There’s an ugly undercurrent that sometimes shows up in the emergency department: indeed all over the world of medicine. I’ve seen it in doctors and nurses alike. It’s a meanness, a smallness, a kind of moral judgment that can lead us to make poor medical decisions. Or it can simply make us poorer in spirit.
I remember the day I had a young man who was in custody. He was 18, …
Physicians need to learn to avoid moral errors
1. Cancer is not rare. Technically, childhood cancer is rare compared to adult cancer, but it’s not as rare as you think. Outside of my work, I can think of 3 people who I know personally that had a childhood cancer. A teammate on my high school basketball team, my sister-in-law, and a high school debate teammate. My guess is that you also know someone from church, a coworker’s …
10 things a pediatric oncologist wants you to know
How many physicians know how many visits they are approving when referring to a specialist?
This was a germane question posed to me today. I first asked this question of myself as a junior faculty member, while busting the residents’ chops over the egregious numbers of referral visits they were approving. You see, as any good resident knows, being proactive in the referral department demonstrates skill in the art of “avoiding …
Attention PCP colleagues: We can do better with referrals
As a mom to two little girls, I understand the lure of online forums. With so many accessible tools — including Google, Instagram, and online support groups like Facebook groups — before a parent brings their child to the doctor, they will inevitably first post their inquiry online.
They post a picture: “What’s this rash?”
Or they’ll write: “My baby has had a fever of 135-degrees! Do I need to take her …
Being a mom doesn’t make you a medical professional
Burnout affects as many as 50 percent of physicians. Interventions have been proposed at virtually every stage of a physician’s life, from medical school to residency training to professional practice. While the rigors of medical training certainly contribute to the high levels of burnout in the profession, there are indications that the trouble begins at the undergraduate level.
I recently graduated from an undergraduate program geared toward students interested in medicine. …
Burnout doesn’t start in medical school
During my first pregnancy, I frequently dreamt of my baby. I couldn’t remember the details of facial features or hair color, but I always knew that I was going to have a girl.
Three years passed after Claire was born, two more heartbeats were identified and then lost somewhere deep within my abdomen. On two occasions, I watched blood seep from my body and stain my clothing, realizing that I didn’t …
Perils of a postpartum pediatrician
It was 4:30 a.m. on a freezing cold winter morning when I dragged myself to my car and started down the street to the hospital. I was working in the ICU for the month, and sleep had become a commodity I no longer enjoyed. I tried to shake my brain out of the dense fog it seemed to always be in lately.
I looked up in time to see my car …
A resident physician’s story of depression
The process of setting up a new pain management clinic has allowed me to critically consider the role of patient intake forms, an area that has traditionally been ignored by technological advances and institutional innovation.
Health care must empower patients to conveniently complete intake forms digitally — whether at home, en-route to our clinics, or in our waiting rooms. When done correctly, the forms can greatly enhance the patient …
It’s time to upgrade the outdated intake forms at health care clinics
Caribbean medical schools are, first and foremost, schools of opportunity. They’re a necessary one, too. Nearly 3,000 U.S. citizens study abroad and match into residencies in the U.S. every year, nearly all of which do so after not gaining admission at home. The Caribbean is a huge part of that. With no shortage of qualified people wanting to be doctors, and a marked shortage of doctors, it’s no wonder the …
Addressing the “ugly truth” about Caribbean medical schools: Why they’re not all the same
I just spent two days at the Florida Medical Association Annual Meeting. We were there to help educate the physicians on real asset investing. I met many interesting people and likely started some new and exciting relationships. Many of the physicians stopped to talk to us about real estate investing and the benefits of passive cash flow, but there was a troubling undertone that permeated many of the conversations. A …
A physician’s strategy to conquer burnout
I’d be willing to bet most of you have heard of, or previously used, telemedicine in some shape, form or fashion. Stated simply, telemedicine is the process of seeking care from a medical provider using your phone or laptop. This field is exploding, and I have no doubt popularity will continue to grow as large health systems and pharmacy giants dive in.
It’s easy to appreciate the convenience and efficiency of …
Beware the limits of telemedicine
“What do you want to be when you grow up?” I see their eyes light up as they smile, and get prepared to answer this very important question. For some of them, it is the only smile I have seen during the entire visit. And for me that makes the entire visit worth it.
I move my eyes away from the computer and solely focus on their face as I hear …
Inner-city teens still have a dream
Each year, thousands of newly minted MDs are elevated from mere medical students to — drumroll, please — interns. If that’s you, congratulations and welcome to the world of residency.
Welcome to the world of motivation, inspiration and altruism — where you wake up every day knowing this was what you were meant to do.
And welcome to the world of the hungry, the tired, the poor. …
12 tips to help you survive residency
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A good friend of mine, B., once told me a few years ago that before her divorce, her husband was verbally and occasionally even physically abusive toward her. Somewhat shocked by this news, I expressed how glad I was that she had gotten out of that situation.
I did not think that B. would be a typical victim of domestic abuse. Coming from an affluent background, we met as co-workers in …
Domestic abuse can affect anyone, even physicians
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated in follow-up after being diagnosed with severe obstructive sleep apnea 8 weeks ago. Continuous positive airway pressure (CPAP) was prescribed based on a titration during in-laboratory polysomnography. He notes some improvement in his sleep with CPAP, but he still feels drowsy during the day. He does not have …
MKSAP: 52-year-old man with severe obstructive sleep apnea
Being a hospitalized patient is perhaps one of the most disempowering experiences an individual can face (besides being in war, or a prisoner). Patients face constant uncertainty; having no idea what time their physician will visit, when they will be taken for their tests, or who will suddenly interrupt them again with a demand – perhaps an early morning blood draw, or yet another round of interrogation and uncomfortable examination …
Patients need an advocate at the bedside
As we follow the national opioid epidemic, with its greater than five deaths per hour from opioid overdoses, the focus is shifting to methods for limiting an individual’s exposure to these drugs. For most of us, our first contact with these highly addictive medications is after surgery.
Studies now reveal that 60 percent of pills prescribed for pain after surgery go unused. These opioids often make their way to other family …
The era of opioid-free surgery has arrived
Well, cement trucks and health care used to have a lot in common. Now all of that has changed.
Cement plants have a market that is determined by the time it takes for special trucks to transport wet cement and get it in place before it sets. We see those cement trucks out on the roads with their spinning cargo bins — and all of them are bound to a local, …
What do cement trucks and health care have in common?
Time is our most valuable resource. It’s nonrenewable — once spent, you can’t get it back. We all understand this logically to varying degrees. But many of us feel the compulsion to manipulate time, to restructure it to fit our lifestyles. “Make the time,” is the common expression, as if we could create something out of nothing. You can’t. You can’t change the laws of nature and “make” time, no …
We need more unstructured time for doctors
Hippocrates wrote the Oath for Physicians about 2,500 years ago, and numerous translations and variations have emerged for medical students to take, usually at graduation time. That era of Western medicine had great changes so that an oath appeared necessary to protect the patients in those ancient times. The thrust of the Hippocratic Oath included not only the physician’s competence and dedication but also the critical needs of each patient. …
The impact of the Hippocratic Oath in 2018
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