Locum tenens (literally “place holder”) is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride.
When I decided to leave my practice related to losing a couple of partners and wanting to update my knowledge base and re-evaluate my career, I decided to do locum tenens work. I had always thought that …
My first year as a locum tenens physician
Would it be silly to ask, “Is the history and physical examination worth performing anymore?” especially in this era of high-technology medicine? Does it matter if the diagnosis is made by the bedside in contrast to CT or echocardiography? Someone did ask, and the answer is intriguing and was debated. Let’s look at the data.
Four hundred and forty-two consecutive patients were admitted from the emergency department to an …
Is the history and physical examination worth performing anymore?
Once upon a time a doctor first attended 3 or 4 years of college, then finished 3 or 4 years of medical school, trudged through 1 to 8 years of residency training to hang out “a shingle,” and finally begin to practice medicine, usually in solo practice. Those days are long gone. Time has expanded—schooling and training are longer.
Breaks are taken between and during this once but no longer traditional …
5 ways to adapt to an evolving healthcare workforce
Have you ever gone to the doctor and felt like he wasn’t listening to you? Have you tried to tell your story, only to have him interrupt with a checklist of questions: do you have chest pain, shortness of breath, fevers, cough, and so forth? Have you ever felt ignored, and left thinking that your doctor never understood why came to him in the first place?
Studies show that Read more…
6 tips for getting your doctor to listen to you
Christmas morning at 1:30 am the phone chimes away. What the … I’m not on call.
“Please call Dr. Dred for patient Selma, perforated colon at local ER,” read the text message.
Why are they calling me, I’m not on call. Dr. Young is. Maybe something’s happened and they can’t find him.
So, I called. It was just as reported. There was a fifty year old female with abdominal pain for three days, …
You’re still a doctor, even if you’re not on call
Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner.
When there is bad air in the mine, the canary’s sensitive lungs will cause …
Doctors are the canaries in the coal mine of medicine
A version of this column was published on January 13, 2013 in USA Today.
Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season.
I recently saw a patient for a sinus infection whom asked, “Why did I have to come in to see you? Couldn’t you have given me an …
A virtual office visit for your cold is not a good idea
An excerpt from When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.
Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a …
When patients feel trapped by doctors and the medical system
I saw 17 patients in my primary care practice yesterday. Six of them were coughing.
One of the most basic parts of my job is sorting out who’s a little sick from who’s very sick, or in danger of getting very sick. How do I do that when so many people have the same symptom? And, as a patient, how do you …
How to know whether your cough is serious
Sometimes, I feel like I belong in law enforcement. There was a time in my life that I seriously considered a career where I would haul in the bad guys and make society a better place. Of course, every American male youngster fantasized that he would one day drive the Aston Martin, get the girl, defuse the bomb, and sip on a …
Law enforcement and medicine: The ties that bind both professions
To treat observation care as simply a loophole that allows hospitals to avoid the Medicare penalties from readmissions — as Brad Wright, an assistant professor of health management and policy at the University of Iowa did earlier this month — is to take a short-sighted approach to a complex health issue.
Observation care in fact aims to address several of healthcare’s thorniest challenges head on. In the process, …
What is observation care? Clearing up common misperceptions
Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like the false dichotomy of “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery.
It doesn’t matter who’s doing the quacking. A quack is a quack, even if …
Behind the fetish of vitamin B12 shots
A common rebuttal to any discussion about of gun control is motor vehicle accident deaths. We don’t blame the car, we blame the driver. Regardless of the object’s intent (the car is for transportation and the gun is shoot people, targets, game, and skeet), neither a car nor a gun can kill or maim without human touch.
And I agree. Comparing guns and cars is fair, after all they kill about …
We can learn a lot by comparing guns to cars
My mom wrote me the following letter during my first semester in medical school. She has been a patient, and a mother/wife/sister/daughter of patients. She has been around countless doctors. Here is her take on what makes a great one.
Dear Son,
I am so very proud that you are becoming a physician and that you chose this profession, not for the prestige or the financial advantages, but because you want to …
From Mom: Here’s what it takes to be a great doctor
Somewhere near where you live, a couple will discover this week that they are infertile and that if they want biological children of their own, they are going to need in vitro fertilization (or IVF). According to treatment protocol, the woman will need to take powerful medicines to ramp up her production of fertilizable eggs. One monthly cycle of this treatment will run …
Do doctors take advantage of desperate couples with infertility loans?
“Sometimes, how you feel at the end of an interview can be clinically revealing,” my preceptor says. “How does this patient make you feel?”
***
“Mr. M?” I ask gently, knocking on the hospital room door. “May I come in?”
“Hello? Hello?”
I enter at what I think is an invitation to me, but see that 79-year-old Mr. M is speaking into the phone instead.
“I’m sorry, I can come back…” I start to say. …
Countertransference is a reality that must be grappled with
I wrote in a previous post about what life was like growing up in Newtown, Connecticut. It truly is a picturesque New England town. But what might be surprising is that within that town sat a gem. A hundred acres of wooded rolling hills within which sat an inner campus of professionally landscaped and meticulously manicured grounds crowned with stately and handsome brick buildings in a colonial architectural style. These …
The closing of a mental health facility in Newtown
I have a confession to make. I don’t think what I do each day makes any sense.
Perhaps I should explain myself. Six months ago, I started my own private psychiatry practice. I made this decision after working for several years in various community clinics, county mental health systems, and three academic institutions. I figured that an independent practice would permit me …
Why I’m not sure that psychiatric medications work
On my birthday several weeks ago, I was lucky to get an iPad Mini from my husband. I already have an iPad and have shared my experience. In fact, we gave all of our residents iPads (one of them contacted Steve Jobs and got a response), and documented an improvement in efficiency on the wards. So why the Mini? What is …
Using the iPad Mini in the hospital: One doctor’s experience
Here is a little appreciated fact: Patients cannot order medical care; they can only accept or refuse it. Only a doctor can order medical treatment. In an extreme medical situation, the doctor can offer CPR, but it is the patient’s job to accept or reject. Any patient can refuse CPR. This refusal is known as Do Not Resuscitate or DNR, and for obvious reasons needs to be made ahead of …
When is making the decision to be DNR appropriate?
Get free updates delivered free to your inbox.
