It’s been a long day, and you just want to decompress. My boyfriend tells me about his day. I get to hear about the insane amount of reading he has to do for graduate school, or about the occasional annoying customer he’s had to deal with at his part-time job as a bank teller. When it’s my turn to decompress, I usually gripe about a patient or two from the …
Taking care of patients who stop caring about themselves
There isn’t any such thing as an ordinary life.
– Lucy Maud Montgomery
Heroes are ordinary people who make themselves extraordinary.
– Gerard Way
My colleague, Dr. Jesse Ehrenfeld, is currently on leave from his academic anesthesia practice as well as from his post as speaker of the house of delegates for the Massachusetts Medical Society to serve as Lt. Commander Jesse Ehrenfeld, combat anesthesiologist in Kandahar, …
The occupational hazards of being a doctor are frightening
Parents are appropriately expressing concern about the safety of Miralax®, a commonly used stool softener in kids, after a recent New York Times article exposed a potential association with long-term use of the drug and undesired behavioral side effects. As the article explains, the FDA has awarded a research grant to a team at the Children’s Hospital of Philadelphia (CHOP) to directly address these concerns.
Miralax® has been used …
The truth about Miralax in children
I have to admit, I’ve been excited to see radiology slowly infiltrate into the mainstream of sports. Fifteen years ago, it was rare for the public to know when an athlete had an MRI. Now I hear people in the coffee shop saying:
“Man did you see Derrick Rose go down last night?”
“Yeah, we’ll just have to see what the MRI shows.”
In …
What ESPN doesn’t tell you about MRI in professional athletes
My friend, Trent, is an auto mechanic. When he was growing up, he loved to work on old cars. He rebuilt his first one when he was fourteen — and drove it for 11 years. He loved finding problems and figuring out how to fix them. He never cared about getting rich; his goal was to make a decent living doing …
If mechanics were paid like doctors
“So, I told the doctor at the nursing home that I loved my father more than anything. Dad was my friend and the most wonderful man I had ever known. I wanted everything for him. But, I said, Dad was sick, weak, confused, and he never wanted to live like that. The next morning he was dead. That was OK by me.”
I once participated in a panel discussion about hospice, …
The line between comfort care and murder
Living in the trenches of a surgical internship can be a gut wrenching, lonely experience for many. The journey from medical student to resident to surgical attending is a notoriously steep trek, necessitating our long 6+ years of training. Surviving intern year remains as hard as ever despite the significantly greater resources and awareness that exists among residency programs today.
These burdens are felt by all specialties and have tragically led …
Survival pearls for surgical interns
“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
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