February 24, 1991, and I wait. I wait on the edge of my cot under the pitched canopy of my far-away canvas home; its sides pulsating from the ever-present wind; sand somehow traversing the walls, everything inside airbrushed a pastel tan; outside the surrounding Saudi Arabian desert limitless in all directions. The winds of war have been blowing, and the time has come. There are 10 of us inside the …
We are again at war with another unseen enemy
“In medicine, empiric therapy is treatment that is administered based on the probability of success because we don’t have all of the information. We make our ‘best guess.’ Actually, empiric decision-making exists in our everyday lives — running the garbage disposal when the sink is clogged, jiggling the key in the …
An inflexibility and inflammation root-cause approach to treatment [PODCAST]
As cases of COVID-19 sore around the nation, the days of New York as the epicenter of the pandemic have become a distant memory for this emergency room doctor. Did the government really once send us refrigerated trucks for our dead and a naval ship for our sick? Did we really sit masked, goggled, and wrapped in plastic while sweating out shift after shift surrounded by coughing, gasping coronavirus infected …
The long months of winter are coming. Will we be ready?
I recently met a student and aspiring surgeon who asked me if I was happy with anesthesiology and a career in medicine in general. I told him that aspiring to medicine is wonderful and that while I am indeed happy with my career choice, it does come with daily challenges, both professional and personal. This led to a discussion of work-life balance, particularly with regard to family life, in which …
Advice to aspiring medical students on work-life balance
On November 9th, the governor of North Dakota, Doug Burgum, decided to allow hospital workers with COVID-19 to continue to come to work. He required that they be asymptomatic and that they only work on COVID-19 wards with COVID-19 patients. Given at-capacity hospitals and skyrocketing case counts in that state, health care workers (HCW) had asked state leadership to take extraordinary measures to curb disease spread. HCW were (and are) …
The problem with allowing COVID-positive health care workers to continue working
Concern that the scientific growth of medicine has come at the expense of the art of medicine is not new. However, should we consider that not only does this impact the quality and practice of medicine, but might it also contribute to the rampant burnout in physicians? Does a narrow focus on the linear, scientific thinking that characterizes medical education and training mean that physicians are more vulnerable to the …
Medicine for the soul: Harness the power of the humanities to counteract burnout
“While there is a myriad of expert opinions on what long term effects this pandemic will have on our children and their physical and mental health, we must also remember the age-old idiom: this too shall pass. We must also be sensitive to not add to parents’ already full plates. Meditation …
Why the pandemic is the perfect opportunity to introduce meditation to children [PODCAST]
“Those who cannot remember the past are condemned to repeat it” is a quote by George Santayana.
It rings true in so many facets of life and medicine. In my career in psychiatry, I have held fast to this treatise.
Psychiatry, as a practice, has changed over the years. We operate with the knowledge that we must always remember our past, especially since our past has been quite …
Weighing the ethics of paternalism and autonomy
I rarely post more than pictures on Facebook. In fact, I rarely use Facebook for much of anything anymore. But I need you all to just listen for a second.
I’m scared. For you and for me.
I need you all to take a minute and think of the last time that you interacted in-person with someone who does not live in your home. Did you …
We are making sacrifices for you. Please make a sacrifice for us.
With the rapid growth of modern medicine and awareness in lifestyle and environmental influences, individuals can live longer and healthier lives. Approximately 15.2 percent of the U.S. population consists of individuals 65 years and older. To make the added years of life expectancy fulfilling, older adults need to stay socially connected and involved. One key method is through the development of meaningful …
The value of intergenerational relationships
As the mother of a child born with hypoplastic left heart syndrome, besides going through four open-heart surgeries and coding, my son has also had eight abdominal surgeries, including a Ladd’s procedure and resection of his colon. William also functions without his appendix, spleen, and gall bladder. In addition to every kind of therapy imaginable, he has had to endure pamidronate infusions, daily shots, G-tube feedings, and TPN. Who knows …
Thank you pediatric medical professionals, as we fondly bid you adieu
“Customer #4, please step up to the counter. How may I help you today?” As a patient, have you ever felt that it seemed you were waiting in line at the deli department, listening for your number to be called? Sorry to say, the practice of medicine has evolved in this direction in the past couple of decades. Gone are the days when one could enter the physician’s office, and …
Physicians: Take back the title you have earned through your training
“Appreciation in the personal finance world has two different components to it:
These are both important, but the qualitative is the best predictor of increasing …
Appreciation in the personal finance world [PODCAST]
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This question resonates in my mind each day I pass through the prison gatehouse. The gatehouse is a physical barrier and a mental one, separating the outside from the inside, seceding the lives of people who guard and care for inmates from the lives of those within.
Each morning, the gatehouse is abuzz with activity as people file into work. It’s like going through airport security. Every single day. If you …
Over the last decade, as health care solutions have become more specialized and fragmented, primary care physicians (PCPs) have frequently been cut out of the loop, particularly in coding initiatives. Retrospective and in-home risk assessment solutions work around PCPs. This dynamic further complicates PCPs’ ability to thrive in value-based care, which hinges on primary care being underscored.
PCPs can take back control of care and accelerate their own transition to and …
How PCPs can leverage better coding to succeed in value-based care
The practice of anesthesiology is the practice of medicine. People who go to medical school and do a residency in anesthesiology are best equipped to deal with anesthetic delivery because they are qualified physicians before starting four years of specialty training in anesthesia. Many also have a fifth year of subspecialty training before entering their practice. With all this training, why is it that we cannot figure out how to …
Why can’t I cover my operating rooms?
Lulu was a force of nature. She didn’t believe in expiration dates. Her version of attending church was driving her pumped-up (to manage ranch terrain) golf cart out to the pasture to watch the sunset. She always had dogs underfoot who often ate better than humans. She often would write her birthday card messages on a piece of paper inside the card and then ask me for the …
We are human and all in this together
The Prussian pathologist, Rudolf Virchow, who gave us Virchow’s triad: hypercoagulability, endothelial injury, blood flow stasis also gave us the foundations of social medicine, claiming that “physicians are the natural attorneys of the poor” and should be equipped to solve the pressing social problems of their time. In addition, he argued that politics was indeed “medicine on a grand scale,” assertions that are all the more prescient during a global …
Reimagining medical education from within a pandemic
“While the rise in substance use disorders during COVID will become more apparent as the pandemic eventually ebbs, the silver lining is that this is not a novel problem. We understand substance use disorders far better than we understand COVID-19, and we also know that one of the largest obstacles to treatment is the shame associated with admitting that one has …
COVID-related stressors and increasing instances of substance abuse [PODCAST]
Doctors are often called “heroes” – a surprisingly uncomfortable label. Physicians are already tired of being held to a higher standard than the average person; raising the pedestal is problematic. While doctors are compassionate individuals who care about bettering lives and curing illnesses, we are also human. At the end of a standard workday, we would like to live normal lives. Unfortunately, the hours are longer, and we are never …
The pedestal that’s killing doctors
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