Are you a medical liberal or a conservative?

Meds
August 9, 2014

Our nation is highly polarized today, and often bitterly so.  Democrats rail against the GOP.  Pro-lifers face down pro-choicers.  Fox News disses MSNBC.  Isolationists push back against expansionists.  Traditionalists disdain the politically correct.  Free marketers duel against government advocates.  Carnivores deride the gluten-free crowd.  Martin Bashir trashes Sarah Palin, two proxies in a culture war.

There’s a philosophical divide among physicians also.  Would you prefer a liberal physician or a conservative …

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One more thing syndrome: 4 tips for doctors to stay on time

Physician
August 8, 2014

“Doc, can I ask you one more thing?”

These words are classic symptoms for those patients suffering from the “one more thing” syndrome. We’ve all been there. The visit has ended, your hand is on the doorknob, and you’re about to leave the room. Precisely at that moment, your patient stops you and says he has one more thing to discuss.

You think to yourself, “No! I almost made it out of …

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A letter to new medical students

Education
August 7, 2014

Dear new medical student:

Congratulations! You are about to embark upon an exciting, life-altering experience, one you will never forget. You are about to join an elite group of people who will now be your peers going forward.

You will be continually fascinated, and not a single day will go by from now until you retire that you aren’t challenged by something you have never encountered before. You will be solving problems …

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5 things that make U.S. health care great

Policy
August 5, 2014

Anyone from outer space reading the news and watching TV would think that the U.S. has some of the worst health care possible. The negativity appears to be pervasive. Controversy over this, outrage over that. Whether it’s inadequate health outcomes, policy debate, or scandals with patient care, the stories and discussion abound.

As someone who grew up and went to medical school overseas and then came to the U.S. for medical residency (along …

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What is the most important trait in a doctor?

Physician
August 3, 2014

Medical errors are estimated to be the third leading cause of death in America’s hospitals. Though some of these errors are beyond physician control, many are the direct result of physician action and inaction. I spend a lot of time thinking about how to reduce these errors and I (like many of my peers) lose sleep over the mistakes I witness.

When you ask patients what quality is most important in a …

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What if jet lag was infectious?

Conditions
August 2, 2014

Jet lag, also known as desynchronosis or flight fatigue, is defined as “extreme tiredness and other physical effects felt by a person after a long flight across several time zones.” Besides insomnia, symptoms of jet lag include weakness, fatigue, dehydration, body aches, diarrhea, dizziness, headache, irritability, and memory loss. Jet lag is one of the circadian rhythm disorders; others include shift work disorder, sleep phase disorder, and irregular sleep-wake rhythm.

Symptoms …

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Law and medicine are more intertwined than they should be

Physician
August 1, 2014

I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform.

I’m not suggesting that an unwelcome …

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Welcome to the world of metamedicine

Physician
July 30, 2014

Knowing what to do when faced with a sick patient is relatively straightforward. We learned a lot of it in medical school, picked more up by experience, and usually have the opportunity to look things up quickly on the Internet. Even when faced with a brand new situation, we can usually fall back on our general knowledge of science and medicine.

But in today’s practice of medicine, that’s not enough. Physicians, …

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Doctors are helpers, not healers

Physician
July 28, 2014

It’s a seductive idea.  We doctors possess knowledge and experience which can not only help people, but can save their lives.  We get opportunities to be the right person at the right time to offer the right help that makes all of the difference.  It’s one of the greatest things about our profession.  It’s also one of its greatest traps.

I’ve heard many doctors refer to themselves as “healers,” as if …

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Choose your career: Should I be a nurse or a doctor?

Education
July 26, 2014

doctor v nurse

Having been both a nurse and a doctor, most of the questions I get from readers have to do with making the decision between nursing and medicine.  Let’s lay aside for a moment the reality that the fields are totally different and that direct comparisons are useless.

But people ask me all the time, so, as a little experiment, I …

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Doctors still work while on vacation

Physician
July 26, 2014

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Last week, I took a 6-day vacation.  Two days before and two days after, I put in a total of 32 unpaid hours of work which was cut short by a call from my daughter asking me why I am working during my time off.  While away with my family, I ran into people of different walks of life and noted …

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MKSAP: 68-year-old woman with exertional leg discomfort

Conditions
July 26, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old woman is assessed for a 6-month history of progressive exertional leg discomfort, described as a “heaviness” involving both calves. The symptoms are relieved within 5 to 10 minutes of rest. She has noted the same limiting heaviness with bicycling. Medical history is significant for hypertension, type 2 diabetes mellitus, and …

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The secret lives of doctors

Physician
July 25, 2014

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Recently, when my parents came for a visit, our conversations led me to realize something important: I have been a doctor for more than 20 years, and yet my parents have no idea what my daily life is like. It then occurred to me that if they have no idea, then surely my patients have no idea either.

So, if you’re a …

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Dear patient: Your 5-minute appointment is awaiting you.

Physician
July 25, 2014

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Dear patient:

I am writing to inform you of some recent changes to my practice. These changes have been implemented to improve the quality of your care.

I will no longer be able to see you for a 20-minute or 40-minute appointment. These will instead be shortened to a 10-minute or 20 minute-appointment based on your stated needs. For example, if you just …

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Digging deeper into the Commonwealth Fund health rankings

Policy
July 22, 2014

The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none.

Yikes.

The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third …

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Why you should love your doctor

Physician
July 18, 2014

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Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth.

Doctors may amass up to $500,000 in debt for the honor of one day caring for you and your family.

Doctors delay childbearing and starting their own families so they can care for your family.

Doctors miss their own kids’ ballet recitals and baseball games …

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Stop calling nurse practitioners mid-level providers

Physician
July 14, 2014

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I really hate it when a nurse practitioner is called a mid-level provider.

“Mid-level provider” isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.

The term “mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and midwives. It is insulting to health professionals …

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A medical student speaks up and saves a life

Education
July 12, 2014

Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms.

The patient …

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