I’ve never been the doctor who yells. However, if you work in medicine, you’ve met him or her. I’ll call this physician “Dr. Barkus Yellby.” Dr. Yellby is angry. A lot. In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted. Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated …
Are you the physician who yells?
The U.S. health care system is the world’s top in health care spending per capita, but in terms of performance, we’re dead last among developed countries. As a young physician embarking on a career in this landscape, it’s glaringly obvious that we need disruptive innovation to create better health at a lower cost. Physicians are uniquely positioned to make critical contributions to medical innovation, but even among …
Physicians as innovators: 6 ways we help and hurt ourselves
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well.
Medical history is significant for a recent diagnosis …
MKSAP: 32-year-old man with a rash on his face and midchest
Did you know that married men have a lower colorectal cancer mortality when compared to unmarried men? What about the fact that married men have higher rates of colorectal cancer screening? Interesting, right? In fact, studies showing the association between marriage and favorable behavior regarding colon cancer screening have been published as early as 2010.
More recently, a study published in the journal Preventive Medicine found that married men are …
How marriage affects men’s colonoscopy rates
Josef Stalin famously said: “One death is a tragedy; one million is a statistic.” Perhaps 250,000 preventable deaths from medical errors, according to an analysis by Makary and Daniel in the BMJ, maketh a Stalin.
The problem with Makary’s analysis, which also concluded that medical errors are the third leading cause of death, isn’t the method. Yes, the method …
Hyperbole is seldom helpful. Especially when it comes to medical errors.
As an integrative medicine physician, I am often questioned about what I do and how I decided to diverge from the normalcy of allopathic medicine. I usually go into a short spiel about my love for thinking outside the box and creating solutions for patients that seek a kinder, gentler style of medicine; one that blends effective healing modalities from all over the globe with my traditional allopathic training.
Most people …
Thinking of starting a cash-based practice? Here are the pros and cons.
During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child. Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity. His family physician pulled out the index card that served as this man’s medical record. Yes, you read that correctly. It was not a chart or computer printout; rather a 4 x …
Maybe it’s time to go back to index cards for medical records
Among hospice staff, it is called “getting it.” One says, “He doesn’t get it,” “I think she gets it,” or, “They definitely get it.” It is a little hard to define, but as with pornography, you know it when you see it. Nonetheless, given the importance of “getting” good end-of-life care, let us take a moment to try and explain.
The 92-year-old patient is bleeding into her head, but has blood …
The enemy is not death. The enemy is needless suffering.
On my recent tour of residency programs, I had the pleasure of meeting many foreign medical graduates (a.k.a. FMGs; not to be confused with international medical graduates, who are U.S. citizens who go abroad for medical school).
Almost uniformly, they struck me as confident, mature and articulate. Many were older than me, some by as much as 10 or 15 years. Most had extensive research experience, and a few had even …
Foreign medical graduates get a raw deal. Here’s why.
Now that I’m getting ready to turn 70, I thought I’d summarize what I’ve learned since I finished my residency, when I was 28. Of course, I didn’t learn all this only by being a psychiatrist, since I would hope that most folks have also learned lots in the last 41 years.
1. Psychotherapy is important, particularly if the patient is on the right medication. I won’t do “med checks,” since I …
What I learned after 41 years of practicing psychiatry
The following is paraphrased documentation, authored by a physician I know, regarding an intoxicated patient in the ER:
1 a.m.: Patient is telling nurse, “Before I leave, I need everyone’s name for my lawsuit. Tell the phlebotomist that if he’s good, he’ll get a cut.”
1:40 a.m.: Patient is making inappropriate sexual comments and is verbally aggressive with medical staff. He is advised to stay in bed.
2:02 a.m.: Patient (who had been sleeping comfortably) wakes up and …
With doctors losing respect, perhaps it’s time to expose medicine’s dark side
Virtual visits are increasingly the rage amongst forward-thinking healthcare providers that want to jump on the telehealth band wagon. Extending the office visit across distance, using the same technology we use to keep in touch with loved ones (videoconferencing such as Skype and FaceTime), is a safe and logical way for providers to venture into a new tech-enabled world that may still be scary for some.
One way to think of …
Here are the limitations of virtual doctor visits
Many young physicians in training have asked me, quietly or by e-mail, “Is it possible to be a Christian and practice emergency medicine?” I think that they ask a good question, and likely for good reasons.
In their rotations, they have witnessed, first hand, life in the ER. They are uncertain, perhaps, because they see the frustration that boils over in the words and actions of otherwise compassionate and caring doctors …
Is it possible to be a Christian and practice emergency medicine?
As a fourth-year medical student, I love introducing myself to patients as the “extra eyes and ears of the team, so feel free to tell me anything you forgot or would like to address, even if you think it’s irrelevant or burdensome. I will be your advocate.”
As I establish rapport with them, the walls come down, and they often provide important information that helps my team provide the best care …
The inspiring reasons why this medical student wanted to become a doctor
Aristotle said, “To avoid criticism: do nothing, say nothing and be nothing.”
Sometimes I wish I was nothing; surely, that would just be so much easier. I screw up all of the time. And I hate it. My latest gaffe was killing our simulated patient by causing him to aspirate. I’m sure no one in my group is still persevering on the events that unfolded during the sim. I also really …
It’s OK for medical students to make mistakes. Here’s why.
Meet Dr. Svetlana Kleyman, a powerhouse chief surgery resident with a heart of gold, who works 16-hour days and runs marathons in her free time. Just 18 months before she was to graduate from SUNY Downstate, she developed a spinal infection that left her paralyzed from the waist down. After months of rehab, she was cleared by her doctors to resume work …
A paralyzed surgery resident is told not to come back. She needs your help.
We are all familiar with the statistics. Chronic conditions like obesity, hypertension, and diabetes are present in our population at unacceptably high and costly levels. More than 78 million American adults are obese, and more than 1 in 20 is extremely obese. About 70 million U.S. adults have hypertension with only 52 percent having the condition under control. Just over 29 million Americans have diabetes and an additional 86 million …
Your patient should get a health coach. Here’s why.
How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys.
Yet in medicine, it’s common for practices to schedule patient visits in 15-minute increments — often for established patients with less complex needs. Physicians face pressure to mind …
Why the 15-minute doctor appointment is dangerous
There are over 400 pediatric intensive care units (PICUs) in the USA, as most recently estimated by the Society of Critical Care Medicine. These units vary widely in size, from 4 or 5 beds to fifty or more. The smaller units are generally found in community hospitals; the larger ones are usually in academic medical centers, often in designated children’s hospitals, of which there are 220.
Given this size range, it is not …
It’s time to formally classify pediatric intensive care units
I was saddened to hear that one of my favorite libertarians, the wonderful journalist John Stossel, has taken ill. True to form, however, he’s taking it in stride (he nonchalantly quipped, “seems I have lung cancer”), and I want to take this opportunity to wish him very well indeed. I enjoy his reporting and writing, and have learned a great deal from Mr. Stossel over the years.
But that doesn’t mean he’s always …
What John Stossel gets right, and wrong, about health care
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