My first patient of the day has metastatic pancreatic cancer. She’s had it, in fact, for two years. Getting chemo for two years. Her hair has fallen out, her pain is becoming uncontrollable and she’s been in and out of the hospital.
Her daughters came to the clinic with her. She is tearful. Her daughters pull me aside. “Tell her to focus on the positive,” they request. I wonder if there …
“The worst enemy of a doctor is another doctor,” said one of my professors during rounds when I was doing my internal medicine clerkship as a third-year medical student.
I remained skeptical. That did not match the idea of becoming a doctor nor did it support what Dr. Pellegrini said: “Medicine is the most humane of the sciences.”
Nonetheless, my old professor explained that when it comes to patient care planning and …
The worst enemy of a doctor should never be another doctor
They are intangible, as intangible as the space that the death of a loved one leaves behind. There is emptiness where there was once-occupied space. The past tense supersedes the present and definitely any aspect of the future tense and verse. Where they are supposed to be — in our homes, in our cars, at our kitchen tables, out to dinner with us, in our arms — there are only …
A physician’s take on thoughts and prayers
I am a hospitalist at a safety-net hospital. Through my work, I have come to understand how our daily decisions — filtered through our own biases — influence how health care is implemented, and I had a personal teacher in my first year as an attending. Soon after starting my job, I met Mr. K. He was in his 40s, well-kempt, soft-spoken and had the good habit of looking people …
More equitable health care starts with you
The trap had been set. I arranged my baseball cards in the three boxes that I had arranged in a circle around my bedroom floor. I checked again to make sure that anything of value had already been packed away in the dresser drawer in the closet. Bill’s mom would be dropping him off in a few minutes. I salivated as I thought about the bundles of cards he …
A physician’s first lesson in business
It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry …
Am I the cold and detached physician?
Where I practice, the process of referring a patient suffering a mental illness is quite infuriating. The wait to get in to see a psychiatrist or psychologist can be months all the while patients are suffering. Worse yet, with certain insurances, there are just no mental health providers available for any of their covered patients. The failure of treating mental health disease in the U.S. is glaring.
In the U.S., approximately …
The U.S. is failing at mental health care
Health care has undergone innumerable changes over the last decade, and the pace of change only appears to be accelerating. At the crux of most of the changes we’ve seen is the central problem that the cost of our health care system is unsustainable, and we as a nation need to put the brakes on it. The costs to individual patients are also unacceptably high.
Unfortunately, the prevailing philosophy has been …
A fight for the heart and soul of health care
It’s easy to be excited about facts when they support our own opinions. It’s nice to believe that uncomfortable facts are fake. Likewise, it’s comforting to believe that everyone who disagrees with us is ignorant. When the truth is so obvious, we say, “How could anyone but an uneducated bumpkin deny it?”
And yet, it seems that much of our knowledge is incomplete and that our deeply held beliefs may be …
Today’s unassailable fact could become tomorrow’s flat earth
I will graduate from medical school next week. As it winds down, I’ve spent a lot of time reflecting on what I’ve learned and how I’ve changed over the past five years.
Obviously, I now know a lot more about medicine. There’s no escaping the need to absorb an enormous volume of information. I can rattle off the symptoms, mechanisms, and treatments for heart failure, diabetes, syphilis, and dozens of other …
A graduating medical student reflects on the last few years
I know a bit about the opioid epidemic ravaging America. My wife and I grew up in West Virginia and follow the news from home. I practice emergency medicine in rural South Carolina, and have worked in Georgia, North Carolina, Kentucky, and Indiana. I have seen the enemy, and it is terrible to behold.
The genesis of the epidemic has been covered over and over. It is a complex problem with …
The cognitive dissonance of prescribing narcotics
Recently I posted a piece, describing research out of Johns Hopkins, showing that when patients come to ERs — either with no insurance or insurance that is out-of-network — they often face charges that are four, six, or even ten-fold greater than what Medicare would pay for the same services.
After the post, I was inundated with angry tweets and emails, mainly from emergency medicine …
Don’t blame doctors for outrageous emergency department prices
Vaccines have been hailed by virtually all medical experts, as well as medical historians, as the among the greatest triumphs of public health to occur in the past two centuries. Yet since Jenner first proposed vaccination for smallpox using the vaccinia, or cowpox, virus there have been both skeptics of its effectiveness and people who thought it was dangerous. That is, they had the risk/benefit ratio of vaccination exactly backwards, …
Has the anti-vaccine movement affected vaccination rates?
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There are many days in primary care when you feel like you are treading water; nobody gets substantially better as time and disease progression seem to always win over your own and your patients’ efforts.
But sometimes you hit a winning streak. The past few weeks seemed to bring me one diagnostic or therapeutic coup after another.
There was the depressed man who came in smiling and said: “I’m shaving again.”
There was …
A doctor on a recent winning streak
Congratulations! You made it through medical school, got your MD/DO degree, and can officially be called doctor! One day, you’re a student. The next, you’re a doctor and with that come the responsibility, trust, compassion, and professionalism associated with our career. But how do you transition?
It starts with your mindset and then deciding to be the best doctor you can be. Your thoughts inspire your words, which direct your actions.
I …
The new doc on the block: 7 lessons from my first year of being a doctor
This year marks the 50th anniversary of the passage of the Fair Housing Act, which formally outlaws racial discrimination in the sale and rental of housing. The Act, passed in the wake of the assassination of Dr. Martin Luther King Jr., had, at its core, the goal of affirmatively promoting equitable and integrated housing across the United States.
Earlier this year, however, the current presidential administration announced that it would suspend an …
Why physicians should care about structural racism
My last patient of the day was an elderly woman with metastatic lung cancer, a non-smoker who had been battling this terrible disease for more than a year. I was running thirty minutes behind. I had a packed afternoon with difficult cases and patients who required more of my time and care. I peeked into her room, said hello and apologized for running late. Ms. B. greeted me with her …
This physician vows not to rush
I’ve thought long and hard about writing this, so here goes: I am a female surgical subspecialist. I trained at a Harvard program back in the 1990s, and was one of a handful of women to have completed residency training at a stodgy 125-year-old program. The eighth, to be exact. During that time, I was treated as an inferior, sexually abused verbally, routinely given the bottom of the barrel when …
Not me: the story of a female surgical subspecialist
1. You sleep when you can. Despite what medical television dramas portray, call room beds are for sleeping. Period. As you curl up into the bed you have no idea whether you are about to get a couple hours of sleep or a couple of minutes, but in that moment of sheer exhaustion, the drab hospital cot or bunk suddenly transforms into a luxurious sleeping pad. Bonus if you can …
After a semester of medical school, I returned home to the Antelope Valley in California, an area CNN coined, “health care’s nowhere land” because of low health insurance rates and limited provider networks that force residents to travel far for care. I wanted to help my family and neighbors by using the physical exam skills I learned during my first few months as a medical student, but …
Identifying social determinants of health is critical to the patient interview
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