As many of you picked up from the tone of my last article, I am feeling much, much better. As more time has passed from the disasters of six weeks ago when I lost my relationship and home (making me feel more physically ill than I had felt this entire time), my body has finally had a chance to recover. I also have benefitted from a …
8 ways to better support someone dealing with cancer
The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none.
Yikes.
The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third …
Digging deeper into the Commonwealth Fund health rankings
Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth.
Doctors may amass up to $500,000 in debt for the honor of one day caring for you and your family.
Doctors delay childbearing and starting their own families so they can care for your family.
Doctors miss their own kids’ ballet recitals and baseball games …
Why you should love your doctor
I really hate it when a nurse practitioner is called a mid-level provider.
“Mid-level provider” isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.
The term “mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and midwives. It is insulting to health professionals …
Stop calling nurse practitioners mid-level providers
Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms.
The patient …
A medical student speaks up and saves a life
Only in America can we find a way to scare the bejesus out of a woman with normal breasts and a normal mammogram. Because that’s exactly what happened when New York Times reporter Roni Caryn Rabin read her entirely normal mammogram results letter: “A sentence in the fourth paragraph grabbed me by the throat. ‘Your breast tissue is dense.'”
I can’t really blame Rabin for being afraid. The information about breast density in …
Dense breasts on mammogram? Don’t be afraid.
I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive. I have been criticized for this position, on the grounds that I am rationing care from people with …
Doctors must discuss the cost of care with their patients
A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia.
This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined …
Why are doctors still prescribing Zetia?
During my third year of residency I trained for and completed an Ironman triathlon. I’ve discovered, despite its growing popularity, many people have no idea what a triathlon is and often nod at me in hesitant approval when I talk about this particular passion of mine. An Ironman triathlon is a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile run, completed in succession, all in one day.
And it happens …
Learning from and living the triathlon lifestyle
Imagine this: You are sick. You are the sickest you’ve ever been. You want to die. You almost did die. You want to bury your head in your cozy bed for the next two years.
But you’re not in your bed. This bed has plastic for covers and sandpaper for sheets. You need to throw up every thirty minutes but you have to share a bathroom with someone you don’t know, …
Do everything you can not to get admitted to the hospital
For days, I have been trying to get long-term patient, Stan, on the phone; his blood work came back abnormal, and we need to repeat it. I called the number in our file a bunch of times. The odd thing is that sometimes it rings without stopping, sometimes it is answered by a machine, which immediately beeps and disconnects, and at …
When patients yell at staff, they end up hurting themselves
I met Madelyn for the first time last month in clinic. Six months prior, she was an otherwise healthy 14-year-old girl. One afternoon, Madelyn’s phys ed teacher led a gym class aimed at completing fitness and health assessments on all of the children in the grade. One at a time, each child was asked to step up and onto a scale …
When school boards fancy themselves health care providers
In his commencement address at Sarah Lawrence College, international affairs journalist and author Fareed Zakaria defended the value of a liberal arts education. “At its essence,” explained Zakaria, “a liberal education is an education to free the mind from dogma, from controls, from constraints. It is an exercise in freedom.” His speech, I imagine, was well received and much appreciated by the over 400 graduates earning liberal arts degrees that day …
Why premedical students need the liberal arts
Here’s a doctor’s health tip for patients that I’ll bet you haven’t heard before.
If you’re a patient who walks into a hospital for an elective procedure of any kind — surgery, or a diagnostic test — and you find out that Joint Commission reviewers are on site, reschedule your procedure and leave. Come back another day, after the reviewers have left.
Why? …
When the Joint Commission is at the hospital, leave
Taking call is the worst thing about being a doctor. There, I said it. But wait! What about medical malpractice lawsuits? What about dealing with patients’ suffering or dying either from their illness, or far worse, relating to decisions you made or procedures your performed? Certainly these are far worse events than being on call.
Granted. However, these awful events are part of …
Should doctors be paid overtime for taking call?
I was on the cusp of my first year in medical school, and time was running out. Classes started in two weeks. I needed a place to live: Ideally someplace cheap, not too far from school.
There was an opening at Phi Chi medical fraternity, a large brick house of faded elegance located less than a block from my classes at the University of Minnesota. At $75 a month for a …
The night when I entered the cult of medicine
I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery. The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa …
A perfect thank you note to an oncologist
Nearly all physicians are now subject to patient satisfaction ratings. In my case, and many thousands of my colleagues across the country, it is via the survey tool sold to health care facilities by the Press Ganey Company. There are also many, many online sources that rate physicians.
The idea is a good one: Physicians should be subject to feedback from patients about patient perceptions of how good a job the doctors …
Why patient satisfaction surveys are riddled with problems
As a medical student I was in awe when a professor looked at a patient’s hands or nail beds and described their medical condition without taking a history. I was also enthralled by a TED talk by the best selling author, Abraham Verghese, where he described a lesson that Arthur Conan Doyle, author of Sherlock Holmes, learned as a medical student at the medical school in Edinburgh, Scotland from the famous physician …
Estimating a patient’s age-clinical implications
When I first met Ralph, he was 82-years-old. He suffered from shortness of breath which started when his wife of 56 years was diagnosed with a rare bone cancer. Upon further investigation, I diagnosed him with a weak heart and a very tight aortic valve which required immediate surgery. Ralph made it; his wife died. Today, twelve years later, he brings me treasures from his metal detecting hobby on the …
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