1. Our health care system is broken, and there isn’t going to be an easy way out. Costs are too high and our outcomes too poor. There’s a lot of finger-pointing in how we got to this point, but one thing is for certain — physicians must lead the way to a better system. The heart of health care is still the doctor-patient relationship and that needs to be protected at …
10 things I’ve learned 10 years after I finished medical school
Fourteen hours into their shift, the intern headed down to the lobby to pick up the delivery. Today it was Indian food. He struggled to push the elevator button while holding the bags but managed to make it up to the top floor ICU. The rest of the surgeons gathered around the table cluttered with spent pens, journal articles and unused bottles of lidocaine to eat. Someone offered up their …
Imagine spending days or even weeks in an emergency room without treatment for a broken leg or painful kidney stone.
Patients in psychological crisis across the country are living this exact scenario. Long waits in an ER, hospital room or prison for an inpatient psychiatric bed, otherwise known as psychiatric boarding, are their unfortunate reality.
Rewind to over 50 years ago — as institutionalized patients were gradually integrated into communities, the availability …
Let’s talk about the psychiatric boarding crisis
She tells me that she sees them at night when she is lying in her bunk bed — eight to a room. Grotesque forms with masks over their heads and guns across their chests. She hears panicked shrieks, but is never certain if they are coming from the next trailer, or if they are inside her head. They cannot be nightmares, because she never sleeps. She reminds herself that haunting …
What being held at the Mexican border is really like
I have a few hundred thousand dollars in 529 plans. We have been growing them for years. Although not everyone’s cup of tea, this lump of money invested in this manner suggests that not only am I prepared to drop a boatload on college education, but also feel that it is cash well spent. Although this type of thinking was self-evident a decade ago, there is a growing chorus of …
A college education is money well spent
Dear first-year medical students,
Welcome to medical school — congratulations! You have worked, sacrificed, waited for this moment for many long years, have left blood, sweat, and tears along the tracks of your life marathon. This is the first checkpoint in your journey. You’ve made it. Your loved ones are right here cheering your accomplishments, there are many. That new, freshly-pressed, short white coat makes you look like an absolute …
Welcome to medical school. Welcome to the rest of your life.
Darkness covers the sky so that no light can enter the soul. Only a silhouette of life is possible — only a shell devoid of existence, devoid of meaningful experiences. Living is like walking in a dense forest where its canopy envelopes all who dare to enter. The falling rain is black. It covers everything like a shroud. The air is so heavy, breathing is, at times, too much to …
Physicians are at the frontline of depression
I began practicing as an internist/nephrologist in the early 1960s. Having rented an office in Los Angeles, I introduced myself to the local medical community and set out to build a practice.
With a growing family, a mortgage and an office to support, I was hungry for patients. Hospital emergency rooms were good referral sources, so I took ER call at three different hospitals.
Late one Friday night, I got a call …
You can’t always expect a miracle, but you can always hope for one
Can the health system survive?
It comes down to the people. It is not about their work, but how they feel: feeling valued, feeling their work is valuable to those they serve, and feeling valuable doing the work. It is work as an extension of what you believe, what you love and how you want the world to be reflected back to you.
For 22 years, I have watched systems work to …
Want to change the health system? Find your why.
I have a fantastic leader as our chief. He develops a certain softness in his voice and demeanor when he has to sit down with me and share some concerns. It’s like he is on my side. It’s like he believes in me. He thinks this was an act, but this is not who I am. I am trying to emulate this quality in me as a person and a …
What do you do when you’re criticized?
Last year, a cardiologist at my institution presented the story of a patient he had cared for and correctly diagnosed with a not uncommon condition after several other physicians had failed to do so. The patient was a 72-year-old man with near syncope after exercise for several months, with no other symptoms or clues to the diagnosis. The cardiologist asked him to discuss each episode in detail, and the man …
Is Watson the answer to all of our problems?
There’s this prevailing theme in modern medicine that I don’t understand. It’s called: “Do no harm to others, but neglect yourself.”
It’s perpetuated by ridiculous working hours, emotional, psychological and sometimes physical stress, minimal vacation and maximum pressure to always do a little more. Did you overwork yourself as an undergrad, watch your hair fall out during MCAT studying, then give up family and friends for a fire hydrant of information …
Doctors: First, do no harm to yourself
Have you ever been the only customer in your local supermarket? Although the experience can be a bit unnerving, at first, you soon start to notice the advantages: No line at the deli, no pushy shoppers, no carts jamming up the produce section. As you breeze through checkout, you think to yourself, “Gee, I could get used to this.”
Now, imagine walking into an empty waiting area at your local emergency …
3 ways to decrease emergency department wait times
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I may have bitten off more than I can chew. I am in medical school, which alone tends to drive people into scheduling mayhem. I am in student government. I am on the official basketball team at my school. I am preparing for an AMSA talk. I workout regularly, I continue to write, I cook and do my laundry and spend time outside when I can. My caffeination is at an all-time …
While managing her schedule, a medical student learns 2 important concepts
Recently, a respected allergist reassured his audience: the mortality rate for food allergy is very low. The risk of dying in a car crash is much greater than the risk of dying from food allergy. The implication seemed to be that the anxiety around food allergy is misplaced. Though any loss of life is too great; statistically, food allergy deaths are rare. To the food allergy community, it just doesn’t …
Food allergy: Death is not our only fear
A colleague recently sent me a link to the American College of Cathopathic Physicians a new organization whose mission “is to protect the professional autonomy and advocate for a full, broad scope of practice for DNPs as a ‘cathopathic physician’ completely equal in every way to our MD and DO counterparts.”
I was, I admit, so stunned by the statement that I thought the whole thing might be an elaborate joke. It was only …
Not all doctors are physicians
If somebody asks you how many bones there are in a human body, please do not blurt out, “206.” The correct answer is nuanced. To respond accurately to the query, you have to address five questions. Who? What? When? Where? Why?
Consider first that humans vary from one another in facial features, hair …
How many bones in the human body? It’s not what you think.
From 2009 to 2012, I directed the graduate course “Fundamentals of Clinical Preventive Medicine” at Johns Hopkins University’s Bloomberg School of Public Health. It was a required course for Hopkins preventive medicine residents, and also usually attracted other master’s level public health students and undergraduates with a strong interest in medicine. The class size was 15 to 25 students. In that setting, with a small group who generally believed that …
Why this physician teaches health policy in medical school
Two cars arrive at a stop sign at the same time. Both start into the intersection. One driver speeds through, while the other jams on the brakes, avoiding a collision. This driver feels insulted, offended, diminished. Who the hell does that other driver think he is? He nearly killed me!
This scenario, and countless others involving merge lanes, contested parking spaces, and aggressive rush hour traffic, are set-ups for road rage. …
Road rage: It’s all in your head
I have to admit, I’m not the biggest follower of popular culture. I couldn’t pick a Kardashian out of a crowd if my life depended on it. I don’t know who Brad Pitt is currently married to, if he’s married. And I have no idea how many kids Natalie Portman has, if she has any at all. (In full disclosure, I was blanking on names and pulled up People.com to …
On vaccines: 1 pediatrician vs. 13 celebrity opinions
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