“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other.
“Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave …
The dangers of being overly apologetic
When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability of allowing a patient who refuses necessary blood products to die. For this reason, these institutions are not welcoming to Jehovah Witnesses. This is of special concern in surgical specialties …
If she gets pregnant, she might die. Do I help?
Dear Me, MD:
Now that you have opened this letter, you may have graduated or maybe you just matched into residency — somewhere, anywhere, hopefully?! As you read this, it should be some time during spring 2017. But, you never know, sometimes the train derails, and it takes a little longer than expected, so forgive yourself if that is the case. You learned a while back that the fast lane is …
A letter from my med student self to me now
More than a decade ago, the job of the pharmaceutical rep was enviable. Direct-to-consumer advertising pre-sold many drugs so doctors already knew about them. Medical offices welcomed the reps who were usually physically attractive and brought lunch. In fact, reps sometimes had their own reception rooms in medical offices.
By 2011 thanks to drug safety scandals and new methods of marketing, the bloom had fallen off the pharma …
It is not a great time to be a pharmaceutical rep
Most doctors are very bright people. I believe that what often sets apart those who perform well on the job and on exams isn’t raw intelligence but rather the ability to learn effectively.
In the MCAT and USMLE steps 1, 2, and 3, I did poorly and barely passed. In 2009, I took my family medicine in-training exam and fell below the minimum passing score. After taking almost five years away from residency …
How I went from the bottom to the top 1 percentile on board exams
So there I was — in deep denial. Maybe you’ve been there: Ignoring the symptoms. Hoping and praying that it would just “go away.”
A little knowledge is a dangerous thing. And as a doctor, I like to think I can Google with the best of them.
So when I had a persistent scary symptom (full disclosure: it was bloody discharge from my left breast. Not subtle. Not intermittent. Not OK, even …
A cancer scare changed my life in 7 seconds
Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their personal role in the genesis of this problem. Our words matter. They can reverse the good we do with our medications and procedures.
If you are a heart …
Watch what you say to patients
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, …
MKSAP: 68-year-old man with new-onset ascites
Welcome to planet medicine, where four rides around the sun earns you a golden ticket to study more, to train more, and to enjoy splicing two sacred letters onto the end of your title. The days are long, the weeks go fast, and sleep is optional. In this world, all-star draftees leave their immaculate collegiate careers as masters of memorization and intellectual puzzle solvers only to still be no more …
Part of a series.
The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again.
There are many …
Normal aging: A steady loss of organ and process function
Am I the only emergency physician who sometimes wonders who left me in charge of an ED? I should be confident in managing whatever comes through those ED doors after more than ten years of single-coverage night shifts, but each night I hear a little voice in my amygdala questioning whether tonight will be the night I won’t be able to handle something. Sometimes I feel afraid of the unknown …
An emergency physician frozen by fear, and what she learned from it
Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium …
How useful is a cardiac calcium CT scan?
Election Day 2016 should have been Christmas morning for Republicans. Long awaited control of the White House and both houses of Congress. A chance to deliver on an every two-year election cycle promise to repeal and replace Obamacare. In 2010 Republicans needed the House. They got it. In 2014, it was the Senate. Delivered. But we still need the White House they said. Asked and answered with President Donald Trump.
So, …
Is health care a right or a privilege? Why can’t the answer be both?
In the market for a locum tenens position? If you search online “How to book a locum assignment?” you’ll likely find vague advice such as “Develop a relationship with a recruiter.” Or “Do your homework when choosing an agency.” Thanks, Internet …
Having worked as a locum tenens recruiter for over 15 years, I have seen consistent trends in how the best clinicians are able to stand out and book jobs. …
8 secrets to landing a locum tenens job
I have now been out of the active medicine for two years. I still have dreams about being a doctor and practice. I don’t think you can do the same thing day in and day out for 40 years and not have it be a part of who you are. I am still asked my opinion by friends and family about their health issues, and frankly, I find my fund …
What life is like for this retired physician
“Ya mero llegamos?”
Are we almost there? These become one of the most dreaded words I have to hear every weekend, when I pick you up from the long commute that is from Sacramento to the bay area to spend time with you. Oftentimes I am just as inpatient as you my love. This has been our sacrifice these last few years, being physically away from one another. I take a deep …
We made it! An open letter to my son.
Are you a medical resident or fellow? Do you have a family to provide for? Do you feel that your biweekly paycheck is not quite enough to justify the hard work you put in? Luckily for you, your program offers the great benefit of “moonlighting.” Should you take advantage? Here are some of my thoughts on the matter.
What is moonlighting?
Like so many other things we take for granted in medicine, …
The pros and cons of moonlighting for medical trainees
A few weeks after I started residency, two of my peers killed themselves in New York City. No one I knew was surprised.
Intern year is hell, and everybody knows it from TV shows like “Scrubs” and books like “House of God.” Old doctors tell tall tales of working a million hours without sleep before training standards got “soft,” limiting residents’ monthly work hours to 320 and requiring four days off. …
Stressed and sad as a medical intern? You’re not alone
“Do you have sex with men, women or both?”
This is the way that we were taught in medical school to ask a patient about their sexual history. When we took our sample standardized patient exams, we were scored whether or not we asked this question. In my understanding, this was supposed to be a non-judgmental, non-assuming way to elicit a sexual history.
However, romantic partners generally come before sex (unless we …
Please stop asking about my wife
Those of us who work in pediatric intensive care have frequent encounters with the problem of suicide and attempted suicide. It has seemed to me for some years that the numbers are increasing, and this has been shown to be the case. After years of declining, the suicide rate in our country has been increasing, now at about 125 percent of the rate of several decades …
The suicide rate is increasing. Why is that?
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