I was offered my choice of bisphosphonates after breaking my shoulder and ended up with a diagnosis of osteoporosis. I initially opted for Reclast, a drug that only requires one dose a year albeit by IV infusion. I made an appointment to get the drug several weeks later. I wanted to have time to research my options. After reading as much as I could during that time, I made an …
A story for those who pontificate about patient behavior
Waiting to get help to improve your life and relationship is like waiting for the cancer to spread. You feel a lump on your body. Do you wait a few months to see if it gets bigger? Do you make an appointment right away? Do you avoid making an appointment altogether and hope it just goes away on its own?
Many times, we wait until after the divorce, after the accident, …
When should doctors see a therapist?
I was working at the free clinic late in the first semester of my third year of medical school when I met a patient I will call Mary, the last patient to be seen for the evening. Mary had a fairly typical story among uninsured individuals. She was 26 years old and worked three jobs near minimum wage to make ends meet, none of which offered cost-sharing for health insurance. …
What does “do no harm” really mean as a doctor?
I quickly finished my day’s work in the resident’s clinic (documentations, relaying results) and raced home to hurriedly double check the list of things that I would need for my week long medical mission in Roatán, Honduras.
The air was frigid, and my pace matched the wind. In the 2-hour car ride to the airport, my mind was alive and restless; making mental note after mental note about our endeavor but …
A physician volunteers in Honduras. Here’s what she learned.
It’s that time again — time to dust off your nicest suit and prepare for either residency or fellowship interviews. Being knee-deep in interview season for infectious diseases fellowships, my interview days bear some resemblance to my residency interviews, yet also are quite different. I have a unique opportunity this year to be a part of the recruitment and decision process for our internal medicine residency program, in addition to being a fellowship applicant.
I was visiting …
Dos and don’ts for your residency interview
Once upon a time, there was a land where parents were anxious, information was pervasive, and trust was hard to come by. Misinformed celebrities with impressive influence (despite minimal education) were spouting ideas that provided concrete solutions to poorly understood situations, and parents were clinging to them as if their (child’s) life depended upon it.
Pediatricians everywhere were scratching their heads, wondering, what has happened? Why are our patients doubting us? …
The day that the pediatricians quit
As a physician, I knew exactly what was happening when I walked into the emergency room. My eyes were nearly swollen shut. My throat was closing. I was in the midst of a severe allergic reaction known as anaphylaxis. I urgently needed epinephrine, a potent medicine that could halt my life-threatening symptoms. When I told the nurse what was happening, she rushed me to the trauma room where doctors and nurses encircled …
A physician experiences a medical error. Here’s her story.
When we think about the technology revolution, we often get excited at the thought of getting what we want instantly. We wait in line for new smartphones. We instant message. We love fast. Getting something done faster, with as good a result, is usually seen as a virtue — unless one is a doctor.
In these times of fast information, we find ourselves bombarded with surveys. Part of the downside of …
I don’t apologize for being a fast doctor
Growing up during the 1970’s and 80’s, Little House on the Prairie was an iconic part of my childhood. Doc Baker was the physician and veterinarian for all of Walnut Grove, in spite of limited resources. Medical lessons were everywhere in the beloved television series: Mary experiencing onset of blindness (most recently attributed to viral meningoencephalitis, likely from measles), the death of Laura’s infant son by unknown cause, and Rose’s …
Patients want to make their own informed choices. We need to let them.
Ah, EMTALA! The revered Emergency Medical Treatment and Active Labor Act! It’s one of those things which is like a nursery rhyme to emergency medicine folks like me. We’ve heard about it from the infancy of our training. “And then the bad doctor sent the poor lady to another hospital because she couldn’t pay! And the King came and crucified him for doing it!” The end.
EMTALA, for the uninitiated, is …
When EMTALA forms meet EMRs, chaos can ensue
I have already opined on my disapproval of a medical marijuana law recently passed in Ohio. Once of my points in that piece is that I did not want legislators making medical decisions for us. They can’t even do their own jobs.
I am not against medical marijuana; I am for science. The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, …
This doctor is against medical marijuana. Here’s why.
I recently watched the movie Sully. It was the first time I’d ever watched a movie on its actual release date. Knowing what a legendary actor Tom Hanks is, and what a fascinating and near-tragic story unfolded on January 15, 2009, I felt confident that my choice to venture out to the cinema on a beautiful Boston September evening, would be a good one.
The movie sure didn’t disappoint. Brilliantly directed …
Captain Sully and the human factor in health care
Upon starting medical school, I remember feeling amazed to learn just how many of my classmates had physician parents. I felt like I was in the minority, not having any family members of my own who were doctors. This made me realize: Physician parents tend to breed physician children. But why? I soon discovered that the answer may lie in the genetics of personality.
The academic study of personality has grown extensively over …
Physician parents, physician children. Why?
Early on a random Tuesday morning, I walked into the burn unit and found my 87-year-old patient, Mr. Gray, in septic shock. While Mr. Gray’s burn injury was small by our standards, it appeared that the sequelae of the injury might prove fatal. I called Mr. Gray’s wife to obtain consent for a vascular catheter through which I planned to begin continuous dialysis and was surprised when she declared, “No …
I was seeing a patient who brought me a bag of supplements she bought from another specialist. I looked skeptical and then she pulled out the list of lab results the other doctor ordered on her. I reviewed the results with her and asked why all these tests were ordered in the first place, some of which I had never ordered in my life. She said she told the specialist …
I question the ethics of any doctor who sells supplements to patients
Do doctors make too much money?
I don’t think so. I read with great interest the blog by Dr. Michael Kirsch defending physicians’ salaries: “If you think doctors make too much money, think about this.” Unfortunately, the public’s perception of physicians’ incomes has been that physicians make too much money.
Whenever I hear this remark from patients or even non-physicians, I show …
If doctors wanted to be wealthy, they would have become UPS truck drivers
September is Sepsis Awareness Month, a month which aims to raise awareness of sepsis and strategies for prevention and treatment. Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when the body’s response to infection becomes dysregulated and white blood cells and chemicals cause injury to organs throughout the body.
Earlier this …
Reflecting on sepsis: Definitions, new ideas, and a continued commitment to patient care
In March, 2016, the CDC released guidelines for prescribing opioids. The guidelines were a response to a serious and growing problem: millions of pain patients became addicted to prescribed opioids, and hundreds of thousands died as a result.
Since the guidelines were released, reports of pain patients being abruptly cut off of their medication or having their medication abruptly reduced have become rampant. These patients report they were using opioids long …
Pain patients are being cut off from their drugs. Here’s why.
One of the most difficult things I deal with as a physician is patients’ demands for pain medications. I treat patients with cystic fibrosis, a genetic disease present at birth with no cure, and its issues are indeed complex. There are legitimate causes for misery from the chronic coughing, abdominal pain, and joint pain recognized as common symptoms of the disease.
But the associated issues of depression, stress with family, and …
When treating chronic pain, don’t compromise your principles
“I can’t find the fetal heart tones.” The nurse states with a tone of underlying panic as she exits the patient room.
It’s around 7 a.m., and those of us working the night shift are getting ready for morning sign out before we can head home and get some much-needed sleep after a crazy 14 hours shift.
“Tessa, go scan her” the resident nods towards the ultrasound machine, and I cheerfully follow …
A medical student’s struggle with continuity of care
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