There was once a woman whom I met for the first time when she came to the ER, on death’s door, metaphorically. I told her and her family just how seriously ill she was, and how slim the chances of survival. We all agreed on that day to take a shot at it — at survival, that is — despite lousy …
We all have the ability to touch other people’s lives every day
Evidence-based medicine (EBM) has been classically described as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” At first look, this well-accepted approach to clinical medicine appears not only completely reasonable, but also somewhat obvious given the immense amount of research available for academic consumption.
EBM has been repeatedly preached as the gold standard of clinical care across all medical …
The challenge of evidence-based medicine to the new physician
No one wants to hear that they have a disease. And yet everyone will develop some degree of degenerative disc disease (DDD) — or degenerative spine disease — over the course of a lifetime. DDD refers to a combination of age-related and wear-and-tear-related changes that occur within the spine over time. It is very common and a natural part of aging.
Most …
A neurosurgeon teaches us about degenerative disc disease
I used to be a surgical resident in the U.K. One day, I was a little dispirited during a brutal call, and my senior resident asked, “Do you love surgery?”
“I like surgery,” I replied.
“If you don’t love surgery, love it unconditionally I mean — like loving your child — you will be unhappy.” He warned.
I really liked surgery. I like radiology. …
Should I go into radiology? A radiologist gives honest answers.
Some months back I read an interesting interview with Jonathan Skinner, a researcher who works with the group at the renowned Dartmouth Atlas of Health Care. More than anyone else I can think of, the people at the Dartmouth Atlas have studied and tried both to understand and to explain the amazing variations we see in how …
The problem with cowboy doctors in health care
I didn’t really notice him standing in line. But how could I? Hundreds of kids came through the high school gym yesterday. His turn for the heart and lung portion of the high school sports physical had come. He said he was going to play baseball and basketball. How could he with that arm he carried so carefully? I am not …
A high school physical that shook this student to the core
What is it like for physicians to fail their ABMS Maintenance of Certification® (MOC) program examination? How does the largest member board of the ABMS, the American Board of Internal Medicine (ABIM), respond to doctors who fail their secure examination?
As I continue to confidentially collect information from physicians who have failed their MOC examination, I thought it would be important to publish …
So you failed maintenance of certification. What now?
An excerpt form Baby City: An Inside Look into Labor & Delivery.
I am going to make this medical student cry.
I don’t know how I know it, but somehow I can sense it. I know it the second she walks into the resident room on labor and delivery at Cadence …
A medical student on her obstetrics rotation: Behind the scenes
There he stood at our beach party, the family doctor I grew up admiring. I timidly approached his circle of friends to announce I had gotten into medical school and would start in the fall. He stopped to attention. His friends stood watching. I couldn’t conceal my smile. I thought, “He is going to be so excited for me!”
“Get out now.” …
Leaving medical school for a startup. And with no regrets.
I’ve been a doctor for more than 20 years, and I hate to break it to you, but it’s time I came clean: We lie. Doctors lie. Not always. Not necessarily on purpose. But we do.
Sometimes the lies are to our patients. Sometimes, the lies are to our families. And sometimes the lies are to ourselves.
But, nonetheless, we lie. A lot. …
A disclaimer before I even get started on this post.
Some of you who know me or work with me will think that by writing this post I am talking about you or even attacking you. I am not. If you’re especially sensitive, don’t read any further.
I am simply writing something that has been kicking around in my head for a long …
Casual Fridays don’t have a place in medicine
I suffered from extreme nausea during my pregnancy; I had triplets, and I’m pretty sure I had a triple dose. I never threw up, but you know how your mouth salivates the moment right before you vomit, that sensation that sends you running to the bathroom? I had that. All. Day. Long. For four weeks.
By day four or five I was …
She took Zofran and her son had a heart defect. Here’s why she’s not suing.
Each year children ingest an array of foreign bodies including coins, magnets, and a new subset of batteries known as button batteries. Awareness of this small yet very dangerous foreign body is important for parents to understand so they can act quickly if their child is suspected of ingestion.
What is a button battery?
A button battery is a cylindrically shaped object measuring …
So your child swallowed a button battery. Here’s what you need to know.
A while ago, I wrote about “The secret lives of doctors.” The post must have struck a nerve because it went viral, maybe because it helped patients to realize that doctors are human.
We doctors can’t really know how human we are until we become a patient.
That happened to me recently. And it wasn’t pretty. You need to know the …
Being a patient is tough. Here are 3 reasons why.
For many women, pregnancy is a wonderful experience. There are, however, many changes and challenges the mom-to-be can expect, and back pain is one of them. The good news for pregnant women is that the development of severe or debilitating low back pain is very rare.
The incidence of symptomatic low back pain that is severe is about 1 to 2 percent. …
Back pain during pregnancy: Advice from a neurosurgeon
Emergency medicine physicians: Could these be your cases?
Tips to avoid medical errors in the emergency department
LabCorp, one of the largest outpatient lab providers in the USA, is soon going to let you skip the tedium of a doctor’s visit to get lab work done. Want some tests? Come on down!
I’ve got mixed feelings about this. While there are some tests that seem reasonable for people to do on their own — pregnancy and HIV tests come …
Order your own lab tests. What could go wrong?
At a recent block party, neighbors asked me questions about the life of a resident. It amazed me how little the general public still knows about the hours a resident works. Over the years, TV shows have shed some light on what the experience of a resident is like, although none are quite realistic, but it is hard to appreciate from …
Counting 80 hours: The life of a pediatric resident
Do you know the difference between a surgeon and God? God doesn’t think he’s a surgeon.
Everyone who goes into the study of surgery has ideas about what they’re going to be. I would imagine that each individual has different expectations of what the future holds, though few find their future at all resembles those expectations.
I recall when I started my surgery …
A surgeon who wasn’t God in the OR after all
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated for a 1-year history of fatigue, headaches, poor sleep, depression, intermittently blurred vision, and weakness when climbing stairs. She takes no medication. Following a physical exam and lab studies, what diagnostic tests should be performed next?
On physical examination, vital signs are normal. Bilateral ptosis and diplopia are …
MKSAP: 30-year-old woman is evaluated for a 1-year history of fatigue
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