When I started medical school, I was most excited to start learning again. Having spent the last couple years as a teacher in a classroom, I sorely missed the experience of being the student. Reflecting on my college days, I missed the intellectual conversations generated in our seminars, hours poring over literature under dimly lit alcoves of the library; even the far-too-frequent all-nighters spent hashing through complex biochemical pathways with …
They were both named Mike. Both were superstar physicians and educators at MedStar Health. Both had a wife named Pam, a son, and a daughter. And both died untimely deaths within a year of 50 at the mid-point of their ascending careers, 18 months after being diagnosed with cancer. I don’t believe they knew each other, but having worked with each of them, they will be forever linked in my …
It is too easy to lose your way as a physician when faced with the daily stress of real medicine. Spending time with the next generation of physicians gives me faith that we will always have a few doctors who stand out as not just competent, but caring healers.
My son is currently a surgical resident. After the break, is a letter I wrote to him when he was an intern. A …
Say the words, “drug addiction,” and most of us think of heroin, alcohol, cocaine, or opiates. However, lurking in the shadows is a less talked about epidemic: addiction to benzodiazepines, commonly known as “benzos.” I should know because after taking a nighttime dose of lorazepam (Ativan) for about ten years; I finally weaned myself off this and all other prescription sleep medications.
About twelve years ago, my father died and then …
A few months ago, I was on my general surgery rotation on the colorectal service as a medical student. It was in the late afternoon that we started a case of a robotic rectopexy to repair a rectal prolapse. Our patient was a kind and warm 89-year-old woman. The operation finished without a hitch.
As we undocked the da Vinci machine, the resident and I began to suture closed the multiple …
The term “old school” in many facets of life has negative connotations. We live in a modern, technologically advanced and fast-paced world — and there’s no room for certain people who appear to hold us back.
Last year I wrote an article about an experience I had with an “old school” physician. That experience really caused me to reflect on the situation the medical profession finds itself in, and …
I make my way down the aisle of the plane, squeezing past my fellow passengers and plop down in my assigned seat. Sitting next to me is a middle-aged woman with a kind smile. As the plane takes off, she begins making small talk: ”What do you do?”
I silently debate, do I adopt my travel persona or answer truthfully? Answering honestly will result in one of two things; either we …
When I had my first baby, I was a busy resident trying to complete my residency on time. I didn’t want to extend my residency even if it meant sacrificing time with my newborn. In order to get my 8-week leave, I banked days whenever I could. There was one period I worked 45 days straight (well, not straight, I did get the mandatory 24 hours off between once a week) so …
The art of eliciting the medical history requires medical knowledge, cultural knowledge, and many “people skills.” History taking is not science, but rather, art, because it requires interpretation and clarification. Patients with the same symptoms express them differently. A major feature of the art of medicine involves learning how to interpret different descriptions of the same phenomenon.
A few examples might clarify these concepts.
The patient tells you that they have chest …
I find it amusing to be accused of being an unsuccessful practitioner of naturopathic medicine. I graduated with high grades from Bastyr University. I landed a highly competitive naturopathic residency. Had I remained in practice, I would currently be eligible to take the naturopathic pediatrics “board-certification” exam offered by the Pediatric Association of Naturopathic Physicians.
I was making decent money at my practices in Seattle and Tucson. By all accounts, I was …
Based on recent data, medical students pay approximately $136 million dollars each year in registration fees for the U.S. Medical Licensing Examination (USMLE) Step 1, Step 2 CK, Step 2 CS and Step 3 exams.
Current registration fees to take the four USMLE exams are $3,320 per U.S. medical student and $4,125 per international medical graduate (IMG). Estimated annual registration fees for the USMLE exams …
I sometimes worry that my wife Paula won’t be able to see me grow old. Not that I expect to outlive her. She is four years my junior and has the blood pressure of a 17-year-old track star. It’s her eyesight I’m worried about, because she is at risk for a form of blindness called macular degeneration. Paula is the youngest in a long line of redheads, several of whom …
A recent publication in a fine peer-reviewed medical journal of the SPRINT study proved that lowering our blood pressure to the old target of 120/80 or less led to fewer heart attacks, strokes, and kidney failure. There was no question on what to do with younger people but to lower their blood pressure more aggressively to these levels. Debates arose in the medical community about the ability to lower it …
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Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, …
There’s a lot of fear and anxiety about the job market with recent medical school graduates. The 2008 crisis almost collapsed the housing market and many of our large banks, prized institutions, and beacons of financial stability, dissolved overnight. If you combine these events with the financial burden of student loans that many graduates have, it’s easy to see why many medical students are somewhat skeptical of the job market.
In …
My husband, Mark, called me at my practice. “I’ve been working on something; I need you to come home now.” He spoke definitively, urgently. “Is it the kids?” I was instinctively anxious. “No, not the kids, just come home now.”
6 p.m., a cool evening, an ordinary day. The life before the fact. And then life afterward, irrevocably and catastrophically changed.
A tense ride home, then the revelation. “I’ve been having difficulty …
Psychiatry was my first clinical rotation, and I did not know what to expect when I began. When I initially got assigned to the dialectal behavioral therapy (DBT) team, I had no clue what that would entail beyond working with some borderline patients and that the preconception of borderline patients is that they can be “the most difficult” patients to help due to their intense emotional instability, chronic feelings of …
Health care providers are often uncomfortable discussing issues of religion with patients, despite studies that indicate nearly 9 in 10 Americans believe in some sort of spiritual power. As a medical student, I have noticed that religion plays an important role in many patients’ lives, and that conversations about spirituality can build rapport between doctors and patients.
As the United States becomes increasingly diverse across religious lines, it is imperative for …
A 52-year-old man is evaluated for low back pain of 3 months’ duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time. His only medication is as-needed acetaminophen.
On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 132/82 mm Hg, pulse rate is 70/min, and …
A patient of mine brought donuts in yesterday for the staff, and I confess! I had the one with sprinkles.
But with the study published in JAMA reporting that 35 percent of U.S. men and 40 percent of U.S. women are obese, I felt the need to talk a little about obesity and reproduction.
The endocrine system is tightly regulated by hormones which provide feedback to the brain to control their …
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