This post is based on a “friend of a friend” situation. Important details have been changed to protect anonymity, but not the basic realities I want to discuss.
A 49-year old man was diagnosed with a rare form of lung cancer about a year and a half ago. This sad situation is compounded by the fact that he was in a stable marriage with a wife and two children, ages 10 …
We must tell sad medical stories too
I was incredibly nervous going into my first day in the inpatient child/adolescent psychiatry unit. “Was this where the truly psychotic kids are? Am I going to be safe here?” I wondered as I casually introduced myself to the staff on the floor. After a morning of sitting in on group therapy led by psychologists and occupational therapists, I calmed down. Against the backdrop of the soothing soft pastel colors, …
The one lesson I learned working in a psych unit
How can a doctor resist an essay entitled, “The Sickness Unto Death?” Kierkegaard, the darkest of the bleak existentialists, begins by asking, “Is despair an excellence or a defect?” Can despair be an excellence?
It is December in Oregon, the rain comes down in sheets, with only a few hours daily of half-light. Kierkegaard’s winters in 1840 Denmark must have felt a lot like this, so I press on.
“In despairing over …
The double meaning of despair in the hospital
As my co-workers and I peered out the window of the Planned Parenthood in Philadelphia, we saw over 200 protestors chanting the name of a man who had killed 2 people and injured several others at reproductive health centers the day before. They kept coming closer and padlocked the entrance gate so that we were trapped. We worried they might have weapons. The stand-off lasted for three terrifying hours. As …
Planned Parenthood and my decision to go to medical school
Chronic kidney failure is a serious disease. When progression to end-stage renal disease (ESRD) occurs, dialysis is required to sustain life.
It is shocking, then, that in the United States, it is estimated that over 1,000 patients annually are involuntarily discharged from their dialysis clinics. Further, they are often “blackballed” from other local clinics. The consequences for such patients, predominately African-American, are dire. A patient may be unable to find a …
Involuntary discharge from dialysis: A health care practice like no other
U.S. life expectancy declined in 2015 for the first time in more than two decades, according to a National Center for Health Statistics study released last week. The decline of 0.1 percent was ever so slight ― life expectancy at birth was 78.8 years in 2015, compared to 78.9 years in 2014. However, this reversal of a long-time upward trend makes these results significant.
While many researchers are scratching …
Do primary care physicians increase life expectancy?
An excerpt from Malpractice: A Neurosurgeon Reveals How Our Health-Care System Puts Patients at Risk.
It is not possible to live life in a way that every choice and decision awaits a definitive, double–blind study with a statistically significant …
Rule #1 of emergency room diagnostics
We need to fail more tests in medical school. I’m serious.
In first year, our class had two of the most memorable weeks of our schooling: A crash course on biochemistry taught by a professor who is widely accepted as one of the best teachers in our medical school. His in-class lecture style kept students engaged and entertained; I, and many of my classmates, learned tremendous amounts of his material and …
Medical students need to fail more often. Here’s why.
How in the heck would three nurses and I ever orchestrate ECMO in the middle of the night in my community ED? I pondered this over tuna tartare while listening to ivory tower docs discuss cutting-edge modalities like they were part of treatment algorithms everywhere. The conversation turned to REBOA, and I wondered how many academicians had ever manned a single-coverage ED.
Ivory tower medicine and my world, where there is …
Don’t engage in fishbowl emergency medicine
In medicine, our motto is first do no harm. Words matter. Choose them wisely. Here are 7 words that shame, blame, and injure people who need our help.
1. Don’t say COMMITTED suicide. Committed implies a crime. Committed rape, burglary, murder. Suicide is not a crime; it’s a medical condition that has been taboo for too long. Let’s come out of the dark …
Stop saying these 7 shaming words in medicine. Right now.
We chat about the day, as I use a sharp knife to cut into her. We joke about my kids, as the blood is spurting. We reminisce about our friendship, as I rip open her tissue.
For most surgeons, their patients are asleep as they perform their surgery. In obstetrics, however, we want our patients awake, not only to witness their baby’s arrival, but also because it is safer. When I …
A harrowing C-section, performed on a close friend
A recent study in the Journal of the American Medical Association concludes that 27 percent of medical students around the world exhibit symptoms of depression and 11 percent have thought of taking their own lives. Equally troubling is the fact that, among students experiencing depressive symptoms, only 16 percent seek psychiatric treatment.
Other studies have suggested that the prevalence of depression in medical students may …
We need a more humane approach to medical education
About a year ago, Yusuke Tsugawa — then a doctoral student in the Harvard health policy PhD program — and I were discussing the evidence around the quality of care delivered by female and male doctors. The data suggested that women practice medicine a little differently than men do. It appeared that practice patterns of female physicians were a little more evidence-based, sticking more closely to Read more…
The difference between male and female physicians. Here’s what it means.
A response to “This resident works 100+ hours per week, but is still a poorly trained surgeon.”
I am truly sorry your experience in a urology residency thus far has been far below your expectations. I am finishing residency in June, and I know how hard it is. There are sleepless nights, thankless tasks, and residency feels like a learning process that crawls forward in inches rather than feet. …
Not all residency programs are bad. Here’s what to do if yours is.
Once upon a time, I worked for a large hospital in the surgical-trauma ICU. It was just a six-month gig, and I had to travel from home further than I wanted. But my son would be starting college soon, and the $10,000 bonus was too irresistible.
Diane was the manager. The most kind, skilled, and helpful person I have ever met as an ICU manager.
She had every possible attribute as a …
An ode to a beloved ICU nurse manager
Medicine is a paradox. To save, we cut with sharp knives. We ignore pain so that it will light the path to diagnosis. We give toxins to destroy toxic disease. We scold our neighbors when they neglect their health, even as we work ourselves to exhaustion, eat too much and evade exercise. We comfort the families of our patients while ignoring our own.
There is one contradiction, which, by its very …
Should doctors’ personal judgments affect their patients?
A friend of mine recently had a very sore throat. She knew how to manage her symptoms — lozenges, warm tea and the like. But she was worried she might have strep and would, therefore, need antibiotics. That should be a simple question to answer with a quick trip to the primary care clinic. Except that her primary care physician was booked, and if she wanted an unscheduled appointment with …
Going to a walk-in clinic? 6 essential things you must know before you visit
As health care increasingly propels itself into the world of corporations and big business, it may seem like the practice of medicine has entered an irreversible new era. Gone are the days of good old Dr. Wilson in his solo private practice around the corner, loved and respected by all his patients and the community. Nowadays, it’s all about mega multi-specialty groups, health care mergers and hostile corporate takeovers.
Being someone …
Corporate health care is doomed. Here’s why.
Dear Husband, MD
I see you. I hear you cough all night, knowing your flu vaccine has failed and you have it. I hear you wheeze with your post-flu pneumonia. I feel you shiver in the bed beside me while you sleep for 5 hours before you get back up and start getting ready for the next “shift.”
I put quotations around “shift” because we both know you will not work 8 …
A letter to her physician husband
It’s 4:17 a.m. as I begin this entry. I’m scheduled to be at the hospital in 43 minutes for one of my last days on surgical rotation, and I’ve been working on the following text message since 3 a.m.:
“Hi, team. Im afraid that im burned out and anxious. I will be taking today off. Sorry to be blunt but i felt it better than to make up an excuse. Thanks …
The word that best describes this medical student’s experience
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