One thing I learned early on as a doctor is different people have different tolerances for pain. At one end of the spectrum, for example, I recall a woman who came to the emergency department with a small splinter in her foot. She arrived wailing in pain, and we had to take her back to a treatment room ahead of other patients because her howling was scaring the people in …
Pain tolerance: A story of two patients
A brief article recently posted the name and picture of a neurosurgery resident accused of smoking marijuana on the job. Dr. Gunjan Goel, MD is a neurosurgery resident at University of California, San Diego, and the list of her awards and publications alone is almost as long as my entire CV. The article is brief, and rather uninformative. The only facts that are known are this: The …
The story of the pot-smoking neurosurgeon is more complicated than you think
I walked silently into the pristinely decorated room of the hospice facility and was greeted by her family. She lay there, not particularly responsive to her surroundings under the pressure and influences of metastatic stomach cancer. The warmness and smiles on the faces of her family told me that at some point and somehow, in the midst of actively witnessing the transition of their mother, aunt, sister, and grandmother, they …
Caring for the dying patient is a rewarding challenge
Dear doctor:
Attached please find the medical records of Mr. Ron C., who is transferring medical care to your office. Ron is a 63-year-old gentleman with recurrent lung cancer, which has spread to his opposite lung and bones. There are multiple treatment choices for his disease, which we have discussed in detail. However, Ron is leaving my care, because he does not trust me.
As you are well aware, metastatic lung cancer …
Treating cancer: Doing nothing is also a choice
Hospital cafeterias are important places. Great progress has been made over the last few years in raising the standard of the food served (to both patients and staff!), with much more emphasis too on making the options healthier and nutritious.
Speaking as someone who has worked in several different hospitals, and with my own general interest in health care quality and improving the patient experience, it’s always very interesting to look …
The cafeteria can tell you a lot about the hospital. Here’s how.
Studies show over and over again that empathy is the key to physician-patient communication and is directly related to patient satisfaction, adherence to medical treatment, lawsuits, and clinical outcomes. Yet despite its importance, many doctors still struggle with showing empathy.
The reality is that while most medical students start school with high levels of empathy, it doesn’t take long before that empathy is beaten out of us. Studies show …
Can you fake empathy until it becomes real?
I’m supposed to speak at the body donor memorial in September. I told the organizers my speech was written. “Don’t worry,” I assured them. “I have it all in my head, just need to get it down on paper. I’m a writer; it’s my process.” But the truth is that I am struggling with what to say. I’ve tried to write it, but I just end up drinking a pot …
How anatomy lab changed this medical student forever
At the heart of American medicine is the concept of bedside manner, and with it the concern that doctors are cold and unemotional. Indeed, doctors are exposed to disease and misfortune on a daily basis. A patient who presents with stage IV metastatic stomach cancer is just one of the many hundreds or thousands of such patients that will walk through the hospital doors in the coming years. Quotidian exposure …
The day I saw the humanity in medicine
I’ve been thinking about this over the last ten and a half years since my soul mate had a cardiac arrest and died. He was 38 and as fit as a fiddle. I am a rural general practitioner in South Australia (family practitioner in American parlance). He left behind four kids (from his previous relationship), and me with a broken heart. We had been together a little over two years.
Western …
6 reasons why doctors grieve differently
Earlier this month I read a Wall Street Journal article about Zeynep Ton’s Good Jobs Index. Who is Zeynep Ton? She is a professor at the Massachusetts Institute of Technology’s Sloan School of Management who has ranked retailers on employee happiness. This was so positive. It was good to hear about businesses concerned about employee happiness and not just about profits and shareholders.
Two weeks later I was dismayed to …
Is your hospital a miserable place to work? Here are 14 clues.
While studying for a certification exam, I came across a question that stayed with me well after taking the practice test. The case discussed a patient who was prescribed antibiotics by his physician for a presumed bacterial illness and then returned the following week with an antibiotic-associated diarrheal infection. The test question then asked what could be concluded from this case. The answer: informed consent (i.e., patient permission for a …
Discussing the side effects of medications: How can doctors do better?
Ask physicians across the country what problems they want solved, and they won’t hesitate to tell you. They worry about the growing health risks they observe in patients based on lifestyle choices, obesity and a variety of social factors that they feel powerless to change. Ask what they would modify if they had a magic wand, and they’ll point to the illogical, problematic and increasingly complex reimbursement schemes still favored …
4 ways to improve the lives of doctors and their patients
My family was driving to see our new niece this past Saturday. While passing through a town on the way, we came upon a motorcycle accident. The rider had been hit by a vehicle and was lying on the pavement with a growing crowd of people who wanted to help. I’ve done it before. I did CPR at the scene of a wreck when I was in medical school, and …
An emergency physician stops at a roadside accident. He finds out he’s not needed.
Sixty years ago, before he became a controversial figure in the field of psychiatry, Dr. Thomas S. Szasz co-authored an article for the Archives of Internal Medicine (now JAMA Internal Medicine) on “The Basic Models of the Doctor-Patient Relationship,” which is well worth reading today, particularly for those who believe that patient empowerment/engagement is a novel and disruptive innovation of our digital times.
The paper is describing …
How can we measure the doctor-patient relationship?
Did it ever occur to some of today’s physicians that many people work awfully hard and complain a lot less than they do about “burnout” and “work-life balance”?
Did it ever occur to them that “work-life balance” is the very definition of a first-world problem, unique to a very privileged class of highly educated people, most of whom are white?
Every day, I go to work and see the example of the …
Why physician burnout and work-life balance is a first-world problem
It was only a matter of time before Kim Kardashian posted a picture on her Instagram account with a bottle of Diclegis, basically announcing her brand partnership with Duchesnay, the manufacturer of the prescription medication for nausea and vomiting in pregnancy. Duchesnay had been tweeting for ages that they were so relieved Kim had found help with Diclegis — so much so that I was wondering if Ms. …
Kim Kardashian’s first trimester nausea: The truth behind Diclegis
“I’m just the night doc,” you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was “just the patient,” who lay suffering hours before her death and the RN was “just the nurse” withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to …
When doctors pass the buck: The ugly side of a shift-work mentality
A few weeks ago, after feeding my face with rich, dense chocolate cake brought by a truly awesome nurse (for no particular reason other than a warm and generous spirit), I walked back into a room to check on a post-cardiac arrest patient.
After surveying his vitals on the monitor, I turned my attention to two nurses and a pharmacist who were discussing the management of his six drips. He was …
As a relatively young physician, I always enjoy my conversations with the older members of our profession, who’ve seen so much change over the last few decades. I’m fascinated with their stories about how different the medical world was when they were residents, how treatments were so novel, and how they used solid clinical skills to get to the diagnosis.
Those were the …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is evaluated for a 1-year history of loose stools. She reports approximately four episodes per day without abdominal pain. She has not had nausea, vomiting, weight loss, bright red blood per rectum, or melena.
On physical examination, temperature is 36.7 °C (98.1 °F), blood pressure is 115/85 mm Hg, pulse …
A patient presents with painless diarrhea. What should you do next?
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