As my husband and I try and make a long term financial plan for paying off my almost $200,000 in loans from medical school, I sit here wondering, why did I pay 200 grand so that I can get peed on, pooped on, bled on, screamed at and sworn at? I’ve delivered a baby without gloves on (it was an emergency). I’ve been kicked so hard I almost fell off …
Taking care of patients is a great honor
Four brutally honest declarations:
1. I can perfectly decide what is best for myself, my family, my patients, and my practice. I don’t need outside guidance telling me how to lead.
2. I decide what works best on my terms to practice the best medicine.
3. I will succeed and lead because I am focused on my goals just as much (if not more) than my patient’s goals.
4. My goal is to make …
Doctors need to stop being so complacent
You would think that for doctors, who work with life and death issues every day, the issues of our own frailties or the tenuous line between health and sickness for our own families would be, if not accentuated, then at least more immediate than to those who, say, do investment banking for a living. But the strange thing is that despite our easy familiarity with human mortality, it is not …
Why maintaining a distance is necessary for doctors
In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over another, typically from a roughly similarly aged peer group. The bullying could be mild such as occasional name calling and having one’s books knocked down when walking in the hallway. This does not mean the effects of the bullying were mild but comparatively speaking, this is generally not …
Impersonal communication on the Internet fuels cyberbullying
Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no closures, conversations in hospital boardrooms are probably questioning whether they should be. But why? Because of health care reform, increasing medical expenditures, hospitals are making less money due to reduced reimbursement, and because of the financial margin of obstetrics. To explain the complex answer further, we need to …
Why are labor and deliveries closing?
Would you consider a career as a singer if you had involuntary tics from Tourette Syndrome?
Well, it apparently didn’t stop 20-year-old Contemporary Christian musician Jamie Grace.
In fact, Grace attributes singing with helping her cope with her disease.
And now she is being rewarded with a Grammy nomination for best contemporary Christian music song, Hold Me. The song features TobyMac, who is a Grammy winning Christian recording and hip/hop artist. He …
A Grammy artist with Tourette Syndrome
Like many of my colleagues, I teach and supervise students, residents, nurses, and respiratory therapists. I’m also the medical director of a PICU. Overall, I’ve been teaching and doing administration for over 30 years. And, like most of my colleagues, I never received any formal instruction at all in how to do these things. To some extent I got help from my own mentors, primarily by watching what they did, …
Reward or punishment in medical training
Do ear surgeons perform facelifts? Absolutely!
And we perform nose surgery and throat surgery, too!
A recent article in the New York Times presented a scathing editorial on complications caused by poorly trained surgeons. However, the implication of the title “Ear surgeons performing facelifts,” is misleading and overlooks the fact that a large portion of training in the specialty of ear, nose and throat surgery includes plastic and reconstructive surgery of …
Plastic surgery is part of the ENT surgeon repertoire
Labels matter. We quickly form judgments based on them. If we hear someone called lazy, the label “lazy person” attaches in our mind even though we may not have even met the person. The same is true for labels given to various medical conditions. If the label for an illness uses language such as “fatigue,” we abstract from our experience and think we know what it’s like to suffer from …
Why we need truth in labeling of medical conditions
If you are like most people, you have probably never heard of Morgellons disease or Morgellons. The first reason you have likely never heard if it is because it is so bizarre and uncommon. Most of what is known about it is based on rare case reports or anecdotal stories. The second reason is because it is not recognized in the medical community as a legitimate medical disease. It is …
The psychological basis of Morgellons disease
Does your medical practice allow anybody to post links and comments on your Facebook page?
The short answer is yes. We do. Why? Because we think allowing patient to post links and commenting on our practice’s Facebook page helps us achieve these four things:
1. It encourages communication.
2. It allows us to address issues that we would otherwise have a hard time addressing.
3. Other patients will benefit by reading the discussions.
4. We …
Addressing comments on your medical practice’s Facebook page
I’ve only had to declare death a couple of times. Once in a three-year-old and once in an adult. In each case the heart had stopped beating. Death was clear.
Brain death is tougher to cope with, both clinically and psychologically. I imagine it would make anyone want to say, at some point, “Are you sure? Are you really sure? How do you know? How can you be sure?” Some times …
Why an anesthesiologist would be needed for organ donation
Billionaire Teddy Forstmann had been diagnosed with a serious form of brain cancer. There’s a tragic twist to the story: according to Fox Business News, Forstmann believes that for more than a year, he had been misdiagnosed with meningitis.
ABC News wonders, “How could such a misfortune befall a billionaire —- a man able to afford the best doctors, best technology and the most sophisticated diagnostic tests?”
They’re missing the point. …
5 ways to avoid a misdiagnosis
It’s amazing how quickly you can lose track of time as you power through the books. Once everything is setup — coffee to the left, pens and highlighters to the right, Grooveshark playlist perfectly tuned — you can suddenly look up and realize that three weeks have flown by and there are 123 multiple choice questions to be answered in the morning.
Over the past year and a half, I’ve learned …
6 things I wish I had known at the beginning of medical school
I’m reluctant to write a post about ADHD. It just seems like treacherous ground. Judging by comments I’ve read online and in magazines, and my own personal experience, expressing an opinion about this diagnosis—or just about anything in child psychiatry—will be met with criticism from one side or another. But after reading L. Alan Sroufe’s article (“Ritalin Gone Wild”) in the New York Times, I feel compelled to write.
If …
Why we should eliminate the diagnosis of ADHD
I don’t like selecting colleagues through the Match. The process was established to allow students to get the best opportunity available and I feel that our program (and our patients who rely on our trainees to provide care) is in jeopardy every year. It always turns out better than I anticipate, so I shouldn’t complain. However, we have to interview 60 prospective residents to fill our six slots so …
Advice to prospective family medicine residents
What could be so simple as a blood test?
A quick prick with a needle, a wait of a day or two for results and a discussion with the doctor about those results. In the words of our vaunted politicians, it would be an “up or down vote” on whether there was anything to deal with.
That was the thinking of my wife’s physician when she ordered a test called the “CA-125.” …
How the CA-125 became a $50,000 blood test
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned to a rotation in pathology where my job was to process specimens taken at surgery, dictate a gross description of the specimen and then place the specimens into the cassettes that would be used to make the permanent sections. I was transferring a prostate biopsy, approximately 0.5mm x …
Patients will understand an honest mistake if the doctor tells the truth
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease …
Diagnosing an illness is an art
When I finished my book on famous patients, the most common question I received was “Are the stories of sick celebrities really relevant to other patients?” My answer was that yes, with some caveats, these experiences are well-worth knowing.
The same can be said for the story of Patrick Swayze’s terminal pancreatic cancer, which has now been told by his widow, actress Lisa Niemi Swayze, in a new book, “Worth Fighting …
How Patrick Swayze died: Why we should care
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