In anticipation of the strain on resources and staff in New York City, part of the battling strategy included deployment calling for providers from all areas to directly devote their efforts in the care of COVID-19 patients. Despite being relieved temporarily of the role of a nephrologist, the COVID-19 population soon showed that managing renal disorders was still part of daily duties.
With COVID-19, providers have been …
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From the COVID-19 front lines: the present and future impact on nephrology
In recent times, physician burnout has rightfully surfaced as a social concern for the medical fraternity. Physician burnout is a thing, and lately, I was thinking about it related to nephrology.
Many national physician organizations and local hospital systems are developing strategies to reduce work-life stress and improve the engagement of the workforce. In November 2018, I represented the Renal Physician Association at the interim meeting of the American Medical Association …
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A case for nephrology
She placed the stack neatly aside with all forms diligently signed and dated. The inbox was cleared. Being finally rested, her tasks of staying on top of duties and focusing on executions became briefly easier. A few patient callbacks, an eight-page disability form to fill out, a doctor to connect with, seven notes to complete and two test results to review and relay would round off the already pregnant day. …
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The dangerous medical liaison
Even during medical school, there was always the running joke about getting kidney stones. With the frenetic pace of many rotations, it was always difficult to squeeze in bathroom time, and I suspect many of us adopted the same solution – drink less water. That is certainly how I survived my month on vascular surgery. After a nine-hour case, I was told by one of the residents that everyone was …
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What’s the biggest lesson of intern year?
These are trying times for health care optimists. Despite all the hype surrounding breakthroughs in clinical practice and technology, American medicine is stuck in in neutral. Though the engine is revving loudly, little progress is being made.
This unfortunate truth came into clearer light last week when I was preparing lesson plans for the health care strategy course I teach at the Stanford Graduate School of Business. During the first class of …
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Pay people for their kidneys? It’s time.
World Kidney Day reminds us of the 850 million people globally affected by kidney diseases. It draws attention to the 1 in 7 American adults managing Chronic Kidney Disease (CKD) and the 660,000 Americans with end-stage renal disease (ESRD). It also reminds us that kidney disease is the 9th leading cause of death in the United States.
But perhaps one of the most important statistics on World …
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Kidney disease patients deserve better, and so do their doctors
How did I miss his hypokalemia? Two weeks into my intern year and my patient’s potassium returned at 2.9. Minutes later, he coded. And I felt responsible. As I explained to my partner how my patient had become pulseless after diuresis of his heart failure, she looked at me and said, “Physicians kill patients, it’s inevitable. Has no one told you it’s part of the job?”
There is truth to this …
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Every physician will kill a patient
Last week I had a patient with mild kidney disease and a high potassium. I thought that it would be easy to take care of. We called around to all the pharmacies from Bangor to Ellsworth to Belfast, and nobody had Kayexalate, the time-tested antidote, in stock.
It happened to be on a Tuesday night with my Suboxone group starting at 5 o’clock. The patient had been there since 4; his …
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A shortage of Kayexalate leads to an ER visit
Before I could see her, I could hear her. My patient, a young woman with messy braided hair, was grunting with every effort to breathe. The noises quieted slightly when I reached her bedside, but her tears continued to fall between gasps. Her body movements were exaggerated, rooted in the rhythm of her labored breathing — several violent shudders with every expansive inhale, and a wave of quivers with every …
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In medicine, what’s in a name?
A number of media outlets recently featured a story about a Florida general surgeon who removed a normal kidney from a woman who was undergoing spine surgery. How could this have occurred?
The 51-year-old patient who had been injured in a car crash was scheduled for an anterior lumbar interbody fusion (ALIF) of the fifth lumbar to the first sacral vertebra. The general surgeon’s role was to provide …
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A surgeon mistakes a kidney for a tumor. How can this happen?
About one in fifty people reading this essay will be diagnosed with kidney cancer at some time in their life. In fact, one out of one people writing this essay has already been diagnosed with kidney cancer. (I had a small tumor removed from my left kidney not long after I turned 50.) But how many people diagnosed with kidney cancer have been overdiagnosed with the condition? And what does moving to Florida have …
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A CT scan for kidney cancer? It may depend on where you live.
Late one Friday night while walking the long and lonely hallways of my hospital, my mind wandered back several years. I recalled my first weekend call as an eager, newly minted nephrology attending. I had met one of my colleagues earlier that morning in the doctors’ lounge, whereupon I had been handed a clunky, black weekend pager. “Welcome to being on call every fourth weekend for the rest of your …
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Medicine is a calling and being on call is medicine
I saw two patients with a chief complaint of bubbles in their urine this month.
One middle-aged woman had eaten some wild mushrooms she was pretty sure she had identified correctly, but once her urine turned bubbly a few days later, she came in to make sure her kidneys were OK.
Even though she was feeling quite well, they were not, and she ended up going straight to Cityside hospital for IV …
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It’s the physician’s job to think of worst-case scenarios
If you search for “how to pass a urine drug test” on the internet, you will get several million results. As physicians, we see and manage the national opioid crisis every day. We see the impacts of this in our practices and our lives. The crisis frankly shows no signs of abating or becoming a less critical issue. Unfortunately, one major reason for our inability to control this issue might …
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Opioid cheating is a billion-dollar industry
