“Doctor, I am ready to die.”
I knew her from a few years back. This patient of mine.
I am a hospitalist and the patients in my care come and go, making it difficult to really form relationships like the ones primary care physicians have with their panel of patients. But this patient was different. I saw her once many years ago when she was gravely ill, and we managed to pull her …
A patient’s death drove this physician to tears
A new television series called Code Black debuted on CBS. The show’s name supposedly means the emergency department has too many patients and not enough staff. In my over 40 years in medicine, I’ve seen many busy, understaffed EDs but never heard anyone call it a Code Black.
There is the usual array of standard medical characters — the inexperienced new residents on their first day at work, the savvy nurses, …
What did a surgeon think of the television show, Code Black?
A long, long time ago, hospitals existed to admit patients when they were sick, treat them with medicines or surgery and good nursing care, and discharge them after they became well.
Hospital care was at one time a charity, which evolved into a nonprofit service, before it became a very big business.
In olden days, nonprofit hospitals charged patients straightforward fees for their services. Then, when you were just a young whippersnapper …
Readmission penalties: Medicare’s ingenious move
If you weren’t aware of the prevalence and severity of diagnostic errors, (misdiagnosis, missed diagnosis, delayed diagnosis) maybe you should be now.
The Institute of Medicine (IOM) released a new report called, Improving Diagnosis in Health Care. The report cited that most people will experience one or more diagnostic errors over their lifetimes. It also revealed that diagnostic errors contribute to 10 percent of patient deaths and account for up …
Tips for patients to help ensure an accurate diagnosis
If she had been eligible for Medicare, the hospital would have charged the government $10,000 for the services it provided to her, with Medicare picking up most of the tab. But lacking insurance, she was billed directly from the hospital, and not for a mere $10,000. The total charge: $120,000!
That 1,200 percent markup is extreme. But out of the 50 U.S. hospitals with the largest price markups, 49 are for-profit …
We need full transparency for hospital chargemaster prices. Here’s why.
I softly scrub blood from the teeth of a man who died moments ago. From the chair where I sat quietly writing nursing notes while he quietly ended, my patient’s sallow skin and sunken cheeks looked so peaceful. But the weeks of stagnant residue on his teeth bothered me.
To brush the teeth of someone who was in the process of dying would have contradicted my orders to provide comfort care, …
A nurse by herself. At the end of a life.
He squeezed into the elevator just as the door was closing. There was a lightness about him, an excitement. His jacket was newly pressed and uncomfortably free of nicks or stains. He stood at attention with perfect posture. There was no sign that working at this early hour on a Sunday morning, nor even being awake, was something out of the ordinary. Extraordinary.
He glanced over at my tattered lab …
The world of the eager medical intern is one that I am accustomed to
It’s amazing when events that seem to be “miracles” happen, and even more magical to be a part of them, however peripherally.
My husband, David Merzel, MD, a physician anesthesiologist and pediatric intensive care specialist, and his patient, 17-year-old Chiann Wheeler, share the remarkable story of Chiann’s brush with death from sepsis, and how David’s quick diagnosis saved her life.
The story began one morning when then 15-year-old Chiann felt so sick …
How pediatric critical care and a physician anesthesiologist saved a teen’s life
As a physician, you are required to have keen senses. Touch, smell, hearing, and sight are absolute necessities for most practicing physicians while we can only hope that taste is reserved for meals and non-professional situations. I recently returned from a week of vacation in the great outdoors and found myself wishing that I had more olfactory agnosia. Olfactory is a Latin adjective from olfacere that translates “of or relating …
The aroma of medicine can be found everyday in hospitals
An excerpt from Black Man in a White Coat: A Doctor’s Reflections on Race and Medicine.
On a humid Tuesday morning, Chester arrived at a busy Durham emergency room. While the other patients around him made the usual requests for pain medications, diagnostic tests, and reassurance that they were …
Bracing myself for racially tinged criticism, I was surprised by what happened next
Dear health care industry:
I think we have a serious problem, and I think we both deserve some of the blame. Over the last couple of decades, I the patient have been demanding many things of you: reduced wait times, increased access to medications and procedures, more luxurious and colorful accommodations, and numerous scheduling conveniences among other things.
Meanwhile, I have watched as an industry long-based on the revered call of service …
Dear health care industry: Give me what I need, not what I want
“Don’t ever land in a teaching hospital on a holiday weekend, they always staff up with residents,” noted a close friend who was all too familiar with the inner workings of hospitals.
That statement sticks in my head heavily today as I prepare to visit my father’s year-old grave. My father, a man that was involved in the Department of Health & Human Services (HHS) and private sector research societies for decades, …
Don’t land in the teaching hospital on a holiday weekend
This story is a great one.
It’s about a female dog with only three legs. Her fourth leg was amputated following a traumatic accident as a puppy.
Now, when she walks, she has a hitch in her step. And, when she hitches, she kicks the stump of her injured leg outward.
Step, step, hitch. Step, step, hitch.
One day, the female dog has puppies. And, her puppies do what all puppies do. They nurse. They watch. …
Health inspectors should be trained to do what doctors do
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I remember the day like it was yesterday. I was a medical student, rounding with my team, and we had just talked to a diabetic patient who was recovering from a myocardial infarction. The attending looked over at the side and saw some chocolate donuts and cakes lying on the tray table, which had been brought in by the patient’s relatives. The attending shook his head disapprovingly and said, “I don’t think those are going to …
It’s time for hospitals to take nutrition seriously
I learned a valuable lesson recently about how difficult it can be to make the correct diagnosis when you see a patient for a very short period of time. In the acute rehab setting, I admit patients who are recovering from severe, life-altering brain events such as strokes, head injuries, and complex medical illnesses. It is challenging to know what these patients’ usual mental function was prior to their injuries, …
When a doctor is in doubt, she asks a family member
BEEEP BEEEP BEEEP BEEEP … I pressed a button to silence my pager and rose groggily from the bed in the on-call room. I hadn’t truly been asleep, just catching a quick rest between pages. It was 2 a.m. I was 19 hours into my shift and, from the looks of the page, there was a new patient ready for admission to our family medicine inpatient service. I picked up the …
Thank you for your humanity: A resident night float story
“I’d like an MRI for my leg pain. I haven’t had an MRI for many years, and I’m worried.”
These were some of the first words I heard from a patient I was seeing for a new patient visit. Based on this patient’s story and physical exam, her pain was most consistent with a muscle strain. My preferred approach to manage this complaint was to ask the patient to rest her …
When patient-centered care becomes patient-dictated care
In psychology, the Lake Wobegon effect refers to a mythical town where “all the women are strong, all the men are good-looking, and all the children are above average.” In other words, humans have a tendency to overestimate their capabilities, particularly in relation to others.
As a physician, I have yet to meet a fellow doc who didn’t think that their patients loved them or that they weren’t great clinicians. And …
How good of a clinician are you?
I’m not going to be a doctor. It feels more like a confession than a statement — like I’m disappointing someone. Each time I say, or even think, those words, I feel as if I need to atone for it. Survey a hundred scribes. Ask them of their goal in becoming a scribe, and all of them will tell you about higher aspirations. They want to be surgeons, cardiologists, intensivists, …
Who is caring for the caregivers? A medical scribe’s perspective.
Dear attending, I’m a third-year medical student fresh out of the classroom. I’ve studied from books for years, and now I finally get to see what it is like to be a doctor. It’s exciting but also a daunting experience. I look to you as a guide: what you wear, how you speak, what tools you use, and how you treat others. This is the year I will be socialized …
Sometimes the best care a patient can get is a discussion
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