Sheila’s jaw is clenched. Sweat is beading on her forehead. I make a slow audible inhale, non-verbally inviting her to do the same. We’ve been talking about the nightmares which started shortly after she began receiving help with personal care. I remind her that she is safe — the day she was raped is decades in the past. Her conscious mind knows this, of course, but for people with posttraumatic …
PTSD can happen at the end of life
This is a tough post to write. I struggle with this issue daily. Is it OK for a physician to retire early? The obvious answer is: yes. Each individual should live their life as they see fit. But with a continued shortage of physicians (granted this is more in rural areas and not big metropolitan cities), and the time, money and resources required for training physicians, is it selfish to …
Is it OK for a physician to retire early?
While in training, we were told that we were not efficient if we couldn’t see 20 or more patients and complete our notes for billing. We were told that primary care offices were asking our residency program for our efficacy data before consideration of hire. This was the line drawn in the sand by our new health care system. We would either rise to the occasion or be harassed by …
What do primary care doctors need? More time.
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In 1996, I had an illness that nearly killed me. I was exhausted, felt awful, could barely stand up and had trouble remembering things. Yet, I somehow had to find the energy not only to take care of my newborn and 5 year old, coordinate our upcoming move, consult with doctors and other medical providers on my condition and treatment, and receive treatments that might or might not help me …
8 ways to be your own health advocate
A commencement address delivered on August 5, 2017, to the 2017 class of anesthesiologist assistants (AAs), Emory University.
Distinguished faculty, graduates, honored guests:
It is a great pleasure and an honor to be here, and to congratulate all the graduates of the Emory University Class of 2017 on your tremendous accomplishment. Just think about all you have learned in the past two years. You’ve transformed yourselves into real anesthesia professionals, able to …
A commencement address to anesthesiologist assistants
I read something recently that shocked me. Despite working in health care for 15 years, I had no idea that nearly 80 percent of the U.S. health care workforce is comprised of women (according to the Bureau of Statistics.)
I did know, however, that women make up less than 20 percent of executive boards and less than 40 percent of middle management in health care. Those that do exist in the …
How can we ensure medical leadership includes more women?
The Society to Improve Diagnosis in Medicine has on its website this quote:
The current focus on diagnostic error raises an interesting question: Is this a larger problem in 2017 than in the 1970s and 1980s?
In this post, I …
We must make the word “diagnostician” the most prestigious term in medicine
It was late afternoon. The woman who had seen my colleague, Dr. Wilford Brown, a few days earlier was sitting in my exam room. Her chart note read like a typical unnameable virus: headache, body aches, fatigue, low grade fever. She had always seemed like a level-headed resolute woman, but she had called three days in a row for medical advice because she felt so poorly. And it all sounded …
A lesson learned after seeing a tick-borne illness
“Hello Dr. Payne, thanks for calling back, there’s a consult I’d like you to see.”
“What’s going on?”
“Well there’s a patient up on 7 East who …”
“Wait a minute. 7 East … isn’t there some other specialist covering there?”
“No Dr. Payne, the schedule says you on Wednesdays.”
“Oh, I’ll check that.”
“OK, Dr. Payne, well we have this 72-year old, Mrs. Jones, who originally got admitted with pneumonia. She now has unusual inflammatory …
To those who want government-run health care: Be careful what you wish for
We in the medical community believe wholeheartedly in the prevention of all illness, especially by vaccination. Science and history continue to show that vaccination dramatically decreases both the mortality (death rate) and morbidity (severity of illness) of infectious diseases. And, more than 98 to 99 percent of the general population (non-medical) agrees with those statements as well.
Yes, it is absolutely frustrating when parents refuse to follow our advice and protect …
Why pediatricians should not kick out unvaccinated children
It’s 7 a.m. We sit down around a table in the physician’s lounge to discuss and our patients. I am a general and critical care surgeon. Every fourth week I’m “on service” for the ICU. This is my week. I was off over the weekend. I’m refreshed and ready to go. I’m excited. I enjoy the challenge of taking care of critically ill patients.
I get sign out from my partner. …
Physicians should not tolerate racism from patients
Good pain physicians are dying. Recently, Dr. Todd Graham was shot dead in a parking lot over refusing to prescribe opioids to a man’s wife. Physicians who care deeply and try to do the right thing are being murdered for not prescribing opioids.
I prescribe very few opioids in my chronic pain practice. I do so in a judicious and safe manner for my patients. I have excellent training, and I …
Physicians are being murdered for not prescribing opioids
At 3 1/2 years old, my son was the picture of health. I have an actual picture. He is in jammies, wearing my sunglasses, laughing and chalk coloring the driveway while the sun is shining on his blond hair. That picture frequently flashes in my mind. I posted it on Facebook, my happy, healthy boy. There was no warning and nothing to prepare me for the months ahead.
First, it was …
How Frozen saved my son in a way medicine couldn’t
I struggle with customer service. I truly never anticipated that it would be such a big part of my career. I never fathomed that it would be something that I struggle with on a daily basis. Well, honestly it does not happen every day and does not occur at every facility that I work at. Yet, it happens often enough that it has affected where I work, how I interact …
A physician struggles with customer service. Can she still be a good doctor?
Competition often works. Competing dry cleaners or donut shops must either improve the quality of their product or keep their prices low, or customers will go somewhere else for their cruller fix. In time, the better businesses — the ones that provide tastier pastries at a lower price — will thrive, and less-good, more-expensive businesses will go away. In the long run, all customers benefit from competition between businesses.
That’s how …
The problem with the free market in health care
Recently, the Republicans’ health insurance bill was withdrawn, partly because of some Senators’ fear of underfunding Medicaid. The media and Democrats have clearly identified Medicaid as a wedge issue that divides Republicans. Unfortunately, those Republicans that have chosen to support conventional Medicaid, as opposed to supporting a much-needed revamp of this program, have succumbed to false advertisements. So let me review some facts, and suggest some common sense changes that …
Improve Medicaid with these simple steps
I spent the week in meetings discussing logistics and hospital preparations for the alt-right’s “Unite the Right” rally to be held this weekend in my hometown of Charlottesville, VA. We discussed the likely injuries that would occur, how we were going to decrease the hospital census to deal with potential overflow, methods of securing the campus, and the latest police updates.
On Friday afternoon I summed up our discussions with my …
White nationalists are marching through my town
Today, I hugged a stranger.
And I didn’t know his name.
We had just operated on a young man, probably in his late teens. He sustained multiple gunshot wounds to the chest and abdomen, and was in critical condition. When he lost pulses in the trauma bay, we cut his chest open and spread his ribs. His lifeless body laid there as we held his heart in the palm of our …
An excerpt from The Other Side of the Bed: What Patients Go Through and What Doctors Can Learn.
As soon as I’d opened my mouth, I regretted it. In the hospital, it’s bad luck to say “It looks quiet,” or anything to that effect. At the sound of those words, alarms begin to ring. In the hospital, crises always seem to come in waves. There are spurts of relative …
A code in the cath lab that was unlike anything I had ever seen
In his famous novel, Moneyball, Michael Lewis illustrates the phenomenon of professional baseball scouts focusing on all the wrong characteristics when looking at players. He describes how scouts focus on fastball velocity as a way to compare pitchers, despite the lack of correlation between fastball speed and the quality of a pitcher. As it turns out, the most important factor in a pitcher is deception, not a high-velocity fastball. The …
Residents need to learn medicine, not how to pass a test
