Relaxing on the couch, my family already in bed, watching TV to calm my mind before leaving for a busy night shift in my emergency department, I was shocked to see an advertisement that insulted me, my colleagues, and my profession.
A trailer for a show called “Nurses” is shameful.
The idea behind the show is admirable — nurses do not get recognition from society for the work they do and the …
Why a new TV show offends physicians
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 60-year-old man is evaluated for a 5-month history of exertional chest discomfort that improves with rest. His symptoms have progressively worsened such that he has reduced his activity to a minimum. Medical history is significant for hypertension and hyperlipidemia. Medications are low-dose aspirin, losartan, hydrochlorothiazide, and atorvastatin.
On physical …
MKSAP: 60-year-old man with exertional chest discomfort
A wise professor of medicine always told me as a young physician, “Eighty-year olds are to be revered and not messed with.” This is especially true for those 90 or older. Here in South Florida, there is always some senior citizen telling us today’s 80 is yesterday’s 60, and today’s 70 is yesterday’s 50. It just isn’t so. I see this erroneous belief of the elderly having the healing power …
The erroneous belief that the elderly have the healing power of younger individuals
I am healthy, a mom of two boys, a wife, and an emergency medicine PA for the past 12 years. I don’t just say I’m healthy to say it, but I really am. I’ve never taken medications, until now. It’s New Year’s Eve, and I’m scheduled for my injection. I grab my sharpie and write injection on the 31st. I suddenly didn’t know whether to laugh, cry, or be angry. …
Chronic illness? Have faith in medicine.
Most physicians recall the rigors of their residency training through a mixed lens. In prior generations, a single-duty shift could stretch to 36 or more consecutive hours, but the exhaustion was buoyed by the camaraderie of sleepless on-call nights in the hospital. Despite the exhaustion, resident well-being received scant attention. Beginning with the 1984 Libby Zion case, and later the Accreditation Council on Graduate Medical Education (ACGME) duty hour restrictions …
A paradoxical fix to physician burnout: more patients, less supervision
As the year winds down and must-pass year-end spending bills are completed — and with that, any chance of attaching and approving health care legislation — the special interests have won big, and consumers have lost big.
Employers, unions, and insurance companies won big with the repeal of the “Cadillac” tax on high cost-benefit plans at a cost of $200 billion over ten years as well as the repeal of the …
How special interests won big and consumers lost big
Ninety minutes before my Sunday night shift, my two-year-old, Titan, comes screaming up the stairs looking like a scene out of a slasher horror movie. His older sister sheepishly admitted to chasing him into the edge of a door frame. We created an ED bed on our kitchen counter and slipped a pillowcase up his arms, behind him, with him laying …
Doctors: Always be prepared to suture wounds
All of us are aware of what has been termed our “obesity epidemic.” The current prevalence of obesity among adults in the U.S. is around 40 percent, a dramatic increase over the past 50 years; it was about 15 percent in 1970. Rates are also increasing across first world countries, so we are not alone in this.
Obesity is defined as a body mass index (BMI) greater than 30. Values of …
The progressive increase in adult obesity is more complicated than we think
Year 2000. I’m sitting in a semi-fancy hotel ballroom near LAX along with several hundred slightly edgy emergency physicians. We’re all awaiting the start of our ABEM written re-certification examination. This was in the old-school days of live exams. We had an MD master of ceremonies, a famous EM leader; and I can still remember his message to the assemblage. “If you’re re-certing for the first time, welcome, relax, good …
Tales of an emergency physician, recertifying for the third time
There was outrage over the sudden rise in the price of the EpiPen. But the rise in many other pharmaceutical prices gets less attention but is just as concerning. It can be easy to forget issues like this until they affect us personally. My two encounters with irrational drug price increases for dermatologic conditions are a reminder of how pervasive this problem is today.
I have rosacea, a …
Beyond the EpiPen: Irrational drug prices are now pervasive
I went to a bar last night — and I looked good: red coat, black dress, knee-high suede boots. I was feeling pretty good.
I met my best friend at this bar — he lives elsewhere now — but this is his favorite spot in the world. Like Norm in Cheers, he is also their favorite customer.
We ordered dinner, and my best friend stepped away to talk to the bartender. I …
An orthopedic surgeon goes to a bar. Here’s what happened next.
We live in an era where plastic surgery is routine. Indeed, in many parts of the country, plastic surgery is an expected rite of passage. Years ago, facelifts and “tummy tucks” were done on those in middle age who were trying to experience a surgical time machine. Now, folks in their 20s are having all kinds of work done, not to recreate a prior image, but to create a new …
Patient demand doesn’t justify medical excess
The night I almost swallowed a bottle of Percocet post-call in residency is still clear in my mind, as is the hours leading up to it; the thoughts going through my head, the swirl of emotions seemingly pulling me like an ocean undertow. I can only attribute my pause to a power greater than myself. The truth is when I look back on that night, I can see that those …
The thought cancers that almost took my life
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I recently had the pleasure of interviewing famous television and film actress, Claudia Christian. She has played significant roles in many notable movies and shows, including lead roles in the long-running sci-fi series Babylon 5 and the Disney film, Atlantis: The Lost Empire. In our podcast interview, we discussed treating alcoholism using the FDA-approved drug, naltrexone.
Why listen to an actress about medical treatment for addiction? First of all, doctors generally …
What can a famous actress teach us about curing addiction?
I think I’m finally burned out. And it’s been a long time coming.
It likely started when my private physician-owned emergency group got bought out by one of the big corporate groups. The changes were small at first. Turning us into hourly paid employees instead of an RVU-based salary. Shiny new VPs and directors sending us emails. Things seemed fine for a while. Then came the many, many emails about better …
Burnout is death by a thousand cuts
In medicine, contrary to common belief, it is not usually enough to know the diagnosis and its best treatment or procedure. Guidelines, checklists, and protocols only go so far when you are treating real people with diverse constitutions for multiple problems under a variety of circumstances.
The more you know about unusual presentations of common diseases, the more likely you are to make the correct diagnosis, I think everyone would agree. …
Experience and in-depth knowledge can empower you with an appreciation for nuances
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The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge is shaping …
Our optimal future U.S. health care system
I can’t speak on behalf of all in my specialty, but I wager that there is a good percentage of radiologists out there who essentially work nonstop from the moment they walk in the door to the moment they leave, working through lunch hours, etc.
Throw in a mandatory meeting every now and then and “the list” of studies to be read can explode, and it can truly be demoralizing.
I have …
Combat burnout one bite at a time
There was a time, before treatment algorithms, when physicians would rely on the detailed bedside and/or office observations of their patients in conjunction with the most recent published peer-reviewed studies.
Time spent with each patient was considered essential and appropriate to reach a proper diagnosis and treatment plan. Now, due to corporate mandates to produce higher RVUs, time is regarded as an unnecessary luxury, to be controlled and curtailed. Yet recent …
Experienced-based medicine has value
Over the past 40 years, the number of U.S. hospitals declined by 12 percent, from more than 7,100 in 1975 to 6,200 in 2017, according to the latest American Hospital Association survey. And, yet, despite shuttering nearly 1,000 facilities, hospitals remain the nation’s largest source of health care spending, accounting for $1.1 trillion annually (or 33% of all national health care expenditures). Much of that money goes …
5 improvements needed to modernize the American hospital landscape
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