It was an ordinary day in clinic — I had gotten very behind schedule when a 90-year-old gentleman, who was in for his third visit in a month related to falls, came in with his equally frail wife. We had to spend extra time discussing his placement in a nursing home for safety concerns.
I hastily entered the room of a 46-year-old attractive female, who was here to meet me as …
I work in a male-dominated field. As a cardiac anesthesiologist, I work with mostly male cardiac surgeons in a department where the majority of my fellow anesthesiologists are male. I work with some fantastic male colleagues. They are caring, skilled doctors, and I consider many of them to be friends.
While most of them know how to handle emergencies, trauma and difficult work situations, many times they clam up when we …
15 tips for working with women
I swiped this editorial cartoon by Steve Sack from the redoubtable Dr. David Gorski’s blog, who goes by the nom-de-web of Orac. Recent epidemiology shows reducing the fraction of vaccinated children in the population rather promptly leads to a resurgence of the diseases vaccines protect against. This is the concept of community or herd immunity.
Epidemiologists debate the concept around …
The mythical unicorn of vaccine denialists
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In Houston, all of my colleague’s offices are closed, and there is limited access to the Texas Medical Center due to Hurricane Harvey. As a virtual medical doctor, there was only one thought on my mind this entire weekend, “How can I help?”
As a Floridian, I have certainly faced my share of natural disasters beginning with Hurricane Andrew, a category 5 hurricane in 1992. Living through Hurricane Andrew gave me …
5 ways virtual doctors can help during a natural disaster
I bought a pocket ultrasound in 2011, determined to learn how to perform and interpret ultrasound at the bedside and thus transform my internal medicine practice. I bought it new, and it cost over $8,000. That was a staggering amount of money to spend on something I knew very little about. In 2015 after having performed many thousand ultrasound exams with my little GE Vscan with the phased array transducer, …
4 times a bedside ultrasound made a difference this week
Recently, there have been many times when you may have gotten a news alert on your phone or checked the latest Twitter hashtag and wanted to scream. Or you were too busy to even check until later that day and did not know what to say other than to lurk and watch a train wreck in progress. You may have thought about saying something, but paused and wondered, “Is this …
Physicians: Use your voice to make the difference
A white coat ceremony address to the University of California, Riverside School of Medicine, August 4, 2017.
“It takes a village” is one of my favorite proverbs, an African proverb, that resonates with each of us on this monumental day. There is without a doubt that every one of you worked very hard to get into medical school. However, this difficult journey was supported by dozens of important individuals: teachers, …
The white coat symbolizes 2 important commitments
Reformers have expended considerable effort to change the way Medicare buys health care for millions of Americans, finding a wide range of support across the political spectrum. But Medicare’s current structure may doom these reforms. Some primary care doctors fear that the skewed incentives in Medicare’s pricing system will get built into any new system, whether it is “accountable,” “affordable,” or “value-based.” This fear is well-founded. If special interests buy …
Fix the pay imbalance between specialists and primary care physicians
An exchange between former Vice-President Joe Biden and EPIC CEO Judy Faulkner at a Biden Cancer Initiative event has again elevated the discussion of patient access to their medical records.
You can read the discussion on Politico. However, Biden’s main point was that patients needn’t justify their claim to their own EHR records.
In fairness to Ms. Faulkner, they did express a common view: medical records are too complex for …
Patient first: How EHRs can better serve our shared mission
I was browsing the latest issue of the Journal of the American Medical Association, as I often do, and an article by one Andy Slavitt, MBA, and Gail Wilensky, PhD, titled “Reforming Medicaid,” caught my eye. From 2015 to 2017, Mr. Slavitt served as the Acting Administrator for the Centers for Medicare & Medicaid Services (CMS). In that role, he oversaw the government’s awful Meaningful Use EHR program, and helped …
Administrators who don’t see patients often make the most important decisions
Obamacare repeal and replace is going nowhere, despite seven years of promises by Republican members of Congress. For the foreseeable future, it will remain the law of the land, along with rising insurance premiums and deductibles and fewer plans to choose from. It’s worth remembering the next time someone asks you for money to support Republican incumbents.
What if the airline industry could light the runway toward fixing one of the …
What health reform can learn from United Airlines
White nationalists and neo-Nazis marched through Charlottesville, President Trump addressed the nation in what should have been a straightforward call for unity against racism and bigotry. Instead, he left us perplexed, wondering if he had just insinuated anti-racist counter-demonstrators were to blame for the violence that ensued. Trump then made explicit his intentions by attempting to spin an argument of moral equivalence between white supremacists and racial justice advocates. He …
After Charlottesville: What are physicians responsible for?
We all practice medicine for different reasons. Of course, it’s almost reflexive to say we practice medicine because we care about people. I’m sure this is true for many physicians. However, if I were being honest, I think I went into medicine more because of the educational challenge. In addition, the profession yielded respect, status, money (back in the day!) and yes, an opportunity to help. I won’t challenge my …
What I learned as a hospice director
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 58-year-old man undergoes follow-up evaluation for cancer of the ascending colon diagnosed 3 weeks ago. Colonoscopy at that time revealed a fungating mass in the ascending colon. Biopsy revealed adenocarcinoma, and additional studies showed no evidence of metastatic disease. Right hemicolectomy was performed. The pathology report showed a 4-cm primary adenocarcinoma …
MKSAP: 58-year-old man with cancer of the ascending colon
We are all guilty of having biases. Some of them we know about and proudly flaunt. Some of them have been ingrained so deeply that we do not even know they exist. Weight is an issue that brings out strong biases, and multiple studies have demonstrated a high level of bias from physicians against overweight and obese patients. Obese patients are often treated rudely and are not given the same …
Doctors must stop fat shaming their patients
When I finished my medical training almost sixty years ago, I was like many new graduates: I thought I knew it all.
I opened a private office in Los Angeles and paid courtesy calls on the local physicians to let them know my qualifications and my availability for consultation, as both an internist and a nephrologist. (The treatment of kidney disease was then in its infancy, and I was the area’s …
Good clinical care takes more than medical acumen
There is a definite finality to the decision of which specialty a physician pursues. The reasons are as vast as they are individual. Hopefully, the med student has done due diligence and has a solid grasp on what their future entails, at least for the future as far as anyone can confidently foresee. Here is my story.
1. Challenge. No day is quite like another, and life as an emergency medicine (EM) …
4 reasons to choose emergency medicine
“F*ck!”
I pried my eyes open and had the realization of exactly what time it was. I was going to be late — again. I jumped out of bed as fast as my stiff and weary body would allow, threw scrubs on I was mostly sure were clean, ran a brush through my hair so I didn’t look totally disheveled when I had to look like professional in a few minutes …
A surgeon makes a mistake, and couldn’t stop crying
An on-call weekend: 48 hours of being at any moment “on,” of being edgy, of being exhausted. This weekend included a full house of patients to see in the hospital, a patient list of three pages to be exact. As I went from patient to patient, room to room, each held its own unique story filled with the yin and yang of life. I realize too, this may be a …
48 hours in the life of an on-call gynecologist
A couple of weeks ago, I met my new medical students. These 10-12 trainees will be my small group for the next two years. We will meet monthly to discuss the soft stuff of medical training — hierarchy, tribalism, death and dying, medical errors, difficult patients, etc. Some call it “third-year medical student support group.” This is my 6th year of the pleasure and privilege (I inherited my first group …
A teacher’s job is to show love first
