It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned to a rotation in pathology where my job was to process specimens taken at surgery, dictate a gross description of the specimen and then place the specimens into the cassettes that would be used to make the permanent sections. I was transferring a prostate biopsy, approximately 0.5mm x …
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease …
When I finished my book on famous patients, the most common question I received was “Are the stories of sick celebrities really relevant to other patients?” My answer was that yes, with some caveats, these experiences are well-worth knowing.
The same can be said for the story of Patrick Swayze’s terminal pancreatic cancer, which has now been told by his widow, actress Lisa Niemi Swayze, in a new book, “Worth Fighting …
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever before. In fact, the rate almost doubled in the 10-year period between 1999 and 2009.
This drives up the cost of care, as specialist consults tend to be more expensive than primary care visits. Furthermore, specialists tend to …
Hospital stays can be traumatic for patients and their family members. I give you the top 10 ways to survive a hospital stay while maintaining your sanity.
10. Bring your own pillow. Trust me.
9. Bring a laptop computer or request one from the hospital. Hospitals all have free wireless these days and many will actually provide you with a laptop if you just ask.
8. Bring an accurate and updated medication list …
Celebrity is an interesting phenomenon.
On a hot summer night in 1990, my chief resident and I were on call at Harlem Hospital. We were informed that a “guest” was coming to interview us. Hot, sweaty and looking haggard rather than glamorous, we wanted to choke our director when Spike Lee walked through the door with film crew in tow. Lee was there to film the infamous movie, Mo’ Better Blues. …
“Are you saying, doctor, that mom’s not getting better?” Eleanor asked.
“I’m afraid so.” I replied.
“Someone should have mentioned this to me before.” she said, before returning her gaze to my shoes.
We were talking about Eleanor and Roger’s mother, Bertha, who had been hospitalized in our intensive care unit for three weeks. Bertha, 67, had been admitted with an exacerbation of congestive heart failure. Despite everyone’s best efforts, she’d steadily grown …
The fact that the term “cancer survivorship” is now part of our vocabulary is a testimony to advances made in management of these diseases. Most cancer survivors, however, are not unscathed by the experience. As I tell my patients, they won’t be entirely as they were before treatment. How these issues are dealt with varies from person to person. But, awareness that chronic problems may persist long after treatments end …
I’ve written many times that losing weight is the second hardest thing I ask my patients to do. (Breaking an addiction like smoking or alcoholism is the hardest.) The frustrating thing is how little we know about how to lose weight successfully. But we are learning more all the time about why losing weight is so difficult.
Much about dieting and weight loss is poorly understood, but let’s first lay out …
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take the plunge and join an online social network. There are significant advantages that can be gained for doctors who embrace social media. Here are five ways you and your practice can benefit from such professional connections.
1. Finding a better job. The business of the health care economy continues to …
On the first day of the 1st Caribbean Obesity Forum, I presented various talks on obesity – its economic implications, its assessment and the need for firmly anchoring obesity treatment in primary care.
Interestingly, several family doctors in the audience raised the interesting issue that here on Barbados (as probably on other islands) many patients are actually quite happy with their weights.
One family physician noted in his presentation the case of …
An excerpt from Everything I Learned in Medical School: Besides All the Book Stuff.
My body jolts awake to a familiar sound. After a few blind swipes, my blows hit their target, and once again, there is silence. The air in the room is cool and crisp, and every fiber of my being wants me to remain in the welcoming warmth under the covers. It is Saturday morning. On any other …
This is an account of my first encounter with an in-patient from a little while back — I have provided only minimal details about the patient to maintain compliance with HIPAA.
After a firm handshake with each of us, our preceptor embarked purposefully up two floors to our first in-patient encounter. As we walked, I peeked into the rooms with the door left ajar and wondered what brought each individual to …
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In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: “Doctors around the country taking an exam to become board certified in radiology have cheated by memorizing test questions, creating sophisticated banks of what are known as ‘recalls,’ … The recall exams are meticulously compiled by radiology residents, who write down the questions …
The third year of medical school is a lesson in humility. In the OR, you’ll invariably cut the suture too short, or too long, or too slowly. On the floors, the one laboratory value you haven’t checked is the only value vital to the patient’s survival. And just when you think you know everything there is to know about a disease, the Attending Physician will keep asking you questions until …
Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs. The word “malingering” comes from the French word “malinger” meaning “poor or weakly” as these are the characteristics feigned or exaggerated by the malingerer. Malingering has been documented as far back as in the Bible when …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman is evaluated during a follow-up visit for a 6-month history of diffuse muscle and joint pain above and below the waist, fatigue, and difficulty sleeping. She has a 2-year history of hypothyroidism treated with levothyroxine. Her only other medication is hydrocodone-acetaminophen, which has …
I’ve had the luck to attend medical school in the city of San Francisco during what will be looked back on as the start of transformational change in our health care system. My growing interest in technology and new business models as the disruptive forces behind this change, as well as marriage to a technology entrepreneur, has me frequently rubbing elbows with movers and shakers in the digital health space. …
“Do you remember my name?”
Like a broken record, I repeat this question again and again as I make rounds in the hospital. My patients’ universal answer, given with furled eyebrows and an apologetic look is “uh, no, I don’t remember”.
My response: “Don’t worry. It’s Dr. Tony Breu, but call me Tony.” Theirs’ (again with furled brow, but also a smile): “Oh, okay.”
In a busy teaching hospital, it is not uncommon …
Every medical student is a bit apprehensive when he/she knows they will be assigned a new resident. The same questions always come up. Will the resident be nice? Will they understand my busy schedule? Will they make me do a ton of scutwork? Will they make me write all of his/her progress notes? And maybe most importantly, will they let me leave early to study for boards or enjoy the …
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