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10 things you might not know about the emergency department

Physician

July 22, 2015

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1. Wait times in most emergency departments are ridiculous. But, if you have a real emergency, you won’t have to wait. If you have abnormal vital signs, a worrisome ECG, or concerning chief complaint, you will be seen long before the person who checked in with a sore throat to get a work excuse.

Patients with chief complaints like “GSW abdomen” and “found down/unresponsive” don’t wait to …

Why the Surgeon Scorecard is a journalistic low point for ProPublica

Jeffrey Parks, MD

Physician

July 22, 2015

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With much hype and fanfare, the independent investigative journalism outfit, ProPublica recently released their Surgeon Scorecard, assessing individual specialist surgeons who perform elective knee and hip replacements, spinal surgery, prostate surgery, and gallbladder removal surgery.

I had blogged about the impending release. My trepidation about the idea of a non-medical, non-scientific organization analyzing complex surgical data concerned issues such as …

Asian-American discrimination: Is medical school next?

Vamsi Aribindi, MD

Education

July 19, 2015

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In the news recently has been a complaint filed by over 60 Asian-American groups, alleging discrimination in admissions at Harvard. They point to such statistics as this: in 2009, among accepted applicants to the Ivy League, the average SAT score on a 1600 point scale for Caucasians was 310 points higher than Hispanics …

There’s a good reason why doctors don’t send test results

Deep Ramachandran, MD

Physician

July 17, 2015

Recently I read an article in the New York Times by Elisabeth Rosenthal. She’s the same author of the enlightening article, “My doctor charged me $117,000 and all I got was this lousy hospital gown.” That may not have been the exact title of the article.

Following that article she wrote a follow-up about the long and difficult ordeal …

A patient is angry with her emergency care bill. But here’s what she really got.

WhiteCoat, MD

Physician

July 17, 2015

Natalie Fuelner created a well-written article in the Bangor Daily News describing some of the tribulations many new parents go through with young children. One weekend, her toddler fell face first onto a metal patio table. Immediately, the toddler’s face is full of blood. The dad panicked. Natalie was a “trembling mess” on the inside.
Their physician neighbor wasn’t available to look at the child. …

A physician’s experience with a false positive test result

Justin Reno, MD

Physician

July 14, 2015

“Your wife has gestational diabetes.” My heart stopped when my wife’s physician called to tell me this. “I want you to tell her because it’ll be easier to give it some time and let it sink in. Tell her to call me if she has any questions.” But I had questions — about a million.

Let me give some background information. I’m …

Comfort may be the most important thing that physicians can provide

Amrapali Maitra

Physician

July 13, 2015

A hospital can be full of discomfort. My patients tell me that the food is unappetizing. The beds hurt their backs. The noise echoing through the hallways at night makes it impossible to sleep. And for those patients near the end of life, the treatments being offered may no longer be of benefit, causing more pain than good.

The answer to discomfort for those who are very ill is comfort care, …

The physician is the ultimate patient advocate

Kathryn A. Hughes, MD

Physician

July 13, 2015

“Only one rule in medical ethics need concern you — that action on your part which best conserves the interests of your patient.”
– Dr. Martin H. Fischer, German-American Physician and Author

“A physician shall, while caring for a patient, regard responsibility to the patient as paramount.”
– Principles of Medical Ethics, American Medical Association

“I pledge to pursue the practice of surgery with honesty and to place the welfare and the rights of …

What to do when your doctor says you can’t have an IUD

Jennifer Gunter, MD

Conditions

July 12, 2015

I hear this fairly often: Women telling me they asked their GYN for an IUD and were told that they couldn’t because they had never had children. Their GYNs are wrong and unfortunately it’s not just a few who think this way.

A study from last year tells us that 32 percent of OB/GYNs think that women who have never …

A quiet day in the doctor’s office: And that’s the way it’s supposed to be

Rob Lamberts, MD

Physician

July 10, 2015

It’s been a very slow week in my office. Today we almost pitched a no-hitter, having only one patient come in toward the end of the day. Overall, we’ve been quiet in nearly every way: few phone calls, few patients stopping by, few appointments, few secure messages.

What’s wrong?

That was a trick question. This is exactly what should be happening when things are going …

A neurosurgery case that this medical student won’t forget

Basheer Elsolh

Education

July 10, 2015

After the last elective case of the day, the neurosurgeon I was shadowing told me that he was on overnight call that evening, and that I could stick around to observe more surgeries if I wanted to. “Yes,” I responded. “Absolutely yes.”

My fascination with surgery stems from its ability to provide immediate results to a patient by cutting out, repairing, reshaping, or …

10 thoughts on the transition to a third-year med student

Robert Centor, MD

Education

July 10, 2015

The transition between the basic science years and the clinical years in medical school are jarring, mystifying, exhilarating and thought-provoking. Recently, I did an hour conference with approximately 30 medical students. About half started their clinical year five weeks ago, while the remainder have only three weeks left before they finish the year. They gave me permission to share our discussion. We focused on their (and my) observations about the …

There are only 3 ways to allocate health care resources

David L. Katz, MD

Policy

July 8, 2015

Manny Alvarez is a 23-year-old college student with the misfortune of having not just a devastating cancer — but the wrong devastating cancer. The chemotherapeutic agents shown to be highly active against his specific tumor cells are FDA approved for the treatment of leukemia, but not for the stunningly rare kind of sarcoma with which Manny has been diagnosed. Nothing is …

You’ll be shocked to see what an emergency C-section is really like

Heather Rupe, DO

Conditions

July 7, 2015

The scalpel hits the skin immediately, splaying it open with one smooth swipe. Two more swipes through yellow globular fat and I hit the glistening white fascia layer. If this weren’t an emergency, I would stop to carefully cauterize the small bleeding blood vessels in the fat layer, but there is no time for that now. I nick the middle of …

The problem with medical TV shows. A surgeon sets the record straight.

Dr. Nikki Stamp

Physician

July 7, 2015

I never really watched medical shows, even before and during medical school. I watched maybe one season of ER, a couple of seasons of Grey’s Anatomy and House MD and maybe one episode each of Private Practice, Chicago Hope, Emily Owens MD and other random medical shows. The only medical show I made an exception for was Scrubs, because it was …

Poker face: The complex psychology of the patient-doctor interaction

David Jones, MD

Physician

July 6, 2015

Patient-doctor communication often has many facets, wrinkles, and twists. Medical school prepares a doctor minimally for the ups and downs of these patient interactions. There is no mannequin who can train each medical student how to deal with every personality, response, or even outburst by each patient. On the job training is sine qua non.

During and after medical school, it took …

There is no shame in honest work, no matter what the job description is

Erica McCaleb Camp

Physician

July 6, 2015

When my sister, Jessica, was a nurse anesthetist student at the University of New England, she had the opportunity to rotate at Johns Hopkins, and she seized it. She was young and fairly new to the medical world and so she did not recognize at first the name of the neurosurgeon with whom she would be working — Dr. Ben Carson. After receiving multiple comments from numerous people about how great it …

An inappropriate use of medical jargon: Words do matter to patients

Laura Withers, MD

Physician

July 6, 2015

My patient had suffered a terrible, crushing injury to his chest leaving many ribs and his sternum fractured, his lungs and heart badly bruised and his body on the edge between life and death. He was on a ventilator, the tube through his mouth into his windpipe pushed air into lungs that couldn’t draw for themselves. He was on constant medications for pain and to sedate him while we used …

Mad Libs for medicine. Do you think you can use these?

Edwin Leap, MD

Physician

July 5, 2015

Do you remember Mad Libs from when you were a child? A story is filled with blanks, and as you fill them in with inappropriate and ridiculous words, you laugh until you can’t see straight. You laugh until you can’t breathe, and your parents beg you to stop! Let’s be children again. Share these with the nurses, and give the shift a little levity.

Pain medication. You see, doctor, my pain specialist …

A physician enters rehab. What happens next should disturb you.

Anonymous

Physician

July 4, 2015

I’m a physician, and I’m adrift. I am pretty much lost at sea. I’ve often thought of writing this column, but afraid I’d be recognized, I’ve hesitated for years. Even now, I’ll most likely remain anonymous, because I’m in a vulnerable position. Let me preface my remarks with the reassurance that I’m not a bad person.

I developed dependence on opioids several …

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