As an American internist and expatriate in the Netherlands, I still follow the unfolding U.S. health care drama. Critics of the Better Care Reconciliation Act (BCRA) are numerous, including doctors, patients, policy experts, and the former top U.S. health administrator — even President Barack Obama. The Dutch and other developed nations must be wondering (again), “Why can’t America …
What can the U.S. learn from Dutch health care?
My smile freezes on my face as my patient says to me, “I’m so glad you’re back – that I get to see Mrs. Lycette today!”
He has been my patient for several years, and I am perplexed to hear him address me as “Mrs.” rather than “Doctor.” At the same time, I really do not think he means an intentional insult, so I keep my face neutral and continue with …
Don’t call me “Mrs.” Call me “Doctor.”
Margaret Edson’s 1999 Pulitzer Prize winning play, Wit, tells the story of the final hours of Vivian Bearing, PhD, an English professor dying of cancer. Early in the course of her disease, one of her doctors sees the value of her case from a research point of view and asks her to enroll in a clinical trial of an investigational therapy. In the film version of the play, which stars …
The decline and fall of informed consent
1. You might get sent home. If you show up pregnant with your first baby, and it turns out you aren’t 4 cm dilated yet, you will get sent home because you aren’t in active labor. Please don’t cuss out the charge nurse. Yes, you are in pain — we aren’t denying that. But, there are limited numbers of beds on labor suites, and we need to keep some open for …
Having a baby in a hospital? Here are 10 things you must know.
My husband, the anesthesiologist, came home one evening, he was solemn, affected, not himself. His patient died in the recovery room. It was sudden and unexpected for my husband. Despite the team’s swift efforts and perfectly executed code, the patient died anyway. It’s relevant to note that his patient was an almost 90-year-old man with significant congestive heart failure, probably chronic kidney disease, and complete occlusion of one of his …
5 ways to make dealing with death easier
It may seem strange that a gastroenterologist like me does not prescribe pain medicines.
Let me rephrase that. I don’t prescribe opioids or narcotics. I write prescriptions for so few controlled substances that I do not even know my own DEA number. You might think that a gastroenterologist who cares for thousands of patients with abdominal pains would have a heavy foot on the opioid accelerator. But, I don’t. Here’s why.
I …
Why this physician doesn’t prescribe pain medications
1973, as we prepare to start our clinical rotations, the chief medical residents taught us the new concept of SOAP notes.
Larry Weed developed the concepts of the problem-oriented medical record and notes that included subjective, objective, assessment and plans for each problem. We wrote our notes each day using his system.
I have wondered in many conversations what he would think of the unreadable computer printout notes of …
Remembering Larry Weed, founder of the SOAP note
There are many different theories out there about the direction that health care should go, and what we need to be doing in the future.
Passions run high, and peoples’ opinions vary wildly. It’s frequently difficult to find agreement on anything. There is, however, one universal truth I’ve found about the everyday practice of medicine, and what constitutes great medical care for any individual in any health care system. Having worked …
Good communication is at the core of all good medical care. Here are 3 examples.
As physicians, we are regarded as intelligent. Are we, as a community, as emotionally intelligent as we could be? The answer is no. Let’s face it. We are trained from the time we are medical students to disconnect and suppress our emotion, and we are taught to appear stoic and strong. Showing emotion in front of patients is discouraged, even in a situation that would be deemed acceptable by most. …
Doctors are smart but not emotionally intelligent
Early retirement is a hot topic these days, particularly in the field of medicine. It is associated with the concept of financial independence, and together they are known by the acronym FIRE (financial independence and retiring early). In essence, FIRE means having enough saved that you can live off your investments, and no longer need to work for a salary. While FIRE is not for everyone, it is something my …
The great dilemma: Go part-time now or retire early?
When I started my intern year, I was told that I was going to be sleep deprived and it was going to be the worst years of my life.
Yes, there were times I racked up a sleep debt, but it was for patient care. And because of the camaraderie and relationships I formed (both inside and outside the hospital), I will forever remember residency with a smile.
Rather than the words …
11 tips medical interns need to hear before they start
At the graveside, they still talk about judgment, intelligence, and the wisdom that is the practice of medicine.
Deans and health care leaders wax poetic as they tell stories of great cures to lift in memoriam remarkable healers. Yet, though we bow to Hippocrates, Osler, and Salk, the time has come to mark a revolution in human history: The art of medicine is dead.
It is not that doctors have fallen from …
Is the medical profession at its end?
It is surprisingly easy to sell snake oil. I know, because I’ve done it. In 2014, I helped create and sell The Right Detox. This was a bogus detoxification program that purported to improve anyone’s well-being and perhaps, cure disease. I was the face of the scam. I launched The Right Detox at a spring-time women’s health expo in Tucson, Arizona.
I kicked off my sales-pitch in front of a small …
Behind the scenes of a detox scam
Thinking outside the box is a somewhat cliché way to illustrate thinking beyond the norm and imagining what “could be” with an innovative mindset. This imagery of being stuck in a box rings true for many physicians, given how many of us are quite literally surrounded by the four white walls of an exam room most of our lives.
Physicians work hard to treat each patient individually, but this feeling of …
10 ways for doctors to think outside of the box
The patient in front of me is trying to die. Elderly and frail, he is lying in bed. His ribs outlined under the skin that should be smooth. His temples are concave where they should be flat. Both are an outward display of internal damage from his lung cancer. More striking than his cachexia are the strained muscles in his neck and his pursed-lip breathing. He is working hard for …
My patient is dying, and I don’t know what to do
An excerpt from The Three Stages of a Physician’s Career: Navigating from Training to Beyond Retirement.
The practical aspects of making a medical career transition can be divided into three phases or stages: waking up, taking stock, and taking the leap of faith. Note that this process is the same whether the physician is anticipating a transition out of full-time practice, planning a transition …
The 3 phases of a physician’s career transition
There was more than one tooth missing, maybe three or four from what he could tell. He held one in his scraped hand as I searched for the others, not sure what I would do with them if I found them. My little sister’s bike laid on top of him, a paperweight on his frail frame. Blood pooled in his mouth and dripped onto his shirt when it ran out …
It’s Friday morning in any operating room, USA. Nurses and techs are scrambling to get everything in place before the surgeon arrives because if not, there will be hell to pay. The first patient arrives late, the second patient needs to use the bathroom, the third patient needs blankets before the IV is started … and here he comes … and we’re not ready. The fear is palpable.
Down the street, …
Trauma in the OR. From doctors’ bullying.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 21-year-old woman is evaluated for mosquito bites on her arms and legs that she received 1 week ago that she has been scratching regularly. One of the bites on her left thigh is now painful with a small amount of drainage. She otherwise feels well, has no significant medical history, and …
MKSAP: 21-year-old woman with mosquito bites
It’s still dark out when I walk into the busy and bustling preoperative area where patients and their family members crowd into small bays. They hand over their personal belongings to the RNs and their trust to me. As I walk in, I grab my patient’s hand, smile and say, “Hello. My name is Dr. Shillcutt. I am a cardiac anesthesiologist, and I am going to take care of you …
I’m your anesthesiologist. Let me explain what that means.
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