the hook, and we cannot seem to hire enough nursing staff to deal with …
Dear Mom and Dad: Are you calling your pediatrician’s office too often?
The public’s apparently insatiable appetite for medical drama continues unabated as yet another prime-time TV show set in a hospital has hit our screens. FOX’s The Resident has generated discussion like no other. This may simply be due to the fact it’s the first major launch in the era of widespread social media, but it seems to have enraged a vast swathe of our ranks. Has The Resident crossed a …
In defense of FOX’s The Resident
In 2011, my first novel was published. It is a medical novel, and, unsurprisingly, since I practiced as a nephrologist for many years, it takes place in a dialysis unit. I learned a lot from writing this book, seeing it published and living with the consequences. Since its publication, many professionals have confided to me that they harbor a secret desire to write a book. I want to share my …
To aspiring physician-writers: It’s time to write that book!
For patients, being patient can be the most difficult part of receiving health care. For some, this ends in the waiting room, but others, unfortunately, anxiously await insurance approval, test results, surgery, transplants, and sometimes — even death.
However, in medicine, patients aren’t the only ones who need patience. It’s important that physicians learn to be patient as well; something that is much easier said than done for many type A …
Medical school admissions: Patience is a virtue
I’m usually a hugger. When I see people I haven’t seen for a while or want to acknowledge someone in an open-hearted way, I often will automatically reach for a hug. Physical acknowledgment is usually perceived as a sign of warmth. But not always. In the last few years, I have noticed that this automatic hug can actually cause harm or insult even though my intent is not to.
I learned …
Think twice before you give a hug
We physicians stand witness to countless tragedies in our careers.
At some point, as we stand by the bedside of a dying patient, comfort a heartbroken relative or officially call a death. We learn that love and loss, sorrow and joy are intertwined. They depend upon each other. They are two sides of the same coin. Dealing with loss after loss, we learn to look for the beauty in all of …
When we think of a brand, we usually think of companies such as Apple or Coca-Cola with their recognizable logos and colors. We may also think about celebrities, such as Beyoncé and the Kardashians, who have large-scale exposure and garner massive attention.
But, what is a brand? A brand is a particular identity or image that’s regarded as useful or valuable. And, a brand’s identity is how a business wants to …
7 tips for branding: What doctors need to know
I was taught anatomy and physiology by a pediatrician-turned-professor who found in academia an opportunity to meld his love of medicine with a propensity for the performing arts. His lectures were scripted and theatrical, and he gifted a generation of students with an awe and understanding of the human body that would serve as the foundation for hundreds of medical careers. Because he was a physician, ours was one of …
The story behind a cadaver: Fall down, get back up. Even after you’ve passed out
I watched the young woman across from me wrap the soft stretch of fabric around her face. She folded a part of it that hung close to her ears and loosened it slightly, put her fingers slowly under the fabric and experimented with how much room there was. Would a stethoscope earpiece fit through each side easily? She unwrapped it again. Repeated the same finger test.
She had chosen a light …
Change the experience: a Muslim medical student’s story
Money is great. It provides security, options, and freedom. If you work hard, practice relative deprivation, and save enough money to become financially independent, you will have reached a commendable milestone.
However, financial independence means nothing if you don’t have your health. It doesn’t matter that you have $5 million if you aren’t around to enjoy it, or if your health is so poor you can’t travel, start a business, teach a class …
Financial independence means nothing if you don’t have your health
This week I had some particularly emotionally tough cases at work, and it got me thinking about life in general and how, in spite of having a tough job, I have learned so much from it.
When I think of childhood diseases, there are the ones that are chronic, the ones that let you process that your baby is sick and has a potential life-threatening condition. You have weeks and months to …
What I learned from the ICU (other than medicine)
The final year of any residency is a time of accelerated independence, moonlighting, and an intense search for that first job as an attending. This decision is critical as one embarks on a life-long career in medicine, and it will undoubtedly blend a mix of analytics, emotion, and finance into the final analysis.
With a bit of candor, I want to share the mistakes I made when accepting my first contract …
5 mistakes this doctor made when negotiating his contract
There’s an interesting article in the Journal of Hospital Medicine on what to do when a patient wants to leave the hospital against medical advice. After reading and rereading it, I had to disagree with the conclusion, but it took me a bit to get there because the article, with its confusing use of terms, is a masterpiece of obfuscation. The most obvious example is the oxymoronic use of the term “AMA …
What to do when a patient wants to leave the hospital against medical advice
We’re going to address the most common question I see. Should you pay off debt or use your money to invest? Over and over again it is asked, always with slightly different details. 95% of the time, the answer is a simple “It depends.” So today, we’re going to talk about what it depends on. I’ve written about this topic before, but it has been six years. I …
Should physicians pay off debts or invest? Here’s a detailed answer.
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