Whenever possible I make a point of rounding on patients with their nurses present. I rely on nurses to be my eyes and ears when I’m not at the bedside. I need their input to confirm patient self-reports of everything from bowel and bladder habits to pain control, not to mention catching early warning signs of infection, mental status changes, or …
5 ways how doctors can round with nurses
In 1978, under the pseudonym Samuel Shem, psychiatrist Stephen Bergman published “The House of God,” an iconic novel drawn from his medical internship in Boston in the early 1970s. Earlier this year, Dr. Bergman spoke at the commencement of the New York University School of Medicine. With his permission, the following is adapted from those remarks.
I began writing The House of God as a catharsis, to make sense of what seemed like the worst year of my life.
These are …
Stay human in medicine: Lessons from The House of God
An article from the JAMA has been gnawing at my consciousness for the last couple of weeks. Dr. Prashant Kaul and colleagues out of the University of North Carolina reviewed records from hospitals in the state of California from 2008 through 2011, looking for patients who had been hospitalized with heart attacks. Specifically, they were looking for patients with ST elevation …
Why does treating heart attacks cost so much money?
I chose to become an OB/GYN because I love delivering babies and bringing joy to expectant parents. It is by far the most rewarding part of my job. Seeing the sense of pride on a new dad’s face, the joyful tears in a happy mother’s eyes, or the inquisitive look of a young big brother or sister is priceless and makes my “job” feel more like a privilege. Bringing a new …
After a miscarriage: Answers to your difficult questions
Standing in front of my patient’s home, I reach out to ring the bell. On the other side of the door live a man and his wife, who have been waiting patiently for my arrival. I hesitate for a moment before pressing the button.
As I wait uneasily for the door to open, I think to myself that this is the first time I make a house call on my patient …
The last house call: Turning off the defibrillator
As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this?
Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient …
After residency: I’m scared to practice outpatient medicine
As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals.
In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have …
Why teaching anatomically correct words matters
Middle-aged lady, twenty pounds overweight.
Doing everything I can, doctor. Everything imaginable. Diet: I eat practically nothing. Exercise: all the time! Weight Watchers doesn’t work. Jenny Craig, South Beach, the Zone; I’ve tried it all. Nothing works. Have to lose weight. Have to lose weight.
Yada, yada, yada.
Oh look: A few years back I diagnosed you as hypothyroid and gave you some Synthroid. …
Two patient result letters: Which one did this physician send?
One of the most subtle deceptions hidden inside the cracks of our sick care system is the lie told to doctors: that health is our primary goal for our patients.
I began to understand this paradox clearly when I listened to my friend’s anguish.
She’s been working as a full-time medical assistant in a busy nephrology practice, supporting two sometimes three full-time sub-specialty doctors. The practice is located in a small town …
Medicare’s perverse incentive to keep patients on dialysis
CMS recently announced it would begin next January to pay physicians for care coordination activities. It’s about time. As physicians have been saying for some time, any payment system that hopes to encourage value (better patient outcomes) has to start by paying physicians to coordinate the care of their patients. When physicians follow up on referrals or communicate with patients outside of the office, healthoutcomes improve, costs shrink and the patient …
Medicare will pay for care coordination. Should doctors take the money?
The lipstick sign is an underutilized physical examination finding which can assist in the evaluation and assessment of the elderly female patient. While poorly applied lipstick can result in considerable embarrassment and anxiety in this patient population, those who present with properly applied lipstick demonstrate mastery of multiple domains of functioning.
Fine motor skills and concentration can be correlated with a positive …
Consider the lipstick sign in your next physical exam
Each year, over 20,000 U.S. students begin medical school. They routinely pay $50,000 or more per year for the privilege, and the average medical student graduates with a debt of over $170,000. That’s a lot of money. But for some who pursue careers in medicine, the financial cost has been considerably greater. Melissa Chen, 35, a final-year radiology resident at the …
$2.6 million: Is the cost of becoming a doctor worth it?
We had our first child during the fourth year of my husband’s ophthalmology residency, and our second son joined us during the first year of a surgical retina fellowship. Juggling long hours, multiple medical commitments and the needs of two small children can be exhausting but every day is complete with fulfillment and laughter — and who can ask for anything …
Having children during medical residency: 6 tips to survive
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
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