A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist. I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus.
I expected a benign explanation for her swallowing issue. She was relatively young and not particularly ill. She had seen my partner years in the past for a similar complaint, which he …
Who is a PCP? (And does that second “P” stand for “physician” or “provider”?)
Who gets to say? Does it matter?
Perhaps we should start with some basic qualifications: The degree of MD or DO, the satisfactory completion of an accredited residency in family medicine, and successfully passing the written examination of the American Board of Family Medicine (ABFP, an organization distinct and independent of the AAFP). Hard to argue with those.
How …
Who gets to call themselves family physicians?
Earnest Tipp was very overdue for his blood pressure follow-up. Almost a year and a half overdue, as a matter of fact. The last few times I had refilled his medications, I had added “needs follow-up” to the signum on his scripts.
The other day I finally saw him in my schedule. I thought about him all morning. A tall, muscular 90-year …
Stay away from doctors: From a patient who listens
Anyone considering attending a Caribbean or any foreign medical school should do due diligence. An Internet search is step one. If the school does not list residency match statistics, that could be a red flag. It would not be easy to accomplish, but try to speak with some current students or recent graduates of any schools you are thinking about.
If the school won’t give you any names, use caution, and …
IMGs matching into surgery: What are the chances?
I am lucky enough, from time to time, to be invited to speak to young women who want to be surgeons when they “grow up.” I always have a hard time striking a balance between what I should share that is positive and inspirational and what I should share that is a little harsh and uncomfortable. Once, I turned to my …
So you want to be a female surgeon. Here are 10 tips to make it.
A few months ago, I was seeing an elderly man in the hospital with a sigmoid mass seen on his colonoscopy that day. He had presented to the hospital with fatigue and anemia, and the long meandering workup eventually zeroed in on this malignant appearing mass as the source. His daughter was in the room while I discussed the results, the …
I am a general surgeon. There is no shame in that.
For me, hepatitis B booster shots feel pretty much as pleasant as being sucker punched in the arm. You can imagine that it didn’t inspire much elation when I scrolled through my calendar to see, spelled out in big red letters, a reminder for “Hep B #3.”
Now, as I reflect, this reminder feels like a victory of sorts.
When you are told during medical school orientation that you must be reimmunized for …
Dealing with doubts in medical school
Alright, we need to talk. Those of you who follow my blog know that I don’t shy away from controversial topics and that I don’t have a problem speaking my mind. I try to do it in a respectful, informative, and somewhat humorous way. But I saw something this morning that needs to be addressed, and it’s not funny at all.
As I was eating breakfast before work, I saw a …
Don’t use essential oils for asthma. Here’s why.
Doctors and patients bond over time. Information exchange, education and sharing of expertise are critical activities that add to the effective practice of medicine.
Delivering bad news is, unfortunately, an unpleasant part of a physician’s job. Honesty, empathy, and clear communication are essential to delivering news to patients and their families — even when the news is unpleasant or unexpected. While communication is an integral part of the practice of medicine, …
Doctors sometimes don’t inform patients of bad news. Why?
An excerpt from The Secret Language of Doctors: Cracking the Code of Hospital Culture.
When it comes to modern medical slang, there’s Before Shem and After Shem. Shem refers to Samuel Shem, the pen name of Dr. Stephen Bergman, psychiatrist and author of the blockbuster novel The House of …
The House of God brought attention to medical slang
It is well accepted among health economics wonks that the lion’s share of pharmaceutical company profits come when these companies hold exclusive rights to their products. Once their blockbuster pills go “generic,” competitors enter the marketplace and profits plummet. Consider captopril, a groundbreaking heart failure medication introduced in the early 80s by Bristol-Myers Squibb under the trade name Capoten. After making a fortune for the company, captopril went generic in 1996. …
How are drug companies making millions from generic drugs?
My first experience administering injections involved sitting in an ICU room, ten years old, drinking bitter diet Shasta colas and watching thrillers from the 90s starring Sandra Bullock. The nurses started me on oranges. Easy as pie — I could stab away, practicing insulin injections with saline and fruit. The oranges practically squealed with delight upon puncture, rewarding me with the scent of citrus and a plume of juice — …
My first experience administering injections
When I was a resident, I saw a middle-aged man, “Charles,” who came into the hospital after playing a round and a half of golf. When I looked at his right foot, he had an ulcer in the shape of a golf tee. He had played the entire day with a golf tee in his shoe and only noticed when he found drainage on his sock. The story sticks in …
When examining patients, don’t forget about the feet
Dear patients,
First of all, thank you for calling for an appointment. Seriously. Ever since I’ve gone open access, if the phone doesn’t ring I’m toast. And thank you for your interest in preventive care. The fact that it’s now free (well, no cost to you at time of service: trust me, it’s not “free”) has probably motivated more of you to call. That’s OK. But sometimes it seems that your …
Let’s clear up the confusion about what a physical is
I recently attended the David Stroud Adolescent and Young Adult [AYA] Symposium at Keck Medicine of University of Southern California. It was a very interesting symposium with experts in adolescent and young adult cancer presenting on many different topics important for this population. There was also a panel of young adult …
Should we give patients our cell phone numbers?
I practice gastroenterology in Cleveland in the dark shadow of a large medical institution whose name contains the name of our city. They are a world class medical institution whose reputation is largely derived from its cardiovascular department. Presumably, these practitioners, like all doctors, advise patients who smoke that cigarettes have deleterious health effects. The entire campus is smoke-free, as …
Can hospitals tell workers not to smoke at home?
Recently, a jury awarded a young California resident $28.2 million for a delayed diagnosis of a pelvic tumor. The jury found Kaiser Permanente (KP) negligent. Doctors in the system, touted to be one of the finest systems by the president, allegedly refused an immediate MRI for back pain in a 17 year old. The patient eventually received an MRI three months after …
After a verdict: Doctors need to be taught a lesson. Really?
My interns started the term with mixed career aspirations. One wanted to do interventional radiology, the other, “not sure.” Now, in their last few weeks of our term, they’re thinking about a surgical career. Which I think is great. I’ve been lucky enough to have had some great advice over the years, and I’ve nutted a few things out myself along the …
So you want to be a surgeon? Here are 10 tips to help you.
Mr. U* came to the hospital overnight with severe heart failure. His breathing was supported by a ventilator and he was sedated. Thus, our primary means of communication was via his daughter. His daughter, distraught, stayed awake through most of the night. She appeared suspicious about her father’s care, immediately asking my credentials when I entered the room and demanding that we discuss treatment decisions with her alone. The next …
How doctors and families can work together in patient care
I was asked by one of my readers recently to write a post on how I maintain work-life balance during the all-consuming intern year of medical training. I love this idea because keeping myself sane while spending 80 percent of my time in the hospital has proven to be a constantly challenging task, and I’ve come up with a few ways …
5 tips to maintain work-life balance as a medical intern
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