I’ll just start this off by saying that I am not exactly sure where I stand on the white coat thing. One part of me loves the white coat as a symbol, a shield against disease, and a place with pockets to put my things; and then there are other days when I just want to throw that germ-ridden cotton barrier to the doctor-patient relationship in the trash, roll up my sleeves, …
The white coat doesn’t mean much anymore
I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have …
My double life: Mental illness in the health care
Just three weeks earlier, she had noticed something strange about one of her breasts. An irregular shape. Her daughter brought her to the doctor, and soon the patient, I’ll call her Amanda, was diagnosed with breast cancer, stage “to be determined.” In fact, she was now in an oncologist’s office, learning what tests she would receive to determine the extent of her tumor. And sitting between her and the doctor …
When patients cry, please don’t do this
Guilt was not a huge part of my vocabulary until I became a mom. I never felt much guilt about how I spent my time. Didn’t feel guilty about sleeping in, or working out, or having a girls’ night out. And so on and so forth.
And then I became a mom. You know, that moment when you get shoved into the most beautiful world; a place more beautiful than you could …
Conquering guilt as a trauma surgeon mother
I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs.
I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in …
“You can’t create an addict in the ER.” Yes, you can.
I thought about the rather corny starfish story when I was driving home after clinic today. You know the one. It goes something like this:
A man was walking along a deserted beach at sunset. As he walked, he could see a young boy in the distance. As he drew nearer, he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again …
What this physician learned from the starfish story
A guest column by the American College of Physicians, exclusive to KevinMD.com.
If the old adage “the pen is mightier than the sword” is true, then the doctor’s note is the most powerful weapon around.
When I entered practice over 25 years ago, I wrote notes when people were too sick or injured to work, or to verify …
The ever expanding list of reasons for a doctor’s note
Three weekday call shifts left and two more weekends. The light at the end of the tunnel is shining bright, and I am relieved to be walking towards it. The only question that remains is what will I have left of myself and my life when I get there?
I started residency with a husband who I loved more than life itself. I was codependent to a fault, never wanted to …
Surgical residency hurt the people that mean the most to me
CMS states it wants to increase pay to primary care physicians. And while we might quarrel with their strategies or with the speed of achieving the goal, few would quarrel with the goal itself. In recent years, CMS has developed HCPCS codes and adopted CPT codes, some limited to primary care and some not specialty restricted but all likely to be reported by primary care practices. Meanwhile, although payment systems …
How to perform services that increase primary care revenue
Critics have been making the rounds again with a warmed-over complaint: International medical schools that offer U.S. teaching hospitals financial support for clerkship programs are unfairly buying access for their students instead of “more deserving” U.S.-based students. As the proud dean of a Caribbean medical school, I want to set the record straight yet again: This argument is hollow and based on a false dichotomy. In fact, the argument has …
Why paying hospitals for clerkships is good, and necessary
I recall during my freshman year in medical school, sitting in class and listening to what were supposed to be 50-minute lectures from people who’d been teaching the same course for years. These were highly educated and intelligent folks; they knew how much material they could cover in 50 minutes. Yet, they frequently went past their time; encroaching on what was for some a badly needed bathroom break, and for …
Every physician is a wounded healer
“How are you feeling?”
It’s a question we frequently ask patients — on rounds, in the clinic, post-operatively — and with all good intentions and gentility. But, do we ever stop to think: What is really the point of this question? What information are we trying to glean? I think for most of us, we’re asking the question with a cognitive bias towards the physical. How are they “physically” feeling: better, …
Ask patients how they feel, along with how they are feeling
“Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
– Sir William Osler, “The Father of Modern Medicine” (1849–1919)
In this modern era of oncology, the potential extent of malignant spread is staged by high-quality scans. Further, when …
Learn the physical exam by following an oncologist
There you are in your father’s arms. He is practically running to keep up with the triage nurse. The nurse is walking quickly toward the room that we leave open for true emergencies and the sickest patients. Your father’s eyes are full of fear, and the nurse’s tone is worrisome.
I look down at you all snuggled up to your father’s chest. You are beautiful. So small and bright-eyed. You don’t …
Medicine is the most emotional profession. This story proves it.
A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed …
You should want surgery residents for your operation. Here’s why.
I took a fantastic emergency medicine (EM) job when I finished residency. There was no question in my mind that it was the best job within a hundred mile radius, maybe more. When I first started, my expectations were met. My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed. The hospital was independent, …
How to destroy a great ER: A step by step guide
If you are a doctor, everywhere you hear or read about all that is wrong in medicine. Please do not get me wrong, the medical profession is under assault. Change is occurring all around us, and much of it has the potential to be disastrous to not only us and our families, but more importantly to our patients. For many of us in the profession, we feel helpless. We feel …
Doctors need to fall back in love with medicine. Here’s how to do it.
I learned that the 148-year-old community hospital that I did my residency at will be closing, and I am angry. Who am I angry at? Myself. Oh, and you. I’m angry at us because we as a country have turned our backs on one another. And in the end, your relationship with your own doctor is in jeopardy.
Pawtucket, Rhode Island, home of Memorial Hospital, used to be a prosperous mill …
Your anger towards doctors is misplaced
Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to …
Doctors can’t see the forest from the trees. And it’s cost them.
I just finished reading a very delightful A Piece of My Mind essay in JAMA. JAMA is primarily a research journal, filled with new scientific or semi-scientific studies and comments on those, plus reviews of the literature and editorials on science or politics. There are also letters and announcements and educational sections for doctors or patients, even poems, but the part I like to read all the way through is …
Who are the patients that stay in the hospital for a very long time?
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