Mr. Smith was a sixty-eight-year-old man who came to the Veterans Affairs hospital where I was a medical student complaining of chest pain.
“With chest pain, it’s all about the story,” my resident, the physician in charge of our team, said. We talked to him to find out what he was doing when it started, how long it lasted, how intense it was if it was still there.
His electrocardiogram hadn’t shown …
A case for at-home hospital care
A few months ago, I was on call and admitted a 65-year-old man to the intensive care unit for a flare of his chronic obstructive pulmonary disease (COPD). Although he had only gotten to the point of being unable to speak full sentences between gasps for breath for only a few days, his story started two months earlier when he had gradually started retaining water and getting more short of …
If Facebook knows me better than my spouse, why does my doctor know so little?
“If I get a call about smallpox from the ER I’m not coming in,” an infectious disease doctor said to a colleague in the hospital where I was working. It was the early days of 9/11 and anything seemed possible.
“Are you all OK with providing care for Ebola patients?” our section chief asked. Our ICU is the designated unit to care for all adult patients suspected of having Ebola in our system. We …
Would you treat a patient with Ebola?
“They need you in room 13,″ she said when I answered the phone and I ran back to the ICU. The patient was coding and for each minute that felt like an hour, we tried, and failed, to save her. She wasn’t breathing, her heart wasn’t working, and despite the 30 people gathered in the room, in the end, she died.
Running a code, as we call it, means that someone is …
Running a code is a team sport
When things go wrong in medicine, as they invariably do, we try to figure out what went wrong, and why. We try to learn if there’s anything we could have done better and what we should do next time.
It used to be, in the days of the giants, that the physician responsible for the patient with the bad outcome presented the case during a morbidity and mortality (M&M) conference. It was …
It’s time to bring back morbidity and mortality conferences
I first met Carol* (name and identifying details have been changed) when she came to my clinic after a severe asthma attack had sent her to the intensive care unit. After a few days, she had been extubated and had acquired a new diagnosis: asthma. When she saw me in clinic, she felt better than she had when she had come to the hospital, but she continued to complain of …
Will bronchial thermoplasty for asthma be more widely used?
Doctors are burned out and they don’t enjoy their job as much as they used to. But looking broadly, physicians are still spared the economic difficulties and loss of autonomy that are present in most other sectors where people are still lucky enough to be employed. There are issues that doctors rarely face: unemployment, inability to pay their rent and food with their paycheck, and lack of health insurance.
These …
What we value as a society is reflected in how doctors are paid
I gave a patient my cell phone number today. I have been toying with the idea for a while and talking to various other physicians about how they handle it. We have a 24/7 chain of coverage so that a patient can call at any time of the day or night and reach a pulmonary/critical care physician. But not necessarily their physician, because, like everyone else, even doctors get days …
Do you share direct contact information with patients?
“Sticks and stones can break my bones, but words can never hurt me.” I learned this saying when I came to America, but before that, I learned a different story. A wood cutter got lost in the forest, it was getting dark and cold. He met a bear, who offered him to come to his den. The man entered and said “It stinks in here!” The next day the woodcutter …
Our words leave the most lasting impression
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