Since the beginning of it all, since that exact moment where I shot up from my friend’s dorm room cot with a revelation to pursue my ancestral calling in medicine, I have been continually questioned by family and friends on exactly where I sit in the totem pole of physicianhood. And I get it. With terms like sub-intern, intern, senior resident and attending, it must be confusing …
What does it mean to be a medical intern?
I have been actively engaged in the clinical practice of radiation oncology for the last 40 years, and over the last 10 years have been asked to participate as a radiation oncology expert witness in a variety of medical malpractice cases. Radiation therapy, together with surgery and chemotherapy, is one of the major cancer treatment methods. It is estimated that 50-60% of all cancer patients seen in the USA receive treatment with …
A physician expert witness speaks out
Insurance, in its traditional form, is the wrong model for health care financing. It is the wrong commodity to be bought and sold. We don’t need health insurance, and I will tell you why. I will also tell you what we do need.
Insurance is something you buy, and then hope you never have to use. It is a hedging of your bets against bad outcomes. Term life insurance is the …
Why insurance is the wrong model for health care
Kerry was only 28-years-old. He showed up in the ER one night complaining of upper abdominal pain which started suddenly that day. The emergency physician did the usual workup and found two things which led to an urgent call: a large intrabdominal mass and free intraperitoneal air.
The large mass was not necessarily an emergency, but free air, that is, air outside its usual place inside the bowel, almost always represents …
The remarkable resiliency of the human body
New Jersey is considering following four other states in legalizing physician-assisted suicide. The Death with Dignity Act would allow people with less than six months to live to receive a prescription for a fatal cocktail and then to commit suicide at the time of their choosing in the privacy of home. Recently, I had the opportunity to participate in a debate on the merits of the proposed law. While I oppose this …
An argument against physician-assisted suicide
When I talk to physicians about dipping their toes into the social media waters, I advise starting with LinkedIn. Spend about 45 minutes or so and create a LinkedIn profile, which is essentially a digital translation of your CV. LinkedIn profiles get ranked highest among the social media platforms, and can push down the influence of …
Why I recommend LinkedIn to physicians
However you see the Reverend Al Sharpton, one thing is certain: you see less of him now. His Twitter pic tells you he is proud of his 167-pound weight loss. Good for him, he should be.
If you care about health, the disappearance of the Sharpton-of-old is worth mention. His story teaches us a lot, and, if one dares to look a little …
What we can learn about weight loss from Al Sharpton
Recently, food has become the center of a revival of interest in cultures that make up Chicago.
The smells, tastes, sounds, and even atmospheres created by cuisine allow both tourists and native Chicagoans to sample our city’s diverse cultural heritage. As such, food has become an increasingly popular and a relatively inexpensive way to enjoy what Chicago has to offer. In fact, one …
Food deserts are incredibly complex problems
It’s common knowledge among third year medical students that statistically a lot of us are mentally damaged in some way. Knowing these stats makes us feel better about our ongoing feelings of low self esteem, high anxiety and sometimes outright panic. In the car on the way to rotations, regular starters of conversation are statements like, “Did you know 35% of med students are depressed at any given time?”, to …
When do medical students lose their empathy?
When I introduce myself as a physician who left clinical practice, non-physicians ask me why I left. They’re generally intrigued that someone who sacrificed many years and many dollars for medical training would then change her mind. But physicians, almost universally, never ask me why I left. Instead, they ask me how. They call and email me with logistical questions, wanting to learn the secret of how I managed the …
Self-preservation: Why I abandoned clinical practice
“An ounce of prevention” we all know is good medicine. An example is colonoscopy. It was time for mine so after some lengthy procrastination I called and set up an appointment which I soon found a perfectly good reason to postpone for a few weeks. A common occurrence. The government wants me (and you) to not procrastinate, at least not because of the cost. The Affordable Care Act (or Obamacare) …
Obamacare covers screening colonoscopies, with a catch
October 1st was a special day. The Affordable Care Act (ACA) also commonly known as Obamacare became official. The federal government shut down because Republicans and Democrats disagreed around Obamacare funding. Most importantly, October 1st was when I could finally read Malcolm Gladwell’s new book David and Goliath.
Gladwell ponders why do underdogs succeed when we least expect them to? Is it possible that advantages a Goliath has can be a disadvantage? …
David and Goliath lessons for doctors and our health system
As a resident, probably the most common piece of feedback one receives is, “Read more and expand your clinical knowledge base.” This critique is a standard and generic piece of feedback to encourage the younger generation to never quit in the endless pursuit of knowledge. As our erudite attendings know, medical knowledge always evolves and often reverses course. Thus, the trainee is reminded to establish the habit of keeping up …
What’s the best way to keep up with medical literature?
He seemed a bit grumpy when he came into the office. I am used to the picture: male in his early to mid-forties, with wife by his side leading him into the office to “finally get taken care of” by the doctor. Usually the woman has a disgusted expression on her face as he looks like a boy forced to spend his afternoon in a fabric store with his mother. …
A new tagline for direct primary care
Many years ago when I was a “young” doctor, moonlighting in the ER of a tiny country town, I had an experience that challenged my training. You see, most young, new doctors often think their training and knowledge is superior to that of “old” doctors, which is often malarkey. A wise and sage old doctor in this tiny country town taught me an important lesson on where and how one …
What an old doctor taught me about palliative care
In case you haven’t heard, Malcolm Gladwell recently released his book, David and Goliath. I’m just about finished reading it.
Just as interesting as the book are its reviews. In a recent post from Slate, Gladwell himself responds to the criticism. He freely admits that his books should not be held as pinnacles of academic rigor, but should be considered “intellectual adventures stories.”
He further elaborates on the power …
Why doctors need to be more like Malcolm Gladwell
Medical errors are a real problem. I won’t deny that.
It was bad enough when the often-quoted Institute of Medicine figure that 98,000 deaths per year in the US are caused by medical errors was in vogue, but now a paper in the Journal of Patient Safety states that adverse medical events result in 210,000 to 400,000 deaths per year and 10 to 20 times those numbers of serious …
Not all adverse events are preventable
Historically, the “do more, bill more” fee-for-service model of healthcare measured success by increased billings. In the fee-for-value era, we need a new framework for assessing healthcare results. Quality indicators are logical but they are mostly geared towards measuring actions taken. We can borrow a concept from the energy sector for an additional metric. We need a concept for removing waste and unnecessary care that could be inspired by a concept …
Patient engagement is the blockbuster drug of the century
A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”
The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.
I should say …
Hostile dependency: The real reason for physician burnout
An excerpt from The Heartbeat of Success: A Med Student’s Guide to Med School Admissions.
What’s all the fuss about extracurricular activities? Isn’t doing well in your coursework and on the MCAT enough to get into medical school? Nope. Extracurricular activities and employment are opportunities to explore your interests, become …
Applying to medical school: The fuss about extracurricular activities
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