I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time.
I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of …
What a messy house has to do with medicine today
I recently began a rotation at the hospital as one of the night float interns. As part of this responsibility, I manage the care for approximately fifty patients each night. Day after day, I perform the same routine in preparation for the night ahead: Grab my stethoscope and pager, claim one of the code pagers, pick up a time sheet to fill in the nightly team to-do’s and mentally prepare …
How to survive a night float rotation
Excerpts from The Guide to the Future of Medicine.
Enormous technological changes are heading our way. If they hit us unprepared, which we are now, they will wash away the medical system we know and leave it a purely technology–based service without personal interaction. Such a complicated system should not …
What will future of medicine look like? Start here.
“To help other people overcome their injuries.”
This mantra was accompanied by flushed faces, hidden trembling hands, and nervous chuckles as the majority of my peers told the class why they decided to pursue physical therapy as a career. Soon thereafter, this adage was lost as we dived into our studies, learning every bone, muscle, and organ. Focusing on the human body is a must for all healthcare professionals, and PTs …
Reflections after the first cadaver lab
Training doctors is no easy task. After medical school, newly minted doctors enroll in residency programs at various hospitals throughout the country for a length of 3 to 8 years, depending on their specialty. Some specialties, like family medicine, are even considering adding another year to the process. Resident physicians spend this time working long, arduous hours under their attending physicians, learning the clinical intricacies of their specialties that could not …
Why does Medicare pay resident salaries?
I remember the day like it was yesterday. I was 10 years old, dressed in kid pajamas with sleep still in my eyes. I walked upstairs with a sense of purpose. “I can’t take it anymore,” I told my parents. At that point it had been a year since we found the surgeon who was finally able to offer the chance …
When is it right to share our personal struggles with patients?
This article adapted from a lecture presented by Pamela Wible, MD, at the 2014 American Academy of Family Physicians Scientific Assembly in Washington DC.
Why did you go to medical school?
I’m a family physician born into a family of physicians. My parents warned me not to pursue medicine. So I went to medical school. Ten years later, I’m unhappy with the direction …
Physician suicide 101: Secrets, lies and solutions
Drug prices are a difficult issue to write about because real data about the workings of pharmaceutical companies is very difficult to uncover. Still, I came face to face with something that seemed extremely not right and so I feel I should at least make some comment. It started when I prescribed a patient sumatriptan for her recently more frequent migraines. …
Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals …
It’s time to tell fast medicine to slow down
Medicine is not about money, except when it is.
When I was in my residency training, pharmaceutical reps still roamed the land. Vast herds of gorgeous young women in tight skirts and stilettos traveled through doctor’s offices, clinics, hospitals and residencies all over creation. Their appearance was always a thing of joy, especially for sleepy, hungry physicians-in-training. Someone would run to the …
Money has always been and will always be a big part of medicine
I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference — she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through.
I have a different thought.
Although every experience …
When you can’t share experience: The power of listening
An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine.
A doctor’s self-worth can be tied up with a lot of issues.
How well can we make a diagnosis?
How elegantly can we perform the surgery?
How happy are our patients? Our staffs? Our families?
How many articles …
Fall in love with medicine again
A few months ago I was paged by a medical student in the emergency room at ten o’clock. I had just changed my clothes, and before my pager went off my attention had been squarely fixed on the newest Jack Reacher novel.
You can usually tell when someone is going to ask you to come into the hospital from home, because there …
Medicine cannot be reduced to just a job. Here’s why.
We always want to get it right the first time when treating patients, but the truth is this is difficult. When there is uncertainty of disease course and prognosis, multiple treatment options, and variable responses to therapy this becomes even more challenging. Our typical strategy to making it “just right” isn’t too different from Goldilocks. We have mild treatments (too cold), and aggressive treatments (too hot), and even in the …
The era of trial and error medicine needs to be over
Cheryl loved to dance. There wasn’t a time in our house when the the kids weren’t jumping up and down on the furniture, the radio blasting, and her body swaying in rhythm. Ironically, we were dancing when it happened. It was her fortieth birthday. The kids laughed and clapped as I dipped her dramatically and she sprung back into my arms. And then she crumpled. Tony, my youngest, giggled hysterically …
Years after a stroke, and wondering if the right decision was made
When teaching about life near dying, it is hard to achieve open conversation. No matter what one says in a lecture hall or what brilliant writers publish on the terrible state of end-of-life care, change is painfully slow. While we blame evasion by doctors of challenging conversations, failure by patients to plan or denial by families which blocks open communication, the …
The 75 Plan: Thoughts on Ezekiel Emanuel’s palliative care article
From seeing elegant pictures of our brain and spine, to definitely characterizing masses in the liver and guiding management of orthopedic issues, MRI has an established role in the delivery of optimal care. MRI is an amazing tool that allows us to see inside our bodies and helps us get answers about a wide variety of medical conditions. As a radiologist …
MRI: Myth or reality? A radiologist answers your questions.
Residency life.
I don’t talk about it much, and that’s on purpose. Here’s why: My life is wonderful. I really love it. Is it perfect? No. Is anyone’s life perfect? Definitely not. I would never wish to portray my life in a negative fashion and certainly not to wish for sympathy. I would talk about it in an informative way, but even …
What I wish I knew: Advice for spouses of doctors and residents
Hearing the words “you have cancer” changes everything. In my role as clinical nurse specialist in a busy prostate clinic, I see the effects of these three words on men and their families every day. The shock and disbelief, the fear and confusion as most men feel perfectly well with no symptoms at all. Many men want to do something …
After a prostate cancer diagnosis: The urgency to treat
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 …
MKSAP: 72-year-old woman with severe COPD
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