I am a family physician. Like most of my colleagues, though, I must sometimes step out of the comfort of my clinical role to take on the role of patient or family caregiver.
Generally, these trips to the other side of the exam table inspire a fair amount of anxiety.
During visits to the doctor, I find myself noticing many details and comparing the quality of care to that in my own …
When concierge care is reserved for pets
Ex-marines are some of the toughest patients I ever see, when it comes to dealing with pain from cancer. And career ex-Marines have the market cornered on toughness.
Take for example, an elderly friend in Kansas who woke up one morning with severe upper back pain, feeling faint, and decided as was his Marine Corps habit that a cold shower would be “just the thing.” The cold shower likely saved his …
The best gift of all: When the sickest patients feel better
10:11am Tuesday, June 5, 2006: This was the moment Marge was told the mammogram showed a mass, which was probably breast cancer. “But, don’t worry, the tumor is very small and with surgery and radiation, you will be fine.”
1:55pm Wednesday, March 25, 2009: This was the moment Marge was told that the breast cancer had spread to her ribs. “But, don’t worry, the tumors are small, and with hormones, you …
When does false hope become malpractice?
We’ve all been there. You’re in medical school, sitting in a lecture hall — maybe the course is pathology — and for the first time since starting your studies, you’re actually learning about real diseases, not just benzene rings and the Krebs cycle. You’re furiously note-taking, and you reach back to work out a kink in your neck. There it is! A palpable, enlarged lymph node. You have lymphoma. You …
Why are doctors the worst patients?
She came to see me, alongside her husband. She was 26-years-old, diagnosed with metastatic myeloma involving her bones, which had presented when she fractured her hip while jogging. Her disease had progressed on treatment and she was to start a clinical trial. Despite being pale, she looked well. I imagined she often heard, “Wow — you look too good to have …
The desire to have a baby in the face of metastatic cancer
One of the most satisfying sports is to make ourselves feel better by degrading another. What better way to make up for our own inadequacy, then to shove someone else’s face in theirs? We see this at work, in our families, in politics and in almost every type of social interaction. Nonetheless, it is particularly painful and tragic when we project our own fear and frailty onto someone that is …
Sometimes we give pain instead of hope
“First, do no harm,” as suggested by Hippocrates, is a vital principle that should always guide physicians, but they are also well aware that in modern health care, whether in the form of drugs, operations, radiotherapy or any other form of treatment, there is always the possibility of causing harm to their patients. All drugs have potential adverse side effects and all surgery carries risk. Doctors and patients need to …
Overdiagnosis: When health services harm more than help
“You look nice today. People don’t come to chemo in suits very often.” The friendly and familiar receptionist mentioned as I was checking out, the always full jar of lemon flavored hard candy on the shelf between us. As I pocketed a few of the candies, I managed to swallow the nausea and metallic taste just enough to say, “Thanks. I have a job interview today.”
During my senior year in …
The sense of abandonment from my society
When I first started facilitating a grief support group shortly after moving to New York, my aim was simply to create a supportive environment for members to heal from their grief and to form long lasting bonds of friendship. In the course of five months however, I’ve begun to wonder whether emotional and psychological healing can be contained into an end goal with a finish line.
For the most part, authors …
After grieving and healing: Transformation
On a recent cross-country flight, I feigned sleep and overheard the following conversation between my seatmates: a radiation oncologist (I’ll call her “Dr. M”), and a former firefighter/paramedic called, “Captain.” Thought you’d like to listen in.
DR. M: You guys have been my heroes for a long time, the way you constantly put your lives on the line.
CAPTAIN: We’re in serious danger 10% of the time, at most. Moderate danger another …
Will the real hero please stand up?
The institution that employs me is very bullish on customer satisfaction. Having come from a fourteen year stint in private practice before I came back into the university fold six years ago, the little things that make a practice run smoothly come naturally to me.
Patients are typically seen within a week of the consultation request — same day if they are in an emergency situation. My front office staff actually …
Eagerly awaiting the results of a patient satisfaction survey
In 1996, visiting a mall during an out-of-town trip, I suddenly felt dizzy while descending on the escalator. The sensation rapidly resolved, but to be on the safe side, I went to a local emergency room. My evaluation included a CT scan of my head; the results, I was told, were “normal.”
Shortly after returning home I received another call. The CT results were not normal, and I should see a …
Lessons learned from far exceeding the expected prognosis
It’s been very interesting to read the range of responses to the recent FDA recent crackdown on the personal genetic service company 23andMe. Some have decried the FDA as too paternalistic while others have said the FDA is rightfully protecting the health of the public.
The evidence, I believe, shows the FDA is correct: 23andMe should not be doing genetic tests that have serious medical implications. Let’s look at …
The problems with the BRCA test from 23andMe
ADVERTISEMENT
I have outstanding, compassionate and dedicated partners; rarely goes by a day that they fail to teach me by their intelligence and example. Nonetheless, yesterday, in the middle of 30+ patient office hours, one of them said, “You know there are times when I just can’t stand to listen to another complaint.” He took a deep breath, straightened his coat, and opened the exam room door and, smiling, greeted the …
The difference between playing doctor and being a doctor
As a fourth year medical student I did my “sub-internship” in oncology. I hoped that this rotation would help me choose what specialty to pursue: internal medicine or psychiatry.
One of “my” patients was a woman with breast cancer that had spread to her liver and lungs. Fluffy brown hair fell to her shoulders. Wrinkles surrounded her puffy eyes that held jade green irises. Though she was in pain, she was …
Recognize the blessings that you previously overlooked
A guest column by the American College of Physicians, exclusive to KevinMD.com.
According to the Centers for Disease Control (CDC), in 2012, 65% of U.S. adults ages 50-75 were current with screening for colorectal cancer. Almost 28% were never screened. Despite the availability of multiple methods for detecting precancerous polyps or early cancers, the number of people who take advantage of …
ACP: Increase screening for second leading cause of cancer-related deaths
It occurs to me that I talk to my patients more about death and dying, than about sex. It is not that I lack interest or an appreciation of the importance of intimacy, but like most physicians I fall into the trap of fighting the dread disease, instead of focusing on the wonders and power of wellness. Still, we do not rise each morning planning for our demise, rather we …
The importance of sex in the midst of a cancer diagnosis
We recently spoke with Jill Marshall, MD (name changed to protect identity), who works as an internist. “I unfortunately became a patient when I was 55-years-old,” she told us, “and I was diagnosed with breast cancer, a disease I had always feared I would get.”
Dr. Marshall was found to have multifocal disease and underwent a right mastectomy and lymph node dissection.
“Ever since I had seen mastectomies when I was in training, …
A doctor is humbled about chronic pain
When a patient leaves you for another physician, they simply cancel their appointments. You might get a message that says they are moving on and, two months later, you get a follow up letter from the new doctor.
However, Sam was unusual. He came in to tell me that because of my mistakes, his wife was transferring her care. What made our confrontation remarkable was that Sam was wrong.
I had recommended that …
Getting the medicine right, but failing in the art
The New York Times ran a fascinating piece about a dusty old medical experiment that was brought back to life recently after one of its perpetrators — err, researchers, decided to come clean to a medical historian after having read the book The Immortal Life of Henrietta Lacks.
The unnamed confessor was a surgical resident in the 1950s under Dr. Perry Hudson, the man in charge of the experiment. Dr. Hudson (a urologist, …
Will PSA screening be an ethical tragedy in the future?
Get free updates delivered free to your inbox.
