The preferred route for a hysterectomy is vaginal. This means the entire surgery is done through the vagina with no incisions in the abdomen of any kind. The joke among surgeons is that it is a bit like taking a car apart through the muffler. While doing surgery entirely through the vagina may sound highly complex, it’s really just like any surgery. A vaginal hysterectomy done correctly it is an …
The American Heart Association (AHA) recently proposed new guidelines for all doctors to screen and treat for high cholesterol. For doctors and patients to follow, this would result in a large increase in the number of Americans taking statins.
One of the things I like about the new proposal is that there is no more chasing a number. This was frustrating for doctors and patients to keep having lab draws and medication …
I bolted through the conference room door on the first day of residency orientation. The room full of interns shifted in their seats. All one dozen of the faces looking up at me were male. I got some crooked, goofy grins. So began my introduction to the world of surgery.
So, what would I tell my daughter about how to survive and …
Regular readers here are well-versed on the controversy surrounding maintenance of certification (MOC) and the American Board of Internal Medicine (ABIM).
The story recently made mainstream news, with a comprehensive recap by Newsweek senior writer Kurt Eichenwald: The Ugly Civil War in American Medicine. Go read it.
The ABIM subsequently released a strongly-worded statement. They are clearly not happy with the mainstream media spread …
I’m an old school general surgeon. I graduated from med school in 1974 and after a five-year surgical residency in San Antonio, Texas, I started out on my own, ready to cure the world. Boy, was I raw. Like many of my peers, I got married during medical school, and like every surgeon back in those days I told my wife, …
I came to hospital medicine from the land of pulmonary-critical care. I had spent ten years dealing with septic shock, respiratory failure, and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes; I ran codes. In short I was a critical care bad ass. I thought I was hot stuff. But I …
American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time.
In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is …
I have a unique perspective as a physician. Having traveled to many hospitals in the past two years, working as a locums emergency physician, I can comment on a variety of issues with a reasonable amount of experience.
One of those issues is EMR, or electronic medical records. I have spent plenty of time writing about this in the past, and I …
In the last year and a half, I’ve been able to go to Africa 4 times and Haiti once, for which I give thanks that the world still produces abundant fossil fuels. That much airplane travel does make me feel a bit guilty, even though I’m not actually vacationing.
Going to far away places to practice medicine has always been something I hankered after, and it turns out that knowing how …
There have been huge advances in patient safety, but that doesn’t mean there is no risk when it comes to having surgery and anesthesia. Each year there are more than 100 million operations and procedures performed with anesthesia. Doctors who specialize in anesthesia — we’re known as physician anesthesiologists — play a critical role in keeping patients safe and comfortable before, during, and after surgery.
Before surgery, a physician anesthesiologist checks …
Let’s talk about vaccine ingredients. I am reading less about vaccines causing autism (we all know that theory is utter nonsense, right?) and more about vague concerns regarding the chemicals in vaccines. To begin with, we are surrounded by chemicals. Water (H2O), caffeine (C8H10N4O2), sugar (C12H22O11) are all chemicals. But perhaps it is the unfamiliar ingredients that people find intimidating.
Let’s tackle the ingredients in the measles, mumps, rubella and varicella (MMRV) vaccine …
Every year 300 to 400 physicians commit suicide. More than 10 percent of doctors are thought to have depression, a frequent precursor to suicide. Rates of depression and suicide
Three years ago I received some of the best news of my life — that I have dopa-responsive dystonia. (Yes, a neuromuscular disorder was welcome news.) Painful, life-interrupting muscle contractions had made the dystonia diagnosis likely several years before, despite poor response to standard treatments, and I was fighting through graduate school: trying to compensate for medication-induced memory problems, increasing need to work from bed, and a disappearing social life. …
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On Valentine’s Day weekend last year I found myself at Paddles, the local dungeon in New York City’s Chelsea neighborhood, for the first time. I was perched at the alcohol-free bar when a man politely introduced himself as a human carpet. He asked that I tread on him and lay on the floor to demonstrate. A professional dominatrix-in-training stepped onto his …
A local hospital is trying a new, controversial but more efficient approach to medical care. “We have changed our guidelines, if you want Dilaudid you get Dilaudid, if you want Valium, you get Valium. No questions asked,” CEO Michael Shoemaker told reporters Wednesday.
In what experts are calling pure genius, emergency …
My mother-in-law texted me about The Dress, random friends are blowing up my inbox, and the nurses in the emergency department were huddled around the computer at 2 a.m. debating the color of the dress. Everyone in the world seems to be wondering what color the dress really is and why.
The best way to find the answer to such questions is to find …
I’ve been thinking about this post for awhile, and finally, am going to spill some “secrets” about me and my colleagues.
We are in debt. I mean, real debt. We are in debt. I mean, real debt. It actually costs most of us almost 1 million dollars to become your doctor.
It has taken us a long time to get here.
Let’s do some …
Recently I wrote about the problems with maintenance of certification requirements. One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.” Here’s a quote from the online journal produced by Accenture, the management consulting company:
Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because …
Physician burnout has been previously described as heartbreaking, and this may be an understatement. The growing complexities of health care delivery, intricacies of documentation practices as required by Meaningful Use, and difficulties inherent to billing and reimbursement are only a few of the issues faced by residents and attending clinicians these days.
Unfortunately, these topics are still not formally taught in American medical schools.
As students, we really do not know …
I was glad she never asked if I had done this before.
My first nasogastric tube was placed on an elderly woman with chronic liver disease. As her illness worsened, it gradually turned her skin yellow, her abdomen swollen, and her mind foggy. One day, we realized that she was at too high a choking risk to swallow her medications herself. She would need a plastic tube to do it for …
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