I’m struggling — truly struggling. This year has been beyond hard. I honestly never thought this time last year that I would be in this predicament. Things were good, I had a great job, and I was working on our fixing up our dream retirement home. We had great vacations every year. Yes, the home remodel wasn’t quite on track, but we were making progress. But then, my world fell …
A bad outcome changed this physician’s life
A few months ago, I was having lunch with a friend. He mentioned a recent outpatient surgery that he had and indicated that upon being discharged, he was given a prescription for 30 pain pills. Although the recovery was uncomfortable, the pain was not overwhelming. But, as a precaution, it was assumed that he needed this powerful pain relief to be available even after he told the provider that he …
Our role as parents in the opioid epidemic
“What’s the deal with your people?”
As a baffled second-year resident, I looked up through my scrub mask at the Caucasian female attending with whom I was operating. I had an idea about what she was referring to as I overheard her complain about a laboring patient while she was scrubbing with the other Caucasian attending who was operating in the room next door.
“She acts as if she has never had …
The doctor is in, but please check your bias at the door
Sanjay Gupta. John Locke. Jill Stein. Charles Krauthammer. What do they all have in common?
If you guessed that they are all physicians, then you’re right.
Less salient, however, is the fact that all of them pursued passions outside of medicine. (Dr. Gupta is an Emmy Award-winning medical reporter. John Locke was a physician-philosopher. Stein and Krauthammer both made their mark in politics.) In doing so, they avoided an existential trap that …
Why medical students should not let medicine define them
Anger. Jealousy. Envy. Frustration. I was feeling all the emotions when NYU announced in August that their incoming and subsequent classes would be tuition-free into perpetuity. One consolation: at least I wasn’t one of the chronologically unfortunate that graduated from the school just months, or a year, before that announcement. For them, the time difference was small, but the difference in loans was vast — one year of tuition costs …
You shouldn’t worry about public service loan forgiveness
The nights from that time run together in my memory: The cuffs of my scrub pants getting caught on the heels of my clogs because my pants were sagging; stuffing dry graham crackers I stole from the nursing stations into my mouth at 4 a.m. to stay awake while writing notes; what seemed like my pager buzzing against my hip every five minutes; feeling the enormous specter of unending work …
A story about the Patient and the Big Man
I learned a new word recently: transdiagnostic, which refers to something that is applicable across a spectrum of conditions. It seems that this is becoming an increasingly popular concept in treating anxiety disorders.
No wonder. As I researched this word, I read this:
As of 2013, there are twelve anxiety-disorder diagnoses and over twenty-five subtypes and categories of these disorders, with specific treatments for about half of them. Research has …
Transdiagnostic therapies in primary care
This is an article about certainty, or maybe lack of certainty?
It is about the need for confidence, without having overconfidence.
Doctor! Don’t be arrogant — listen to your patient — they are telling you the answer.
So believe them, but be a skeptic!
Better yet, figure out the diagnosis, but then don’t believe yourself.
Try to prove yourself wrong at every turn.
The definition of the word hubris is important to understand. One definition of hubris is “exaggerated pride or …
Be the honest doctor instead of the confident one
On November 6th voters in Massachusetts are facing a very important health care-related question. In addition to voting for political parties in the midterms, they also face three ballot questions. The first of these is whether there should be mandatory state enforced nurse-to-patient ratios. For a general medical or surgical floor, this will be no more than four patients for every registered nurse. For other types of adult floors and the …
Should there be mandatory state enforced nurse-to-patient ratios?
I have talked in the past about how I try to tackle the philosophy of financial independence. Part of the reason is that there are so many other amazing voices that manage the mechanical side. The other part is my profound belief that the grand majority of Americans can either cleave a path to financial independence or at least substantially improve their economic situation. Yet, the majority don’t. …
3 hurdles to financial independence
Ethical OB/GYNs everywhere sighed heavily when they realized from the action on their Facebook and Twitter feeds that the Ellen Show broadcasted incorrect and potentially harmful information about ovarian cancer screening to almost 4 million people. Millions more will likely hear about it on social media.
Ellen Pompeo, who plays a doctor on the television show Gray’s Anatomy, decided to play doctor in real life and used her celebrity platform to recommend …
The Ellen Show broadcasts potentially harmful information about ovarian cancer screening
By this point, a lot of people have heard the famous Dave Ramsey quote, “If you live like no one else, later you can live like no one else.” Ramsey is known for being a proponent of attacking debt aggressively when people ask, “How should I pay off my debt?”
He proposes one method that I think works for the vast majority of Americans, but today I’ll argue that method isn’t necessarily …
How should physicians pay off their debt?
Financial freedom means different things to different people, but to me, it’s when you can quit your day job and be able to cover your expenses with other sources of income. The dollar amount depends on your unique situation, where you live, and the lifestyle you lead.
I believe all physicians can attain financial freedom, but some encounter obstacles that delay them from reaching that point and sometimes keep them from …
What does financial freedom mean to you?
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Dear patients:
A few things come up daily in my office that need to be addressed. I’m just going to put these out there in the blogosphere in the hopes that someday they’ll be shared widely and save myself and other doctors a whole lot of hair-pulling (as an alternative to crowdfunding a Super Bowl ad).
1. Stop apologizing
So many people apologize out of habit for way too much (I’m guilty too), …
4 things this family physician wants patients to know
I remember sitting in my residency academic adviser’s office as I was discussing the plans I had designed for my community project at the end of my intern year. I can only imagine what she thought as I looked at her with a blank stare when she had suggested I should create an original research project around this. “What?” was all I had managed to mumble out of my mouth. …
5 lessons on doing research as a resident
We do not rely on the benevolence of the butcher, the brewer, or the baker to feed ourselves — Adam Smith observed in the “Wealth of Nations” (1776) — but on their regard for their own interest. The desire to pursue a profitable living also holds true for doctors and nurses, notwithstanding the moral dimensions of their labor.
Health care is a service like any other. We ought to expect price …
Health care is expensive. It’s time to treat the cause.
“There will always be suffering. It flows through life like water …”
Those famous lyrics sung by Nick Cave in his Lime-Tree Arbour ring true for many of us. They take on an entirely different layer of meaning for physicians.
Even the very journey of becoming a physician is marked by suffering. While many of our classmates frequented football games, nightclubs, and social events, most of us were studying day and night …
The gift of suffering in medicine
I still remember the warm, fuzzy feeling of receiving my first few interview invitations. Unlike medical school, I received much more “love” from residency programs. Since I was part of the inaugural class of a new medical school, I interviewed for a lot of programs: 16 anesthesiology, six transitional years, and three preliminary medicine programs. After my first few interviews, it became apparent that most residency interviews tend to be …
What I wish I knew on the residency interview trail
Gender politics aside, let’s talk about why the way doctors get paid matters to you as a patient. Female physicians don’t just get paid less because they prioritize their families, they get paid less because they prioritize patients. In the fee-for-service model, doctors are paid per patient visit, so the more patients they see, the more they get paid. This means that the worst doctors are paid the most. Health …
Female physicians prioritize patients over profits
Yes, this is a piece on observation medicine as the expansion of our specialty. My oh my, have things changes since my days of training where I learned to care for all comers irrespective of their money, background, color or creed. I learned to stabilize, evaluate and treat then admit or discharge. Clearly, I’m simplifying though, historically, our disposition decision was binary, patient in or out.
Then overtime as I practiced emergency medicine (EM) …
Expanding the scope of emergency medicine
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