“I’ve been with my doctor for years and years,” an elderly man, voice hoarse but lilting with fondness for his caregiver, told a nurse in the primary care clinic where I was waiting to see a doctor. “He’s fantastic.”
I was coming to the clinic for a follow-up appointment about an injury for which I’d been seen a few months prior, but neither the initial appointment nor this follow-up were with …
The problem with primary care residency programs
My journey in medicine began as a young child: I was the typical kid who knew I wanted to a be a doctor since I was a child and was thrilled when I was accepted into an 8-year college program which culminated in a medical degree. However, by the end of my undergraduate program, medicine was changing: doctors were spending less …
From PA to MD: An appreciation for physician education
My student’s voice trembled as she answered my question. “How do you think you’ve done so far?” I’d asked her. We’d been together on the general medicine inpatient ward for two weeks — the midpoint of the rotation — and as was my usual custom I was giving her feedback on her performance by first asking her to rate her performance …
How to give feedback to medical students
Primary care is essential to building a higher-performing health care system that promotes personal well-being and saves consumers and taxpayers money. Research shows that more primary care physicians in a community means lower rates of mortality, better preventive care, and fewer hospitalizations and emergency room visits.
Unfortunately, too many Americans lack easy access to primary care. Approximately 50 million Americans live in areas, mostly rural, with too few primary care physicians. …
3 ways to improve primary care access
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications …
MKSAP: 59-year-old woman with pain of the right foot
The Centers for Disease Control and Prevention (CDC) reported that between January 1 and May 23 of this year, there were 288 cases of measles reported in the US. That’s more than the total number of cases in any year since 2000, when measles was eliminated in the U.S..
We have got to get more people immunized.
Essentially all of the cases were linked to “importations,” cases brought in from other countries …
7 common reasons for refusing vaccines
Pretty much on a weekly basis I come across an article about how awful life is as a practicing physician. Articles focus on how unhappy physicians are with their jobs, with their hours, with their pay or with health care reform.
After almost a decade of practice, the fact is that I like my job.
Is it perfect? Absolutely not: quite far from it, in fact. There are certainly many times when …
There is something very special about being a physician
The ALS ice bucket challenge, better known as #ALSIceBucketChallenge or #icebucketchallenge, was almost the perfect storm for viral fundraising. In my course, Designing Health Campaigns Using Social Media at Tufts University, we analyzed why the challenge went viral.
Not surprisingly, given its popularity, my students had all heard about it and watched challenge videos. About half had done it. Some researched amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, and …
The ALS ice bucket challenge: Analysis of why it went viral
The ear, nose and throat specialist who treated comedian Joan Rivers on August 28 has been identified as Dr. Gwen Korovin, a prominent New York physician who is known as a voice doctor to many entertainers and Broadway stars including Hugh Jackman and Julie Andrews.
With a physician who is an expert in airway anatomy at her side, and all the technologic advantages …
Joan Rivers’ death: What went wrong?
Michelle wrote in: “We trained my 3-year-old son approximately 3 months ago, and it’s been great. He’s been having virtually no accidents. The problem is that he’s terrified of making ‘dirty’ on the toilet. He does it in his pamper at night when he’s sleeping. He’s very verbal about it, and tells me that he’s scared to let the dirty come out. It’s really difficult to deal with because there …
When your child doesn’t poop: Solving the constipation death spiral
I have been following the progress of bedside ultrasound (using ultrasound as a diagnostic tool during my physical exam of patients) as it gets a foothold in standard medical practice since I first started learning to do it about 3 years ago. Every so often a study comes out which warms my heart as it proves that less (radiation, expense) is more in treating patients.
An article came out in the …
Emergency room doctors can safely use bedside ultrasound
Medical students are repeatedly taught the importance of the physician-patient relationship. We are told that to be a good doctor we must strive to exhibit compassion, empathy, respect, professionalism and confidence all while applying our medical knowledge to figure out a diagnosis and treatment plan. If you add in the pressure of doing this within a 15-minute visit, all while answering questions faster than an Internet search, it can get …
Vulnerability is a virtue in medicine
Not accustomed to visiting hospital executive suites, I took my seat in the waiting room somewhat warily.
Seated across from me was a handsome man in a well-tailored three-piece suit, whose thoroughly professional appearance made me — in my rumpled white coat, sheaves of dog-eared paper bulging from both pockets — feel out of place.
Within a minute, an administrative secretary came out and …
How hospitals discourage doctors: A step by step guide
The simple truth is that radiology reports can be hard to read, especially for those without a medical background. The combination of advanced medical technology and the wonderful subtle intricacies of the human body often result in a final document that more closely resembles a William Faulkner novel (translation: difficult to understand!) than Dr. Seuss. The goal is to try to …
An insider guide to reading your radiology report
Why do so many seemingly great technologies fail to penetrate the health care system?
I hope the following five answers shed some light on the realities of technology adoption in health care.
1. Many new technologies don’t address the real problem
Tech entrepreneurs often take a backward approach to invention. They start by discovering a nifty technology. Later, they figure out how people can use it.
This technique often teaches entrepreneurs a tough lesson: Technology …
Health care fails to adopt technology. Here are 5 reasons why.
“All your patients will die. Maybe not today, but someday. The defining fact of life is that it ends. Only a fool would dedicate their career to fighting something that can never be beaten. Therefore, a doctor’s task cannot be to fight death. A doctor’s task is to heal when possible and prevent suffering always. Our calling is to support life. Fighting death may deprive patients of the opportunity to …
A twisted argument against end-of-life care
In my mind it’s no wonder the American Academy of Pediatrics has a statement against spanking. Spanking, in the simplest form, is the act of hitting a child, using physical force to try to get a different outcome. Thing is, spanking is an ineffective discipline tool in the long run and research shows it’s damaging to a child’s mental health. …
Don’t spank your children. Do these 5 things instead.
The case
A thirty-five-year-old female presents to the emergency department on a weekend afternoon with the following chief complaint: “I want to give up custody of my son.”
The patient is well dressed — and so is her four-year-old son, who is sitting comfortably on the bed playing a video game on his mother’s cell phone.
According to the patient, she is a single mother with no support system. Her son’s father deserted …
“I want to give up my son”: Is that child abuse?
This evening, I read a post written by a woman who finds herself feeling alone, depressed, desperate, and afraid of losing herself as she goes through medical school.
This post is my response to that woman.
Dear colleague and friend,
You are not alone.
You are far from home. You are far from your family. You are far from the desert, the open …
Responding to a medical student in pain
I have a patient who is a full blown sufferer of health anxiety. He firmly believes he has full-blown AIDS after a single extramarital sexual contact (non-genital) one month prior with a woman not known to have HIV. (Reality check: The other person didn’t have HIV, the specific contact as described was ridiculously unlikely to have transmitted the virus had it been present, and AIDS takes months to years to develop …
How do you know when a hypochondriac is really sick?
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