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Death is certain. How you choose to die isn’t.

Physician

October 17, 2017

“It is not for me to judge another man’s life. I must judge, I must choose,
I must spurn, purely for myself. For myself, alone.”
-Hermann Hesse, “Siddhartha”

What does it mean to die with dignity? As a neurosurgeon who faces life and death decisions routinely, I ponder this question often. When a terminally ill person decides to choose death over suffering, we perhaps recognize the ensuing act as a dignified death. But …

Could being vulnerable lead to better health?

Heather Hansen, JD

Physician

October 17, 2017

Long ago, I represented a doctor who was … difficult. He was a phenomenal surgeon, world famous in his field, but he was not warm and fuzzy — not even close. Cold and hard were more his speed. We spent two weeks together, on trial in city hall. It takes about two years from the time a case is filed to the time the case goes to court. During that …

People, not computers, make health care work

Jason J. Han, MD

Physician

October 17, 2017

Every morning around 5 a.m., the overnight intern updates me on what happened to the patients on my service. In a hospital where disease knows no hour, the nights can often be just as busy as the days.

“Just letting you know, his wound seemed a little wet to me. Maybe it’s starting to get infected.”

“Good to know. We may have to change the dressing more frequently.”

“And this patient had constant …

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Being the doctor he set out to be

Hans Duvefelt, MD

Physician

October 17, 2017

“Jag ska bli doktor,” a four-year-old boy announced to his family sixty years ago.

Somehow, everything he did after that moment seemed to move him in that direction, even when, on the surface, his path through life seemed to be meandering.

As a student, he was just as interested in literature and philosophy as he was in scientific subjects. He even failed his first quiz in organic chemistry just after receiving the …

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Being the doctor he set out to be

Doctors are dangerously tired, and health care leaders aren’t taking action

Suvas Vajracharya, PhD

Physician

October 17, 2017

Do you want your surgeon to work back-to-back overnight 12-hour shifts and then perform brain surgery on you the next morning? There’s currently no regulation prohibiting this kind of dangerous scheduling in medicine.

Physicians are human. Like truck drivers or airline pilots, their fatigue can lead to dangerous consequences for those around them. A recent study showed that even mild sleep deprivation causes the same levels of impairment …

The hurricane in Puerto Rico is leading a shortage in saline bags

Deep Ramachandran, MD

Physician

October 17, 2017

“Doc, you mind switching that to an oral preparation?” our clinical pharmacist inquired during multi-disciplinary rounds as intravenous infusion devices beeped annoyingly in the background. Taking care of ICU patients can be extraordinarily complicated, so doing it as part of a team helps make sure that all bases are covered.

Like many hospitals, ours uses a multidisciplinary model which makes rounds on all patients in the ICU. An ICU nurse, clinical …

All cancer care needs to consider the whole patient

Stephen Rosenberg, MD

Conditions and Diseases

October 16, 2017

An excerpt from Cancer What You Need to Know.

Treating cancer means taking care of the whole patient — the physical, the emotional, and the spiritual. This starts at diagnosis and carries through treatment and beyond.

Unfortunately, for some patients, cancer does find ways to spread that can cause physical pain, emotional strain, and difficulties in dealing with end-of-life issues. Palliative care and hospice providers are experts in helping people …

A letter to my sister (and all other first-year medical students)

Misha Armstrong

Medical Education

October 16, 2017

Congratulations! At this point, you are almost halfway done with your first year of medical school. Either you have finally figured out what’s going on, or if you’re like me, you are still trying to figure it out. Relax, take a few deep breaths. Medical school is unlike anything you have ever done. The volume of information, constant testing, and overwhelming need to keep up with your peers is an …

How not to argue with your kids about marijuana

Laurence M. Westreich, MD

Physician

October 16, 2017

An excerpt from A Parent’s Guide to Teen Addiction: Professional Advice on Signs, Symptoms, What to Say, and How to Help (Skyhorse Publishing; October 2017).

Marijuana, the illegal drug most commonly used by teenagers, is widely accepted as harmless, but is it? Its effects range from the trivial—silliness, bloodshot eyes, etc.—all the way to catastrophic—paranoia, depression, and more. Many teenagers and parents don’t realize that although not as …

The medical student who had a genuine human profile

DrizzleMD

Medical Education

October 16, 2017

“I lift things up and put them down.”

This quote is from a commercial for Planet Fitness I have seen in the past. It portrays a bulky body builder on a tour of the gym premises. There is no real communication with the tour guide since he keeps saying that he lifts things up and puts them down, irrespective of what the tour …

Why HSAs are not the answer to our health care system problems

Cory Michael, MD

Health Policy

October 16, 2017

I was talking to a physician in my hospital several years ago, and he expressed his frustration that the annual well-child exams for his four kids were expensive. Puzzled, I stated that I found it odd that a doctor’s own health insurance plan had poor coverage for routine care, and he replied that his group jointly decided on a plan with considerable upfront out-of-pocket costs. Why would doctors buy bad …

Reduce parallel play to provide decent health care for all

Peggy A. Rothbaum, PhD

Health Policy

October 16, 2017

I have been doing health care research and advocacy for over 20 years. I’ve seen a lot of passion, anger, and rhetoric around the issues. The health care crisis is simple in that everyone needs health care. The question is what to do about it and who should pay for it.

It’s not an easy answer. For starters, we have turned into a culture of entitlement. This includes health care. It …

The most far-reaching effects of our failed leadership

Matthew Hahn, MD

Health Policy

October 15, 2017

We were once a nation noted for its achievements. We are now a nation that gets nothing done, unable to make even the slightest movement forward despite multiple national crises — a desperately broken health care system, a horrifying opioid epidemic, sickening gun-related mass murders, the threat of nuclear war, and massive storms resulting from man-made climate change. In the face of such monumental challenges, when bold action is needed, …

This psychiatrist does most of her work outside of the traditional system

Maria Yang, MD

Physician

October 15, 2017

Every now and then, when some people learn what kind of work I do, they say, “You’re doing God’s work. Thank you.”

They mean well, so I accept the compliment, though I also tack on, “I also like what I do. It’s meaningful work for me.”

So many of the people I see, whether in my current job or in my past jobs working in other underserved communities, have a lot going …

Emergency medicine can be exhausting. Here’s what this doctor does to unwind.

Edwin Leap, MD

Physician

October 15, 2017

So I’ve finished up at one job and moved on to another. I was a director for a year, and it was a learning experience. Right now I’m nearing the final approach after working a long run. Last week I had five nights, 12 hours duration each. I stayed in a hotel near the hospital. Then, after two days off at home, I started a run of five days, of …

An ode to great clinician-educators

Robert Centor, MD

Medical Education

October 15, 2017

When asked to describe my career, I consider myself primarily a clinician educator. Recently I have reflected on the influences that allowed me to have a successful career doing what I love. This post is not meant to mention all those influencers, but just some that I recall often. As I have thought about this post, I quickly realized that all the “heroes” that I recall focused on clinical education. …

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An ode to great clinician-educators

Why veterans deserve special recognition

Jarret Patton, MD

Physician

October 14, 2017

November brings fall weather, raking leaves and one of my favorite holidays. No, not Thanksgiving, it is Veteran’s Day. Veteran’s Day is a day reserved to celebrate members of the U.S. armed forces for their service. Thank you, veterans. Veterans are found in all segments of our society. Some are retired, some have started second careers, and some are struggling with health issues as a result of their service. They …

Alternative medicine for cancer: Greater scrutiny is needed

Skyler Johnson, MD

Physician

October 14, 2017

As the calendar turns to early October, I’m reminded that this is the 6th anniversary of Steve Jobs’ death. At the time of his death, I was a medical student and my wife had just completed six months of chemotherapy. I was surprised to learn that Jobs had died from complications of cancer and shocked to discover that he had initially refused conventional cancer treatment in favor of alternative medicines. …

If health care is a right, so should having legal insurance

Thomas D. Guastavino, MD

Health Policy

October 14, 2017

The main justification for single payer seems to be that access to affordable quality health care is a right. Nowhere in our constitution does it say that anyone has a “right” to individual services or property. Housing, food, health care, even cell phones have become “rights.” What our constitution does say is that each citizen does have the right to equal protection under the law, equal access to the courts …

MKSAP: 49-year-old man with a family history of type 2 diabetes mellitus

mksap

Conditions and Diseases

October 14, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister, and brother) of the disease. History is significant for hypertension, for which he takes losartan and amlodipine in the morning.

On physical examination, temperature is 37.2 °C (99.0 °F), …

Real physician voices, twice a week

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