Triage Note: Fish hook in eye. No bleeding. Tetanus up to date.
It’s a sunny weekend during cottage season. A young woman is rushed into the ER as she cups both hands over her left eye. She’s in shorts, and flip-flops, and she’s hyperventilating. Her friends follow, hands similarly cupped over their mouths. I read the triage note. I’ve never seen this before. I’ve removed dozens of fish hooks — it’s …
The case of a fish hook in the eye
How important is it for a doctor to want to be a doctor?
At first glance, that question is ludicrous. The path to becoming a practicing physician is so long and tortuous that no one would do it if they didn’t want to. Right? First, there’s the four years of undergraduate education, then four years of medical school, then at least three years of residency. No one has ever suggested that …
Why do doctors who hate being doctors still practice?
As a corrections physician I frequently heard the question, “How can you take care of those people?” I understood what they were asking, after all, I was caring for people convicted of such crimes as murder, rape and child abuse.
And yet I had very little difficulty providing the same care to inmates that I provided to everyone else. In fact, the corrections environment was generally easier to work in and …
What I learned as a corrections physician
Here it comes — another email about “physician wellness,” advertising mindfulness training, an ice cream social, or a volunteer day. As a psychiatrist, I can attest to the importance of tending to one’s own mental and physical health in order to strive for wellness. However, the trend of implementing physician wellness programs throughout the U.S. is nothing more than putting proverbial lipstick on a pig. Or, stated differently, this may …
Physician wellness programs are lipstick on a pig
A little ways back, I was at a gathering of friends and family and was in the kitchen setting out a dish of black bean and quinoa dip. Suddenly, I heard someone from behind me exclaim: “What is that? If that’s something healthy, I am not eating it.”
Although somewhat intended as a joke, there was no doubt a truthfulness to what was said, just as exists in similar comments which …
Here’s why we don’t care about our health
Giving birth and running a marathon. They are two seemingly different entities but have many similarities. The inevitable pain, the highs, the lows, the feeling that you may falter or can’t survive the pain and, in the midst of it all, that you will never do it again … but then you do.
Marathons take months to train for by growing your strength and endurance as you increase your training miles. …
Giving birth is like running a marathon
In 1729, a prescient Jonathan Swift wrote an essay that has a place in the health care debates of 2017. “A modest proposal for preventing the children of poor people from being a burthen to their parents or country, and for making them beneficial to the publick” reads almost like the title of a modern academic manuscript. Then, as now, it was important to look past the title before re-tweeting, …
A modest proposal in response to eliminating the individual mandate
Prescription opioid abuse is one of the United States’ greatest public health challenges. Approximately 97.5 million Americans consume opioids annually, and around 90 people die every day from opioid overuse. The last time in recent history a health care crisis garnered this much public attention was following the release of the 1964 “Surgeon General’s Report on Smoking and Health” correlating smoking to heart disease and …
The triangle of blame for the opioid epidemic
The Office of the Surgeon General existed since 1871 when Dr. John Woodworth was appointed the first supervising surgeon of the national hospital system. In the previous year, the Marine Hospital was reorganized into the national hospital system. On January 4, 1889, Congress formally recognized the new personnel system as the Commissioned Corps. The Corps was established along military lines and initially consisted of only physicians. They …
Paging the surgeon general: America needs you
“How did you know what to say to her?” asked the resident, “We have been trying to figure her out all morning and have gotten nowhere.” An expression of mixed curiosity and frustration crossed her face.
“I try not to focus on how she is acting, as much as I try to talk to the part of her Jesus would love,” I found myself answering. This catchphrase would find its way …
Want to make meaningful connections with patients? Here’s how.
After about the first week of anesthesia residency, I was told, “Don’t get pregnant, you are going to ruin the call schedule.” Initially, I took it as a joke because I was getting married that year and I wasn’t thinking of having children yet, but I did think, “what if it happened accidentally?”
After it’s told to you over and over again by your male co-residents and even some of my …
Physicians: Be nice to your pregnant colleagues
Earlier this week, one of the residents and I saw a new patient who apparently had been sent in to see us for a pre-op visit, an evaluation to make sure that her medical conditions were well controlled and that the surgery was safe for the surgeons to proceed with. She reported that she forgot the paperwork they gave her. All she knew was that whatever we wrote had to …
Let’s get one thing clear: pre-op comments from primary care
The Sunshine Act is part of the Patient Protection and Affordable Care Act passed in 2010. This act went into effect in August of 2013 and requires the full disclosure of any payments (or transfers of value, i.e., lunches and dinners) made to physicians from pharmaceutical and medical device manufacturers.
The spirit of the act is to have more transparency with regards to potential conflicts of interest created when physicians receive …
Have you been reported under the Sunshine Act?
In loving memory of my grandfather, my first physician mentor.
Earlier this year, my 90-year-old grandfather passed away unexpectedly after undergoing transcatheter aortic valve replacement (TAVR). Similar to many elderly patients who die each year in the United States, his death was preceded by a litany of costly and time-consuming tests and treatments. Despite this extensive workup, the end of his life was shadowed by suffering left unaddressed. But, unlike the …
We all treat the whole patient. We must avoid tunnel vision at all costs.
You’ve probably heard this story before: a young physician, who has spent all of his or her life succeeding and building goals, stumbles into a career without meaning or enthusiasm. Indeed, my story about burnout is much like the rest.
Like so many before me, I entered into a career in medicine motivated and eager to change the world through the care of my patients. I grew up in a family …
Burnout during residency? Yep, and here’s what it taught me.
The key to staying on time in a busy clinic and to finish the day unscathed is to be in battle mode from the get go. The ten rules outlined below will help you to achieve that goal.
1. Make sure your bladder is empty, and that you are well hydrated. This goes without saying. You don’t want to finish the day with …
10 rules to keep physicians on time
I wonder what the best thank you any physician has ever received? I think this one is mine. This recent thank you was for our efforts to not save a child but for simply allowing this family to have a few more days with their infant who ultimately passed away. This amazing thank you has deeply and positively affected me so much …
Thank you for performing CPR on my child
As a cardiac anesthesiologist, there are times I care for patients who are faced with a tough decision: to take their chance on a very high-risk surgery, or let nature take its course. It is in these times I feel most humble and most human, as I may be the last one to hear the last words they speak.
Recently I was at a social event and introducing myself to some …
For an anesthesiologist, this is the hardest part of medicine
7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel.
“He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, …
Here’s what death really sounds like
It is early on a Saturday morning when I walk out of the elevator of Doan Hall looking for a nursing desk to call the fourth-year anesthesiology resident I am supposed to be shadowing. Instead, I am met with a set of double doors and a staff-only sign.
Before walking through the doors, I decided to read the placard placed on the wall next to them. As I begin to read, …
Medical students must have this mindset
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