One of the skills I really wanted to learn in med school was how to suture. It’s just one of those things that I felt like you’re supposed to know if you’re a doctor. How can you be a doctor if you don’t know how to suture?Anyway, by fourth year of med school, I had totally failed at my goal. I had already done a surgery rotation, but while …
How a doctor learned how to suture
There is no “right” answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus costly and painful and will not address the core issues involved in fixing the inherent systemic problems.
There have been many things written with regard to this topic and I …
Why healthcare is a responsibility, not a right
Perhaps you’ve heard the news: psychiatrists no longer have time to listen to their patients. It’s all about writing prescriptions for medications and the days of “tell me about your mother” are long gone, or so we’re told. The current perception is that large volume practices where patients are seen in a matter of minutes are now standard and acceptable in psychiatry; that it’s how many — if not …
Are psychiatrists rushed, uncaring, and in it only for the money?
Sometimes you just don’t want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The premise of the movie seems absurd. Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?
David …
Policy makers aren’t doctors, and why that’s a problem
Health care is a team sport, and one of the most important members is the office receptionist.
Receptionists are often the first people patients see when the visit the clinic. And those first impressions count.
In a recent piece from the New York Times, Pauline Chen notes a study of the responsibilities of the medical receptionist, and finds they impact …
Why receptionists are integral to the health care team
Erik’s wife had warned him many times, “Stay off ladders dear, leave it to someone younger.” Erik though was a pretty spry 72 years old and had been cleaning the gutters for many years. He had a sturdy 25 foot extension ladder, had years of experience as an athlete, and wasn’t about to slow down for no good reason.
It was an unusually bright crisp November day in Seattle, when Erik …
The secret in caring for the patient is to care for the patient
I recently saw a post in Yahoo questions entitled, “Is it illegal for a medical student to introduce themselves as ‘Doctor’ before they have received their MD?”
One of the answers that was rated highly was “I think it is more unethical than illegal.” Clearly, if a student is deliberately misrepresenting themselves as a ‘doctor’, it is grounds for disciplinary action. More often than not, this misrepresentation …
Should medical students be introduced as Doctor?
With sixteen million more Americans expected to gain health care coverage in the coming years as a result of the Affordable Care Act, access to actual health care providers may become more difficult. This may be especially true for patients with marginal coverage such as Medicaid.
The Kaiser Family Foundation recently explored the role of non-physician clinicians – specifically nurse practitioners (NPs) and physician assistants (PAs) …
The role of non-physician clinicians in primary care
We certainly wish that antidepressants in particular, and all psychiatric medications in particular were free of side-effects. It would be a boon to our patients, and their families. Sadly, there is no such thing as a medication without any risk of side-effects. Even over-the-counter medications such as Tylenol, Benadryl an aspirin can have pretty serious side-effects.
Some side-effects of medications are related to dose — the higher the dose, the …
Neurotransmitters and the side effects of antidepressants
The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.
However self-management skills refer to specific curricula of skills that can …
The benefits of successful patient self-management programs
In the New York Times article “18 Stethoscopes, 1 Heart Murmur and Many Missed Connections,” Madeline Drexler tells her story of being a model patient. Not like a model citizen cooperative and pleasant but, a person with a medically interesting finding who is asked to help teach medical students. These “patients” are examined by small hoards of inexperienced medical students who have little knowledge, little skill and varying degrees …
A model patient in physical exam class
If you’re a new intern you are hopefully a little afraid of the new found responsibility in your life. I say “hopefully” because there is nothing more frightening in healthcare than someone who is “unconsciously incompetent.” That is, someone that doesn’t even realizethey have no idea what they are doing.
Before starting medical school I was an emergency nurse. As an RN, I had the opportunity to see many medical …
Advice to new interns from a nurse turned medical student
A strange thing happens on your first day of med school. Yesterday, you may have joked with old friends about upping your Paxil dose, but starting today, you are expected to be professional. And professional is suddenly a word that prevents you from being open with your new friends, a word that hints admitting to any real struggle could be a career-ending mistake.
I want to tell you that it isn’t, but the truth is, I’m …
A medical student with anxiety and depression
Is Dr. X a good doctor?
Being a doctor, I often hear this question being asked. More often than not, the response that I hear is a rather clear cut one, “oh yes, Dr. X is a great doctor,” or “oh no, Dr. X is not a good doctor,” making me wonder what such a definite response is based upon. Is it based on actual facts? Is it based on …
Clinical competence, and whether a doctor is good, or not
The non-compliant patient who sues his physician for an adverse clinical outcome is a storied malpractice bogeyman. After failing to follow a screening regimen, show for appointments, undergo recommended tests, make health-related lifestyle changes, or take their medications, these patients (now plaintiffs) have the audacity to blame the doctors and nurses for not being adequately clear or assertive.
Are they real?
Yes and no. Not every “difficult” patient is a potential …
Do non-compliant patients really sue their doctors?
We are living a new era where the progress for the civil rights of women is undeniable, yet Facebook COO Sheryl Sandberg points out in her compelling TED presentation:
“We still live in a world where some women don’t have [civil rights]. But all that aside, we still have … a real problem … women are not making it to the top of any profession …
Women in medicine: Gender, mentors and role models
According to Wikipedia, up to the beginning of the 19th century there had been only 3 occupations that were considered to be professions, Divinity, Medicine and Law.
A profession is considered a trade or occupation that transforms itself through “the development of formal qualifications based upon education, apprenticeship, and examinations, the emergence of regulatory bodies with powers to admit, discipline members, and enforce adherence to an ethical code of practice.”
Professionals are …
The professional status of physicians is at risk
Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.
She lived for him. She was always telling me of his pain, …
Death is inevitable, but it is almost always seen as tragic
To do nothing is sometimes a good remedy.
-Hippocrates
Edna Frost is 88 years old, a slender, slow-talking woman with a dry sense of humor and a blood pressure that’s all over the place. At best, she runs ten points higher than any of her previous doctors wanted to put up with. At worst, she flirts with systolics over 200, but that doesn’t seem to be a common occurrence.
Edna has been my …
Sometimes the treatment is worse than the disease
Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.
The data privacy and security concerns surrounding the transfer of de-identified data are significant. To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in federal …
Pharmacies selling prescription information to data mining companies
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