Earlier this year, I made an announcement that may have made a few people think I was half a bubble off level. I’m leaving CCU.
I’ve worked in CCU (and CVICU) for 14 years. 5 years ago I had a baby, and reduced my hours to one day per week.
It took me just about all of those 5 years to fully comprehend that one just can’t keep up with all there …
Why this nurse left the intensive care unit to go into hospice
It was another day in the intensive care unit. The night was clean and calm, ventilators beeping their expected melody, and the laborers of medicine went about their night shifts uneventfully, including me sitting with the obnoxious admission pager attached to my hip. The smoothness of it all shattered when the beeper started screaming – I picked up the phone and soon the emergency room physician was on the line.
“We …
How we die should never be taken lightly
A real code deviates from what they depict in medical dramas like Grey’s Anatomy. Television chest compressions are usually too slow and superficial, they are nowhere near forceful enough to sustain blood flow throughout the body. There is no foreboding soundtrack to hint at what’s coming, only the numbers that appear on the monitor that suddenly dip in the wrong direction.
Although I understood the magnitude of the situation as it …
The importance of letting go after witnessing a code
I remember my first visit home at the end of my second year of medical school. I’d just received my black doctor’s bag loaded with medical equipment. Like a 16-year-old with a new driver’s license, begging to do the very errands she’ll soon groan about, I went around my parents’ living room and took everyone’s blood pressure, looked in their ears and throats — and then made my “rounds” again.
While …
A connection is lost when we outsource the physical exam
If you want to succeed in academic cardiology, get a federal grant for research.
Better yet: get a few well-paid industry grants, too.
These days lower-paid academic cardiologists are finding it tougher to find protected time for research and speaking because grants are harder to come by and money from their academic center is getting tight. For instance, the National Heart, Lung and Blood Institute (NHLBI) of the NIH no longer accepts investigator-initiated innovative …
In a financial squeeze, a way forward for academic cardiologists
More than 80 percent of the United States supply of heparin, a commonly used blood thinner, originates from pigs reared in farm co-ops in China. Farmers scrape mucus from the intestines and send it to central processing facilities, where heparin is extracted and purified before being sold to U.S. pharmaceutical companies.
But in 2007, blue-ear pig disease, causing a respiratory syndrome, became endemic in Asia—leading to a shortage of pigs …
Why the drug shortage is leading to desperate measures in hospitals
As odd as this might sound, my mother was upset when I declared my intention to go to medical school.
It wasn’t the mountain of debt I was sure to incur since I’d already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade). It wasn’t the …
Why are so many doctors complete jerks?
The headline called it “the new” science behind America’s deadliest diseases. Wall Street Journal reporter Laura Landro was talking about inflammation and its role in causing human disease.
Now, you all know my reaction when a prestigious newspaper features a founding principle of this blog. Well, let’s just say it felt awfully nice.
A brief Mandrola review of inflammation is in order.
First, acute inflammation is normal, and required for life. …
Fat cells are factories of inflammation
I knew it would happen sooner or later, and earlier this week it finally did.
In 2003 US News & World Report pronounced my hospital, UCSF Medical Center, the 7th best in the nation. That same year, Medicare launched its Hospital Compare website. For the first time, quality measures for patients with pneumonia, heart failure, and heart attack were now instantly available on the Internet. While we performed …
The upside of hospital rankings far outweighs the downside
“Dr. Fisher, can you teach our residents EKG lecture series?”
Naively, I said “Sure!”
What I didn’t realize is how hard this is to do today.
Much of this is not residents’ fault. They only have so many hours in so many days to attend lectures while caring for patients. Thanks to residency work-hour restrictions, those hours have become even fewer. To make matters much worse, through the year residents are torn to …
EKG reading: It’s shocking what medical residents don’t know
Recently, I decided to take up surfing again. As a 20-year old kid, I was pretty good at most things that required athleticism (even surfing).
However, as a 42-year old, things come a little harder. My daughter began taking surfing lessons about 9 months ago from a young professional surfer. She quickly was able to get up on the board and was soon riding waves (upright) to shore. I decided that …
What surfing can teach doctors about patient recovery
Accountable Care Organizations (ACOs) and “bundled payments” are set to play a central role in the Affordable Care Act. Under accountable care, physicians and hospitals would be paid out of a “single payment” from CMS or health insurers for all the care needed to treat a clinically defined “episode of care” like a heart attack. The premise is that bundle payments will incentivize physicians and hospitals to deliver more efficient, …
What can ACO providers do to increase patient engagement?
On the surface, two Wall Street Journal articles painted a gloomy and depressing picture of US healthcare, now and beyond.
That wasn’t my take. I felt a rush of optimism. Let me explain.
In, ObamaCare’s Lost Tribe: Doctors, deputy WSJ editor, Daniel Henninger wrote about the (forgotten) plight of doctors in the Affordable Care Act. He critiqued the mainstream media coverage of the Supreme Court decision because it left out mention of …
Mainstream media can foster an engaged public on health issues
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As a college health physician, I see my fair share of fainting patients, including syncopal episodes within the clinic itself, typically while they are using the toilet, or after venipuncture and vaccinations. Our staff is as proactive as possible to avoid these predictable occurrences, listening for problems in the restrooms, putting students in a recliner chair for their blood draws and observing them for awhile post-injection for lightheadedness. Despite taking …
How to recognize positional orthostatic tachycardic syndrome (POTS)
Having a major cardiac event can be a stressful, life changing occurrence. Often, the psychological impacts of having a heart attack (myocardial infarction) are underestimated and can be long lasting. In fact, there is evidence to suggest that these that the emotional stressors that occur post-MI are consistent with symptoms of post traumatic stress disorder. PTSD has been shown to be associated with higher rates of recurrent coronary events and …
PTSD, stress and anxiety after a major cardiac event
Identifying and recruiting study participants with rare and under-diagnosed conditions such as spontaneous coronary artery dissection (SCAD) can be a formidable challenge because no single medical center, even my own organization, Mayo Clinic, has adequate experience and/or patient volume to even begin to perform meaningful research. Still in its infancy, “patient-initiated” research may prove to be the new gold standard for the study of uncommon medical conditions.
The people most highly …
The potential of patient initiated research in studying rare diseases
One of the most intense moments of my third-year of medical school was during my internal medicine clerkship when a code blue was called.
It was our responsibility as medical students on the inpatient service to report to every code blue while we were on our calls every 4th night. This time was no different, and my call partner and I ran to the code. When we arrived, I recognized the …
The moments that define the job of a physician
I went to court recently sitting quietly in the gallery listening to the testimony of two designated experts who criticized the care of a cardiologist (admired in local medical circles for his brilliance and excellent care of patients). The case on first glance didn’t look very good for this defendant. The patient had presented to the ER with atypical chest pain, was admitted and evaluated with an exercise test and …
The problem of expert witnesses in medical malpractice trials
Everybody knows that some medications can cost a lot of money. I always try to take the cost to my patients into account when prescribing a medication- after all, if someone can’t afford it, they are not going to take it. When it’s appropriate (and 9 times out of 10 it is), I try to prescribe a generic medication. They are much cheaper and work just as well as the …
Don’t accept the face value price of a drug
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman is evaluated in the emergency department for the sudden onset of severe pain, which began 3 hours ago. The pain is in the middle of her chest and radiates to her back. Medical history includes hypertension treated with hydrochlorothiazide and lisinopril.
On physical examination, …
MKSAP: 68-year-old woman with the sudden onset of severe pain
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