All people are gifted. As an emergency room physician, I see a wide variety of gifts, such as yodeling, knitting, and swearing (mostly swearing). One gift I rarely see is math. As a whole, the U.S. sucks at math. When compared with other nations, the U.S. ranks 32nd in math (though first in confidence). Despite this, we expect mathematical coherency …
Reinventing the pain scale in the emergency department
“Well, if medicine doesn’t work out, you can always fall back on waiting tables,” I joked with my waiter, who, like me, happens to be a medical student. We were bonding over completing our first year of medical school — he, in Detroit, and myself, in the Bronx. He liked waiting tables and decided to work during his last summer of …
Medical students may find themselves without a job
A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …
What do we do with the extreme elderly?
My kids were at the dentist this weekend for their routine cleaning and check ups (yes, Saturday hours!) when the hygienist mentioned x-rays. I smiled and mentioned I’d rather discuss the need with the dentist after his exam. This isn’t a dental x-ray thing, this is what I do for every test that involves ionizing radiation.
My son, Oliver, has had more radiation than most people will have. Ever. In fact, …
Radiation from x-rays and living in Denver: They’re not the same
There is a saying that you enter medical school wanting to help people but exit it wanting to help yourself. It may be a cynical view, but a realistic one. The criteria for being a good medical student are far different from being a good doctor. Medical education may be breeding a legion of self-serving, grade-grubbing, SOAP-note spewing machines rather than …
Being a good medical student doesn’t mean you’ll be a good doctor
An anesthesiologist at a California hospital pasted stickers simulating a mustache and teardrops on the face of a hospital employee while she was having surgery on a finger.
According to the Los Angeles Times, the doctor said, “I thought she would think this is funny and she would appreciate it.”
And if that wasn’t bad enough, a “nursing attendant” took a photograph.
The patient, who said she had to quit her job …
The OR is not a good place for a prank
We’ve heard some interesting things about cow’s milk over the years. I am going to share with you four myths about milk that I continue to hear from my patients’ parents.
Myth #1: Don’t give milk to a child with a fever; the milk will curdle (or some other variant).
Truth: As long as your child is not vomiting, milk is a perfectly acceptable …
Another tragedy, another tragic series of errors, another avalanche of debriefings and politicization, and in Washington, DC, there are 12 more dead. What can we say about this? It seems that the standard commentary fails. Aaron Alexis was not an angry white man, nor a conservative. He carried no assault rifle and he had a secret security clearance. He doesn’t seem to have been motivated by race. He was a …
Why solutions to mental health continue to evade us
Due to ever increasing health care costs, stakeholders in the health care system rely heavily upon front-line workers to assist in containing costs to help make health care more affordable. Since nursing is the largest sector of front-line workers, the field has an opportunity to greatly impact cost containment. Currently, there are 2.7 million nurses in the workforce, with an expected growth rate of 26% over the next decade; however, …
How nurses can help contain health care costs
I recently saw an article about Vanderbilt University Medical Center’s nursing staff.
The administration there came up with the brilliant idea of cutting back on the housekeeping staff and making nurses do some of the cleaning, though it’s not specified how much. Nurses would be expected to take out the trash and linens, and mop up spot cleans on the floors, among other things.
They …
Nurses are too afraid to speak up in their organizations and be vocal
Is there a patient who goes through a hospitalization who does not have stories to tell about the obstacles, errors and indignities that they endured? I just wonder sometimes.
A family relative was hospitalized this week with a stroke at a hospital a few hours from me — and his experience left me demoralized about medicine.
Joe (not his real name) is an 82-year-old grandfather, father, husband and one of a kind. …
Improve health care by seeing through the patient’s eyes
After finishing medical school and my residency in internal medicine, I undertook an additional year of training in a field called palliative care. Patients who notice my background sometimes ask me what exactly palliative care means. It’s really a simple concept. Palliative care is helping people with a serious illness have the best possible quality of life. It’s enabling sick patients to make the most of the time they have left …
Defining the 3 goals of palliative care
Three years ago, in the midst of all that was happening with health care reform, I thought about if I’d ever recommend medicine to my daughter. I thought and thought about that issue and looked deep inside myself for reasons one might still choose this profession, then penned “The Top Ten Reasons to Be a Doctor.” It is, by far, the most popular post on my blog, having been …
Learn to do other things besides medicine that will engage your brain
In a recent post, Dr. Ashish Jha raises this issue as he relates his own story of coming to an ED with a very painful dislocated shoulder. Unsurprisingly, prompt treatment of his pain was deferred while staff diligently completed registration, sent him for an x-ray, and waited for a physician to see him.
On the bike path where Jha took his initial tumble, people went out of their way to …
Why aren’t hospitals more attentive to the needs of patients?
An orthopedic surgeon from New York reportedly has 261 malpractice suits against him. He has been accused of performing “phantom” and unnecessary operations. In one case, he supposedly performed a knee reconstruction, and the patient died of a pulmonary embolism the same day. A post-mortem examination allegedly showed no evidence of a reconstructed knee.
There is also said to be evidence showing that in one day he was doing as many …
3 stories of surgeons that I find disturbing
So what exactly do we want a patient-centered medical record to look like?
What is the point of a patient’s medical record? Historically it has served many functions. Perhaps the time has come to reassess what it needs to be, what it can and should be.
If a healthcare provider from one or two generations ago were to look into a patient’s chart today, would they recognize what they saw? Would they …
How can we revise the patient medical record?
There’s something irresistibly horrifying about doing an amputation. I did several during training, and a few in practice, before eventually turning such cases over to people who did it more. In a way, it’s a microcosm of the perversity and beauty of surgery; of the screaming contradiction that one must somehow accept to be a surgeon. Removing a limb is so many things: failure, tragedy, cataclysm, life-saver, life-ruiner. Gratifying.
Stark and …
The horror and beauty of performing an amputation
Ms. A was a sweet older lady with a bad heart who was transferred all the way from Montana in order to get expedited workup for cardiac (heart-related) surgery.
Her story of her symptoms and disease course was the story told by hundreds of patients seen at any given hospital every year. It started with a few weeks of chest discomfort while walking, followed by a day of chest pain, nausea, …
What to do after you make a medical error
Recently we have learned that 15 patients in New England were exposed to a rare infection called Creutzfeldt-Jakob disease (CJD) when neurosurgical instruments contaminated with the infection were used in their care. Each had undergone a brain or spinal surgery in early 2013, and now their future was uncertain.
Creutzfeldt-Jakob disease is caused by an infectious agent called a prion — as is “mad cow disease.” Originally discovered in the brain-eating Fore cannibals of Papua New …
After a Creutzfeldt-Jakob exposure, should patients be told?
Necrotizing fasciitis is a rare but life-threatening soft tissue infection. Its presentation is characterized by rapidly spreading inflammation and resultant death both of the surrounding soft tissue and fascial planes. Prompt recognition and aggressive treatment is paramount in order to avoid fatality. Often times, symptoms may overlap in their presentations so one must maintain a high index of suspicion and a multidisciplinary approach facilitated appropriate imaging studies and resulted in a …
Necrotizing fasciitis: A case study and discussion
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