“Katie, If you go into surgery, you’re going to miss patients.” It was three in the morning in the ED; the resident was feeling the strain of a 24-hour trauma call, and I was loving it. I had spent the past half hour with a lovely, older woman whose foot had gone through the floor of her vehicle in a crash. We chatted about where she had been traveling, and …
Reflecting on an orthopedic surgery rotation
Ever since we are children, our parents and society teach us how to play together with others. What we don’t realize is that this lays the groundwork for developing important teamwork skills — the same skills that enable success and positive outcomes in the workplace. My own experiences in hospital medicine practice throughout the last decade continue to increase my appreciation for these seemingly simple yet invaluable techniques.
Like many young …
How to build a great hospitalist team
Some people who know what I do don’t really know what I do.
They picture me floating through the hospital extinguishing lives, blowing them out one by one like candles down an endless corridor. They think I practice euthanasia, that my presence alone hastens death — that I consume hope and happiness like a black hole, compressing it all into nothingness. Some call me the Grim Reaper, others the Death Doctor. …
I’m a palliative care doctor. This is what I do.
Many physicians I know are struggling to make ends meet while making several hundred thousand dollars per year. Despite growing incomes, their savings rates remain extremely low due to ever increasing expenses. What they do manage to save, they turn over to professional money managers.
How does this happen? Why are some of the smartest, hardest-working and most responsible members of our society unable to create real wealth? The answer is …
Most doctors are financially illiterate
Mr. Dwyer isn’t my patient, but today I’m covering for my partner in our family practice office, so he’s been slipped into my schedule.
Reading his chart, I have an ominous feeling that this visit won’t be simple.
A tall, lanky man with an air of quiet dignity, Mr. Dwyer is eighty-eight. His legs are swollen, and merely talking makes him short of breath.
He suffers from both congestive heart failure and renal …
We forget to ask patients what their goals are
I will always remember my awkward medical school interviews. Filled with bioethical scenarios and questions to measure my ability to prevent an impaired physician from practicing, the interviewers seemed hardly interested in my prior career achievements or humble beginnings.
Such discussions carried on through the first two years of medical school. They never taught us how health care reimbursement works or why …
A tragic physician story the match doesn’t want you to hear about
I see patients with abdominal pain every day. Over my career, I’ve sat across the desk facing thousands of folks with every variety of stomach ache imaginable. I’ve listened to them, palpated them, scanned them, scoped them and at times referred them elsewhere for another opinion. With this level of experience, one would suspect that I have become a virtual sleuth at determining the obvious and stealth causes of abdominal …
How much testing should you do in chronic abdominal pain?
Nurse Shannon Wilkens on floor 4 west thought she saw someone she knew in scrubs walking into room 414.
“He was tall, I swore he looked familiar. Our charge nurse informed me he was recently hired and volunteered to work nights,” Wilkens recalled. “So being that it was slow, and I had only three patients as opposed to …
Doctors moonlight as nurses to stay competitive
In his popular tome, The Innovator’s Prescription, Clayton Christensen proposes several cures to health care’s cost disease, known as disruptive innovations. One is the replacement of physicians by advanced practice clinicians (APCs). That is, by nurse practitioners and physician assistants. APCs meet the requirements for Christenson’s disruptive innovators: They cost less (than physicians) and are good enough.
There is little doubt that APCs …
Do physician assistants and nurse practitioners really save money?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman comes for a preconception evaluation. She has a history of hypertension that is well controlled with lisinopril. Medical history is otherwise unremarkable.
On physical examination, blood pressure is 134/86 mm Hg in both upper extremities; other vital signs are normal. Results of the cardiovascular examination are unremarkable. There is no …
MKSAP: 25-year-old woman comes for a preconception evaluation
You are human and fallible.
– Charlotte Bronte, Jane Eyre
Alas, the frailty is to blame, not me — for such as we are made of, such we be …
– William Shakespeare, Twelfth Night
Sha-doo-bee, Shattered …
– Mick Jagger, “Shattered”, The Rolling Stones, Some Girls (1978)
The image of the surgeon is synonymous with strength. Surgeons are stereotypically charismatic, commanding, confident, even arrogant. Strong minds, strong bodies, strong wills. Leaders, especially …
This is exactly why surgeons are so fragile. All of them.
I am a doctor today because of Dr. J.W. Epstein, my pediatrician in Cleveland in the 1950s. An immigrant from the Nazi terror in Europe (it was family lore that he had escaped the Holocaust), he had trained in Vienna and spoke English with a Germanic accent. His house calls are etched permanently in my memory. His visits were heralded by a fury of activity, led by my mother. “The …
Professionalism: A commitment to lifelong learning aimed at the care of the patient
When I was in nursing school there was always a lot of eye-rolling when it came time to discuss nursing diagnoses. This was mostly because nursing diagnoses were followed by book-length nursing care plans that we had to produce for various imaginary patients. There was also a faction, including myself, who thought a medical diagnosis was just fine, thank you, no need to reinvent the proverbial wheel.
For example, for a …
The profound wisdom of the nursing diagnosis
In respectful memories of Benson, Rose, and Sandy. I want to thank each one of them for helping me become a better physician.
I stepped into the intensive care unit with a feeling of apprehension. I knew deep down, the patients I was going to care for were sick patients. Their status could change at any time. This was my first week on the ICU as a resident physician.
Benson needed emergent …
A resident working in the ICU: What you cannot control scares you
Citing slow load times, confusing menu structure, and overall frustration with the user interface, St. Barnaby’s Hospital has announced that the old electronic health record (EHR) will be replaced with a new state of the art binder-based system, in which a so-called “paper chart” is kept for each patient.
The new …
Hospital replaces EHR with new, efficient “paper chart” system
As a faculty member, I’ve encountered many medical students excelling inside and outside of the classroom. Students can be recognized for their contributions through scholarships, awards, and grants. Whenever I can, I try to direct students to these opportunities. It’s been a great joy for me to help students win scholarships, and here’s what I’ve learned from award recipients.
1. Your ability to develop strong relationships with faculty mentors is crucial …
What I learned from medical school scholarship and award recipients
Ear infections (or, what we like to call “acute otitis media”) are one of the staple diagnoses of pediatrics. Most kids have at least one before their third birthday. And most pediatricians see at least one every day by 11. You would think we would always get it right. But I have a confession — we don’t. In fact, children are misdiagnosed and over-treated at an alarming rate.
There are several reasons for …
Why is diagnosing ear infections so hard?
Doctors have a difficult time adjusting to other cultures and because of this flaw, patients, and the medical profession suffer. By culture, I do not mean religious or philosophical background, socio-economic difference, country of origin, nor even the silence created by language and education barriers. I am referring to the communication and comprehension chasms that exist between different occupations and physicians.
What …
Why other professions can’t relate to medicine
ESPN sportscaster Stuart Scott’s recent death has given the American public a chance to reflect on what it means to live with a cancer diagnosis. His speech at the ESPY awards in the summer of 2014 was widely hailed as an inspiration to people with cancer. Obviously, the Jimmy Valvano Award for Perseverance with the ties to cancer research (Jimmy V Foundation) and Scott’s public image as someone being …
Stuart Scott and his fighting words
Dangerous ingredients, like toxins, antifreeze, and mercury, are touted by many as reasons to decline vaccination against influenza. However, toxin is an inaccurate term regarding vaccines (a toxin is a poisonous substance made by cells or organisms and is definitely not in any vaccine), mercury is a non-issue (see below), and there is no antifreeze in vaccines (although some contain propylene glycol, …
Scared of the flu vaccine? Let’s see what’s really inside it.
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