As I’ve written before, I have to confess I’ve never been a huge fan of pathways and protocols. They often struck me as rigid and insensitive to the nuances of differences between patients. There are also times when they are just absurd when physicians, especially mid-level providers, implement them when analysis of the clinical situation clearly shows them to be inappropriate.
I suppose part of me …
Do protocols and pathways improve care?
I remember reading a post recently on a Facebook physician group that involved a cardiologist who asked for help on how to manage her finances after a divorce.
The pertinent aspects of this situation involves the physician being left with essentially nothing in retirement savings. She is mid-career with children and wants an option to reduce her schedule eventually to spend time with her children during the weeks she has custody. …
What to do financially when you’re a doctor getting a divorce
When I was twelve years old, I was at a friend’s house with a couple of classmates. The four of us were roaming the rural property, which belonged to my friend’s grandfather. We climbed through cars in an abandoned junkyard, tested our balance on some railroad tracks, and explored the surrounding woods. My friend’s grandfather worked late, so we had the house to ourselves. Eventually, we went into the house …
People own firearms. Clinicians have a unique opportunity to help them do it safely.
The symptoms of systemic discrimination and sweeping organizational problems are ubiquitous in the news and health care literature. Yet, medical students’ curricula focus on codes of professionalism, setting these issues, and the historical forces that created them to the side. While professionalism is undoubtedly an important aspect of being a physician, it is simply not enough to give students the background they need to recognize the historical contextualization of ethical …
Medical ethics and medical school: a student’s perspective
On March 16 — the same day that the nation’s first shelter-in-place orders were announced in the San Francisco Bay Area — a Seattle woman rolled up her sleeve to take the first experimental dose of a possible COVID-19 vaccine.
“We all feel so helpless,” she told reporters. “This is an amazing opportunity for me to do this.”
Also making history that day was Lisa A. Jackson, MD, MPH, physician-researcher with a …
Bridging the gap between the bedside and the bench in the fight against COVID-19
“Holding space means being physically, mentally, and emotionally present for someone. It means putting your focus on someone to support them as they feel their feelings. An important aspect of holding space is managing judgment while you are present.
Like when you tell a patient that they have stage IV pancreatic cancer and that it is nonsurgical and even with the best …
Palliative care and the importance of holding space [PODCAST]
If you are a doctor (or med student/health professional) and are human, you’ve probably made a medical mistake. You’ve probably not received emotional support for the mistake. Maybe you’ve never told anyone about a mistake that still haunts you today.
The truth is that almost all physicians have admitted to medical mistakes sometime in their careers. Depending on the patient outcome, many doctors carry the distress of medical errors for months, …
What not to do after a medical mistake
I am a veteran. My father and all three of my brothers are veterans. I have been to war, separated from my family, with the danger real, living in the desert, in a tent with the sand blowing through the walls, sleeping on a cot with cardboard boxes for furniture. I know how it feels to lay on that cot, in the darkness, missing your family so badly it physically …
Take the time to thank a veteran and to reflect upon the sacrifices they made for you
There is something special about being a “first.” First to go to college; first to start a business; first write a book, etc. Becoming the first person to achieve something is remarkable because it sets a precedent for what is possible. What once seemed unattainable is now alive and well in living color.
Kamala Harris has made history as the first female vice president-elect of the United States and will also …
The many firsts of the 2020 election
Presuming the North Carolina and Alaska Senate seats remain in Republican hands, the Senate will come out no better for Democrats than a 50-50 tie with Vice President-elect Harris being the tiebreaker. If Republicans win at least one of the two Georgia run-off Senate races, the Republicans will maintain control, and the Democrats will not have the votes to move any partisan health care legislation.
But the Democrats will control the …
Joe Biden won. What does that mean for health care?
The motto of the House of Stark from Game of Thrones is “winter is coming.” The meaning is a warning to remain vigilant as there are troubling times ahead. This motto applies to both mental illness and the COVID pandemic. There was a brief time where we saw improvements in case numbers and deaths. People began to see small snippets of normalcy again. It gave everyone false hope that normalcy …
The COVID winter is coming. The time to prepare is now.
“The reality of being a medical practice owner is that we are small business owners and very vulnerable to the impact of COVID. Having previously worked in the telemedicine industry and because I am a psychiatrist, I initially felt that I was in a good position to adapt to this crisis – and this has been overall true, but the reality …
How to balance family and professional needs during the pandemic [PODCAST]
It’s good to have options, isn’t it?
So why isn’t there an option when it comes to taking your boards? In other words, can’t residents have a say with which board to become certified with once they’re done with their residency?
Well, there’s good news for you. The answer is yes. You definitely have options. There are other boards for your initial written exams. (And that also includes the oral exams for …
You have options when it comes to board certification
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An excerpt from Universal Death Care.
Machine gun fire ripped me open—From Left to Right. There were too many bullets. No way could I feel each wound. They blended together like a single strike of lightning. I was paralyzed by pain. It had taken root in me. …
The trauma of a combat doctor in Iraq
Medical schools are increasingly emphasizing early clinical exposure for their medical students. While the traditional medical education format — in which the basic sciences are taught during the first two years, and clinical rotations are stressed during the latter two — are still generally followed, many schools provide their students with exposures to the hospital or clinical settings much earlier in their medical education. For example, just two months into …
The benefits of early clinical exposure in medical education
I started my medical training in the late 1990s. This was after the AIDS epidemic; that is to say, by that time, the human immunodeficiency virus was known, and there were already proven treatments. So, for doctors of a certain age, this is the first time we have battled an emerging disease. This has created a torrent of confusion and therapeutic missteps. The gold standard double-blinded, randomized, well planned, placebo-controlled …
It is overwhelming hopelessness that crushes caregivers’ collective souls
“To help the reader understand the issues better, I would like to relate some stories. A friend of mine was dying of pancreatic cancer. He had an implantable morphine pump and was on both hospice and palliative care. Still, he found that his suffering was unbearable and wanted to die sooner. Doctors told him that his only option to end his …
Medical aid in dying is not assisted suicide [PODCAST]
For thousands of years, bonesetters and doctors could not accurately diagnosis broken bones or differentiate such injuries from joint dislocations and torn ligaments. That changed with a chance discovery almost exactly 125 years ago. Subsequently, perhaps with equal parts of chagrin and enlightenment, doctors began using the new discovery to discount their previous assumptions and accurately diagnose skeletal diseases.
In his darkened laboratory on November 8, 1895, …
Orthopedic surgery enters the modern age on a chance observation
Primum non nocere, or “first, do no harm,” is a fundamental principle in the practice of medicine. Physicians vow to do as much when taking the Hippocratic Oath on their first day of medical school. But where does the buck stop? I posit that we in the medical community harm patients when we fail to engage in political advocacy.
Why should physicians care?
Health care accounts for …
The medical community harms patients when they fail to engage in political advocacy
In the middle of a busy week of balancing clinical, research, educational, administrative, and parental responsibilities, I receive an email request from a prominent journal to review a manuscript. If I agree, I will spend a couple of hours reading the manuscript, offering comments, and registering my opinion. Several weeks later, I’ll probably be asked to review an edited version all over again. And in exchange for this effort? Nothing. …
Fairness in medical publishing: Reforming the peer review process
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