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Conditions and Diseases

Chewing gum to detect cancer? Not so fast.

Sometimes It’s important to know the news behind the news: the comments and the cautions that don’t get into the article that the public gets to read. It’s the sort of thing that keeps me up at night: trying to…

Sometimes It’s important to know the news behind the news: the comments and the cautions that don’t get into the article that the public gets to read. It’s the sort of thing that keeps me up at night: trying to convey the reality, while realizing what most people want to hear is the hope.

That’s the problem I have with a story posted on a major news network website …

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Chewing gum to detect cancer? Not so fast.

Physician Finance

Doctors need to become informed physician investors

D.J. is a 55 year-old woman with recently diagnosed early-stage left-sided breast cancer. She just had a lumpectomy to remove the tumor, and now has to decide whether to undergo chemotherapy after surgery. Her oncologist carefully discusses the clinical and…

D.J. is a 55 year-old woman with recently diagnosed early-stage left-sided breast cancer. She just had a lumpectomy to remove the tumor, and now has to decide whether to undergo chemotherapy after surgery. Her oncologist carefully discusses the clinical and pathologic data about her tumor, in terms D.J. can understand. She discusses the risks, benefits, and side effects of chemotherapy, and recommends treatment. D.J., having learned about the risks and …

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Doctors need to become informed physician investors

Health Policy

Note to Congress: It’s your fault there’s a physician shortage

When you go to the internet or phone book today, there are hundreds of physicians listed in most urban areas. In the next two decades, you can expect more difficulty finding a physician in your hometown — a major physician…

When you go to the internet or phone book today, there are hundreds of physicians listed in most urban areas. In the next two decades, you can expect more difficulty finding a physician in your hometown — a major physician shortage is looming.

In the last year, I have noted many mid-career physicians are leaving the practice of medicine. While the growth of mid-level hospital administrators has ballooned at nearly 3,000 …

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Note to Congress: It’s your fault there’s a physician shortage

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Medical Education

The hardest thing to do as a physician

I’ve been told that one of the hardest things that a physician endures is the passing of her first patient. However, what I imagine to be even more challenging than this is pronouncing the death to the patient’s family for…

I’ve been told that one of the hardest things that a physician endures is the passing of her first patient. However, what I imagine to be even more challenging than this is pronouncing the death to the patient’s family for the first time. Although I find myself in a similarly intimidating and burdensome position of addressing the loved ones of our gracious donors tonight, for my first time, I feel …

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The hardest thing to do as a physician

Physician

Top 5 reasons why doctors lack self-confidence. And how to fix it.

In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back. What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and…

In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back.

What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and compassionate humanitarians. Soon, we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? Attention, medical …

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Top 5 reasons why doctors lack self-confidence. And how to fix it.

Physician

The dangers of being overly apologetic

“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient,…

“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other.

“Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave …

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The dangers of being overly apologetic

Physician

If she gets pregnant, she might die. Do I help?

When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability…

When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability of allowing a patient who refuses necessary blood products to die. For this reason, these institutions are not welcoming to Jehovah Witnesses. This is of special concern in surgical specialties …

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If she gets pregnant, she might die. Do I help?

Physician

Shared medical decision making is a not a new concept

Decisions regarding medical care are often not very straightforward due to the uncertainties, risks, and limited options involved. But, above and beyond the actual choices to be considered, the process of how the choices are made has become a red-hot…

Decisions regarding medical care are often not very straightforward due to the uncertainties, risks, and limited options involved. But, above and beyond the actual choices to be considered, the process of how the choices are made has become a red-hot topic. And the value of the patient — as opposed to the doctor — as the driver of medical decision is, quite curiously, just beginning to be recognized in a …

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Shared medical decision making is a not a new concept

Patient

A hospice worker says goodbye to a loved one

"Why don't you talk loud enough for the whole damn hospital to hear you?" I've just greeted my eighty-four-year-old grandmother, and now this irascible voice has erupted from behind the curtain that separates us from whoever is sharing Grandma's room.…

“Why don’t you talk loud enough for the whole damn hospital to hear you?”

I’ve just greeted my eighty-four-year-old grandmother, and now this irascible voice has erupted from behind the curtain that separates us from whoever is sharing Grandma’s room.

The nursing assistant who showed me in glares across the curtain at the other inhabitant.

“You shut up,” she tells the person firmly, “or I’ll smack you with a bedpan.”

Then, she leaves us …

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A hospice worker says goodbye to a loved one

Health Policy

You’ve heard of Brexit? Here’s what they call doctors who are leaving.

Sean MacStiofain said, “most revolutions are caused … by the stupidity and brutality of governments.” Regulation without legitimacy, predictability, and fairness always leads to backlash instead of compliance. Here’s a prediction for you: If something is not done to stop…

Sean MacStiofain said, “most revolutions are caused … by the stupidity and brutality of governments.” Regulation without legitimacy, predictability, and fairness always leads to backlash instead of compliance.

Here’s a prediction for you: If something is not done to stop MACRA implementation, more physicians will opt-out of Medicare and Medicaid than is fathomable.

Once DRexit begins, there will be no turning back.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is …

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You’ve heard of Brexit? Here’s what they call doctors who are leaving.

Medical Education

A letter from my med student self to me now

Dear Me, MD: Now that you have opened this letter, you may have graduated or maybe you just matched into residency — somewhere, anywhere, hopefully?! As you read this, it should be some time during spring 2017. But, you never…

Dear Me, MD:

Now that you have opened this letter, you may have graduated or maybe you just matched into residency — somewhere, anywhere, hopefully?! As you read this, it should be some time during spring 2017. But, you never know, sometimes the train derails, and it takes a little longer than expected, so forgive yourself if that is the case. You learned a while back that the fast lane is …

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A letter from my med student self to me now

Physician

Take it from a patient: Naloxone is life saving

"Ice! Ice! I need ice!" Paul yelled, rushing into a store. It was a skate shop. They looked at him like he was crazy. "Ice! Ice! I need ice!" he continued to yell. The store employees looked at Paul with…

“Ice! Ice! I need ice!” Paul yelled, rushing into a store.

It was a skate shop. They looked at him like he was crazy. “Ice! Ice! I need ice!” he continued to yell.

The store employees looked at Paul with a blank stare. They pointed to the restaurant next door and suggested that he try there to get ice.

They had no idea what was going on.

Paul’s girlfriend had overdosed on heroin and …

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Take it from a patient: Naloxone is life saving

Physician

In any situation, listening is always best. Doctors should remember that.

"Wait. When did you say you started that medication?" "Two weeks ago." "And when did you say you started having those symptoms?" "Uh ... about ... let me think ... it was — two weeks ago." This kind of circumstance…

“Wait. When did you say you started that medication?”

“Two weeks ago.”

“And when did you say you started having those symptoms?”

“Uh … about … let me think … it was — two weeks ago.”

This kind of circumstance is my holy grail. It is the ultimate moment where I connect the dots. It has happened several times recently where patients have had chronic symptoms and have related to me that they have …

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In any situation, listening is always best. Doctors should remember that.

Medications

It is not a great time to be a pharmaceutical rep

More than a decade ago, the job of the pharmaceutical rep was enviable. Direct-to-consumer advertising pre-sold many drugs so doctors already knew about them. Medical offices welcomed the reps who were usually physically attractive and brought lunch. In fact, reps…

More than a decade ago, the job of the pharmaceutical rep was enviable. Direct-to-consumer advertising pre-sold many drugs so doctors already knew about them. Medical offices welcomed the reps who were usually physically attractive and brought lunch. In fact, reps sometimes had their own reception rooms in medical offices.

By 2011 thanks to drug safety scandals and new methods of marketing, the bloom had fallen off the pharma …

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It is not a great time to be a pharmaceutical rep

Medical Education

How I went from the bottom to the top 1 percentile on board exams

Most doctors are very bright people. I believe that what often sets apart those who perform well on the job and on exams isn't raw intelligence but rather the ability to learn effectively. In the MCAT and USMLE steps 1,…

Most doctors are very bright people. I believe that what often sets apart those who perform well on the job and on exams isn’t raw intelligence but rather the ability to learn effectively.

In the MCAT and USMLE steps 1, 2, and 3, I did poorly and barely passed. In 2009, I took my family medicine in-training exam and fell below the minimum passing score. After taking almost five years away from residency …

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How I went from the bottom to the top 1 percentile on board exams

Physician

Does telemedicine save or cost money?

Over 1 million virtual doctor visits were reported in 2015. Telehealth companies have long asserted that increased access to physicians via video or phone conferencing saves money by reducing office visits and Emergency Department care. But a new study calls…

Over 1 million virtual doctor visits were reported in 2015. Telehealth companies have long asserted that increased access to physicians via video or phone conferencing saves money by reducing office visits and Emergency Department care. But a new study calls this cost savings into question. Increased convenience can increase utilization, which may improve access, but not reduce costs.

The study has some obvious limitations. First of all, …

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Does telemedicine save or cost money?

Physician

The importance of a doctors’ union in the age of Gorsuch

Before I started my residency program at Boston Medical Center (BMC), I had no idea that residents were unionized at 60 hospitals across the country. I actually didn’t know much about unions or the labor movement until I got involved…

Before I started my residency program at Boston Medical Center (BMC), I had no idea that residents were unionized at 60 hospitals across the country. I actually didn’t know much about unions or the labor movement until I got involved in contract negotiations between my own union, the Committee of Interns and Residents (CIR), and Boston Medical Center administration. Through this process, I now know what it is like to …

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The importance of a doctors’ union in the age of Gorsuch

Physician

Why physicians are anxious today

Recently, I heard from a student in her third year of medical school. To date, she has borrowed more than $100,000 to fund her education. She is in the top 10% of her class, with honors in all of her…

Recently, I heard from a student in her third year of medical school. To date, she has borrowed more than $100,000 to fund her education. She is in the top 10% of her class, with honors in all of her subjects and high scores on her national exams. She would be a valued resident in the most competitive specialty training programs. Her goal is to become a primary care physician …

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Why physicians are anxious today

Physician

A toddler, his dad, and the unthinkable

The toddler was a curious, rambunctious, talkative three-year-old who loved to explore. Every week, he’d wait for Sunday to come, because Sunday was he and his dad’s special day. Mikey and his father adored each other. Whether Mikey and his…

The toddler was a curious, rambunctious, talkative three-year-old who loved to explore.

Every week, he’d wait for Sunday to come, because Sunday was he and his dad’s special day. Mikey and his father adored each other.

Whether Mikey and his dad were doing “horseback rides,” playing basketball, or just sitting on the rocking chair for story time, whenever they were together there was fun, love and a forever bond.

Mom called them “the …

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A toddler, his dad, and the unthinkable

Physician

What patients want isn’t always what they need

One of the nurses knocked on my door on a quiet Monday morning. “Hey, can you see this patient? I guess it’s not urgent but he’s here now, and I think what the doctor told him just threw him for…

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One of the nurses knocked on my door on a quiet Monday morning.

“Hey, can you see this patient? I guess it’s not urgent but he’s here now, and I think what the doctor told him just threw him for a loop.”

Of course I had time. In my role as clinical nurse specialist in a busy uro-oncology unit, I see men who …

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What patients want isn’t always what they need

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