Beauty in surgery: Traction and counter-traction

Physician
April 11, 2013

Next in a continuing series.

Traction and counter-traction: along with maintaining excellent exposure, that is one of the fundamental principles of operating. It’s Newtonian: equal and opposite. In nearly all forms of surgical dissection, there’s a need for some pull in the opposing direction: tissues that are a little stretched-out, that are under some tension, fall open more easily when dissected. Plus, it’s a form of stabilization, another obligatory …

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A memorable introduction to the family

Physician
April 10, 2013

Although I rarely get sick with the numerous strains of “bugs” that seem to go around our community this time of year, the week prior to my return to work for my next scheduled string of four shifts was spent mainly in bed, coughing and aching and whining about how miserable I felt. Fully recovered, though, I was excited to return to the emergency department to do my fair share …

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The real reason to be cautious about Z-Paks and azithromycin

Meds
April 10, 2013

The FDA issued a warning about the antibiotic azithromycin (Zithromax). The media stories have some patients terrified and some of them are calling me convinced that azithromycin is poison, a reliable agent for suicide.

What’s the hubbub about?

Azithromycin is in a family of antibiotics called macrolides, which also includes erythromycin and clarithromycin (Biaxin). Erythromycin and clarithromycin have long been known to very rarely cause fatal abnormal heart rhythms. It …

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The best doctors teach their patients

Physician
April 8, 2013

The Oxford English Dictionary (OED) identifies the first use of the term “doctour”, as the year 1303 AD, shortened to “doctor” in the 1557 addition of the Geneva Bible.  The OED first defines doctor not as a caregiver or healer, not as a science researcher or expert and not even as one with an advanced educational degree.  The OED, the world’s foremost English language dictionary, defines “doctor,” 700 years ago …

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4 ways asynchronous learning can benefit medical students

Education
April 6, 2013

Dr. Chris Nickson recently asked, if a Martian landed on Earth and looked at how we do medical education, what would she think?

Could it really be true that so many dedicated, brilliant people with the same objectives could be doing exactly the same thing at the same time without sharing their resources? … That they could put so much work put into teaching sessions that so few actually …

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Blaming others for their health problems helps no one

Physician
April 5, 2013

I inherited motion sickness from my father’s side of the family.  I can’t sit in the back seat of a car for more than 10 minutes without becoming sick.  I take meclizine before every plane flight.

I inherited asthma from my mother’s side of the family.  Exposure to perfume, 90+ degree temps with 90+% humidity, or even a good laugh will all prompt me to cough.

These two maladies of mine have …

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The only thing that truly separates doctors from nurses

Physician
April 3, 2013

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Academic Medicine, a journal of the American Association of Medical Colleges, has sent out a recent call for articles addressing the 2013 question of the year: “What is a doctor?  What is a nurse?”  Thirty years ago this would have been an absurd question.  Not only would it have been absurd for doctors and nurses, but for patients too.  Roles were …

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5 essential concepts to know about code status

Conditions
April 3, 2013

Full Code.  Do not resuscitate.  Do not intubate.

Ask anyone without a personal or family history of a hospitalization on the implication of these terms and you’d likely get a blank stare in response.

Unfortunately, this incomprehension often rings true with those who need to know it most: the hospitalized patients themselves.

Many clinical reports (see here and here) have demonstrated that most physicians are not only inadequate in discussing code status with …

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Writing your medical school personal statement: Tips and myths

Education
April 2, 2013

“I have no idea what to write.”

“I want to stand out.”

“I want to be different.”

“I want to have a theme.”

These are all comments I hear from medical school applicants as they start thinking about what topics to include in their medical school personal statement. I find that applicants often feel pressured to be unique and to write something the medical school admissions officer has never read before. But if you …

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Questions to ask when considering new medical technology

Tech
April 2, 2013

“Hey doctor, what do you think about this product/solution/service?”

These days, I look at a lot of websites describing some kind of product or solution related to the healthcare of older adults. Sometimes it’s because I have a clinical problem I’m trying to solve. (Can any of these sleep gadgets provide data — sleep latency, nighttime awakenings, total sleep time — on my elderly patient’s sleep complaints?)

In other cases, it’s because …

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Are physicians more afraid of death than the general population?

Physician
April 1, 2013

The cavernous hospital amphitheater in Tel Aviv, normally used to screen videos and new surgical procedures, was illuminated only by tea candles floating in decorative dishes of water on a recent Wednesday in January. Hundreds of doctors, nurses and other medical personnel filled the seats, as usual. But we had not come to learn the latest life-saving technique.

Dr. Ofira Ben-Tal, one of Israel’s leading hematologists, had lost her battle with …

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Am I smart enough for family medicine?

Education
April 1, 2013

I’m not sure why my parents were surprised when I told them that I was applying to go into family medicine. It seemed like a logical transition after spending six years working in public health and primary care before medical school, but from the perspective of Taiwanese immigrant parents, I couldn’t have made a more absurd career choice. I was confronted with comments such as, “Most people choose careers to make …

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Clinical pearls that you don’t learn during medical training

Physician
March 29, 2013

Al Franken, the humorist-turned-senator, once published a book that was titled “Oh, the Things I Know!” Indeed, by the time we reach parenthood, it is truly amazing what we keep up there in that attic of a brain.

Here is a brief selection of things about the practice of medicine that I have had to discover for myself or never quite figured out, including clinical pearls, aphorisms, dictums, platitudes, mysteries and …

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Where can doctors publish literary writing?

Physician
March 29, 2013

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There are many ways to write about health, medicine, and health care. And there are many people – patients, caregivers, policymakers, pundits, thought leaders, and health professionals – in a position to do so.

Fortunately, the world also offers a similar and growing diversity of places in which to publish this sort of work.

My focus today is more, well, literary.

I know the word “literary” often …

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Why coroners should fill out death certificates

Physician
March 27, 2013

I happened to read an article in the Columbus (Ohio) Dispatch where Ohio coroners are complaining because some doctors, including emergency physicians, are refusing to sign death certificates listing a patient’s cause of death. The coroners are concerned because they are being “burdened” with hundreds of extra cases every year that they must handle. And if other doctors don’t sign off on the cause of death, sometimes it takes two …

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How can you tell if adjuvant chemotherapy works?

Conditions
March 25, 2013

Think you know something about oncology?  Ok then, pop quiz: If you are giving chemotherapy to a patient who does not have cancer, how can you tell if it works?  Ridiculous question?  Not at all.  The answer to that question is; “hopefully, we will never know,” and it is at the core of modern cancer care.

In the 1960s, breast cancer surgeons had a serious problem.  They were doing large complex …

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8 reasons why your practice needs to stay open during lunch

Physician
March 24, 2013

Most professional business enterprises nationwide understand that they could never expect to compete in the marketplace if they shut down their phones 20 – 25% of important business hours every day. Yet that is exactly what your medical practice is doing if you are shutting your phones down for a “lunch break”.

You might be wondering how important can this really be for a medical practice? Can’t patients just wait an …

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