There is nothing so horrifying as when your doctor is too nice to you. During my first mammogram at Kaiser Permanente, I knew I had cancer before they even told me because of the hushed voices, the pats on my shoulder, and the way, suddenly, no one cared how much time was being spent on my visit. When that happens to you before the diagnosis is official, there is nothing …
The problem with a negative BRCA test
Let’s get one thing clear from the start: I love nurses. My grandmother was a nurse’s aide. My aunt is a nurse. My mother is a nurse. Nurses have been by my side for the most frightening and important experiences in my life (in the hospital and out). However, I’m not a nurse. I’m a doctor. And when someone calls me …
Thanks for the compliment, but I’m not a nurse
Dr. Sam Ko says resident work hours should be limited to 40 per week. Via Twitter, I warned him that I would rebut his assertion.
Without any data or references except a tangential one, he bases his opinion on four premises.
1. Residents will be happier and nicer to patients because they will be less stressed. There is no proof that this is so. In fact, a recent Read more…
Should medical resident training be limited to 40 hours per week?
Today I am going to write about how the US could save up to 10% on its healthcare bill.
The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million people and try to grasp the vast sum of $2,5 trillion.
A lot of changes are taking place with the intent to save healthcare dollars. So far, many of those changes have …
What if doctors worked for free?
An 85-year-old woman with moderate Alzheimer’s disease who enjoys walking in her nursing home’s garden with her walker has fallen and broken her hip. An advance directive signed by the patient states a preference for “comfort measures only,” and specifically states that she does not want to be transferred to the hospital. The physician believes that surgery would provide long-term pain relief and the chance to maintain some mobility.
What do …
When can you override an advance directive?
I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate.
“The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get their attention.
“What exactly were you trying to do before?” some have asked, in that wonderful way …
Quality, cost, and value in health care: How to solve the puzzle
I’m two weeks into my psychiatry clerkship, sitting quietly in the back of a crowded Alcoholics Anonymous meeting and watching a middle-aged man discuss his past struggles with alcoholism. He starts with his difficult childhood, describing his abusive father. When he was eleven years old, his parents divorced. Soon after, he resorted to alcohol as an escape from his loneliness, drinking to “fit in” and impress his friends at social gatherings. As …
Reflection after attending an Alcoholics Anonymous meeting
Recent research suggests that medical students lose empathy during the third (the main clinical year) of school.
Talking with end of the year third year students might make you think differently. Understanding the psychological changes that likely occur during the third year should make you think differently.
Medicine seems easy during the pre-clinical years. You get smokers to stop and prevent COPD and coronary artery disease. Patients just need to listen to …
How to stop medical students from becoming jaded
Being a part time hospitalist, I am frequently on overnight call in the hospital, spending the night admitting sick patients from the emergency room, or dealing with any calamities that happen on the medical floors. I would have to say the that the most dreaded events are: “Code blue” (this means a hospitalized patient in cardiac or respiratory arrest waiting to be resuscitated), followed closely by a nurse calling with: …
The spiritual bond between two souls
For the first time in my career I asked myself that question. Over the years, I’ve had more than my share of difficult cases. I’ve had patients with life threatening conditions whom I wished I could offer more than to just shake my head and speak empty words of encouragement. They stare back at me and I see their eyes full of hope. How many times have been forced to …
What should a surgeon do with an impossible case?
A new crop of medical students will begin a residency in plastic surgery this summer. They have worked long and hard to secure these coveted spots. As a service to them and the profession, I wanted to take this opportunity to help make their path a little easier by offering a bit of advice.
When asked what you do, simply say that …
Being a plastic surgeon requires a lot of explaining
It is hard to see a child in pain.
I have seen quite a few children in the emergency departments of South Carolina in the past three years, more than I could have imagined just a while ago.
Now, in the interest of full disclosure, I am not a child psychiatrist by trade. Like any general psychiatrist, my training provided me with didactic …
A psychiatric disorder or a profound lack of discipline in our kids?
Next in a continuing series.
There’s a reason for the cliche — surgeon barks out the name of an instrument, scrub nurse whacks it into the hand. The reason is this: when you are focused on a particular area — especially if it’s one in which danger lies — you don’t want to look away. If you need to change …
Why surgical instruments are the way they are
As the weather heats up and the allure of grilling returns, it is important to consider some of the potential health risks. One of the great joys of my life is “manning” the grill – beer in hand, wafting smoke rising through the air, a delicious anticipation building. It seems worth the risk of consuming carcinogens present in the smoke …
Grilling with aluminum foil: What are the health risks?
Autism is a communication disorder where children have difficulty relating to other people. Pediatricians watch for speech delay as a sign of autism. Even before your child is expected to start talking, around a year old, you can watch for communication milestones. Problems attaining these milestones may indicate autism or other disorders such as hearing loss, vision loss, isolated language delay, or other developmental delays.
By six weeks of age, your …
How to know if your baby has autism
As the saying goes, “With great power comes great responsibility.” That applies to physicians when prescribing medications, but it also should apply to pharmacies when they’re dispensing medications.
In December, after seven years of exams, lectures and rounds, I received my medical license. Finally, I had the power to prescribe medications without the co-signature of my supervisor. “Be careful,” she advised, “remember the …
Prescription labels need to come in languages other than English
Over the last couple months, I have often been asked what I plan to do as a recent college graduate. My response has been that I will be attending medical school in Chicago.
“Oh! Medical school!” many exclaim as their eyes light up, “So you’re going to be a rich doctor.”
This response as well as most others I have received seemed to imply that medicine is an ideal profession if one …
Is medicine a choice or a calling?
There was a hole in the wall of our bathroom that was a painful reminder of a bad encounter with a plumber. Yes, that hole has been there about a year, and it has been on my to d0 list for the duration, daring me to show if I inherited any of the fix it genes I got from my father. Why not hire someone to come fix it? I …
The ultimate DIY project: Create your own EMR
In America, the conventional wisdom is that we don’t ration health care. But we do, and there’s no better example than patients rationing themselves when it comes to the medicines they take.
Recently, a young twenty-something I know had a nagging cough—seasonal allergies, her doctor said and prescribed a generic medicine for asthma and allergies. She did not fill the prescription—the $160 price tag was too steep. Although she had health …
Is self-rationing of medications a good or a bad thing?
Jess, like many parents, has been hearing conflicting information about what crying can do to your baby.
She wrote: “So, my husband and I accidentally let our kiddo (5.5 months) cry it out. So of course, I’m spending all sorts of time on Google finding out that I’ve caused long-term damage to my son and he’ll be more likely to get ADHD and …
Letting your infant cry it out: Will it hurt your baby?
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