She was having excruciating pain in her pelvic area. I pulled the sheets down cautiously and noted the bruising encircling the waist and inching towards the thighs. I finished my exam and retreated to the nursing station of the skilled nursing facility to comb through the chart. ER records, floor notes, consultations, but no x-ray of the pelvis. There was no mention of pelvic pain.
The emergency room physician had dutifully …
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There is no concern for the discomfort of the patient
She seemed awfully angry and at the very least dubious that I couldn’t do more for her father. After 7 hours of surgery trying to salvage her father’s leg, I tried patiently to explain that this new (third) bypass we had just successfully completed was unlikely to provide her dad with a long-term solution. Ultimately, he would lose the leg, if we were lucky he’d have it for another year …
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Rethinking the fix-it model in medicine
As an early Google Glass explorer, I see many ways this and other wearable technologies will soon enhance patient care.
Google Glass is “smart” eyewear that offers features similar to a “smart” phone: It can take photographs, video, make phone calls, display Internet-based information. The data is transposed onto the glass lens in the wearer’s field of vision. The device is activated by voice command or a touch to the tiny …
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Google Glass is the tip of the iceberg for wearable technologies
I recently got back from a brief trip to Florida. I went down there to celebrate my mother’s 85th birthday. As you might expect, her social circle has shrunk in recent years, but she did get a number of cards and calls from friends and family members. The cards were on display in her kitchen, and a few calls came in while I was there. One in particular pointed out some …
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The patient offered a diagnosis, and the doctor missed it
The patient was a 78-year-old businessman who acted and looked about half his age. He was very pleasant and talked freely about his lower back pain and the pain down the side of his left leg, which had been a problem for about six months. It was consistently more severe when he stood or walked on it, and it immediately disappeared when he sat down. His MRI scan revealed that …
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Before treating physical pain, address the emotional one
My husband suffered with hip and low back pain for about four months. It started right about the same time he was prescribed a new blood pressure medication. He didn’t think much of the pain at first because he was recovering from a groin injury, the result of a close encounter with a hockey puck while playing the game.
But the pain grew in intensity over the following weeks. He’s a …
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Uncovering the answer to a case of chronic hip pain
In a voice confident and ringing with anticipation, Mr. A explained with meticulous detail how he determined which approach shot to hit to the second green on the Black Course at Bethpage State Park.
Only ten minutes earlier, when we first met, Mr. A had been weary, his face drawn, and his speech so quiet that the sound of the aortic balloon pump keeping him alive made it nearly impossible to …
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Sitting with a patient: The least practiced communication skill
As I look back, I remember teachers. One taught to be compulsive and complete. Another, calm and humor in the face of chaos. Another believed in me and thereby taught me to believe in myself. One made me write and rewrite. Above all, there was a mentor who opened my heart and eyes to the need for compassion. That special teacher was Dr. Black.
Tuesday afternoon, 8:30am, July 12, 1966: Dr. …
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A mentor who opened my heart and eyes to the need for compassion
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain at rest and no nocturnal pain. There are no clicking or locking symptoms. She has tried naproxen and ibuprofen but developed dyspepsia; acetaminophen provides mild to moderate relief. …
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MKSAP: 76-year-old woman with left knee pain
It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery.
Do you know where you are right now?
Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon …
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Post-operative check
There are few certainties in medicine. But treating rotator cuff injuries has revealed one to me: People with rotator cuff tears don’t sleep well. If you want a glimpse into the life-altering symptoms of shoulder pain, just ask one of these patients how many times a night he or she wakes up with pain. Hearing the answer, it’s easy to see that improving the ability to sleep through the …
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How wearables can objectively track outcomes in patients
Well over a year ago, I advised my 80-year-old patient and her children that due to progression of her Parkinson’s disease. Because of her frail nature, she needed a higher level of assistance and care if she wished to remain in her home. She was extremely unsteady walking and several courses of physical therapy had not improved the situation. The patient was feisty and would only allow help to come …
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Discussing financial issues before medical issues: Be more thoughtful
Schuur and colleagues in JAMA Internal Medicine listed five low value services in the emergency department (ED). Although compilation was not solicited by the American College of Emergency Physicians as part of the Choosing Wisely program, it has its ethos.
The list was developed by a technical expert panel after multiple iterations. The list is not only wise but derived from sound methodology. Most importantly, the recommendations are …
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CT in neck trauma: Changing the culture in the ED
If knowledge is power, then content (in proper context) is king. Why am I online blogging, pushing content through my website and even interacting on Facebook, Twitter, Google+, Pinterest and many other sites? Because my patients are there. Increasingly, they are utilizing the Internet to self-diagnose; to look for “second opinions” from peers and friends; to research a physician, recommended treatment, or hospital; or to find the latest information on their …
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Go where the patients are: Why this doctor is active on social media
New journals are appearing almost every day. Does anyone read them? Journals keep popping up because of the need for faculty to publish. Another reason could be that publishers, particularly those who charge authors fees for publishing, are in the business of making money.
Authoring journal articles is not only enhancing to one’s CV (the old “publish or perish” cliché), it is required by residency review committees as evidence of “scholarly …
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As journals proliferate, so do authors
I am a huge fan of the winter Olympics, partly because I grew up in Canada (where most kids can ski and skate before they can run) and partly because I used to participate in Downhill ski racing. Now that I’m a rehab physician (with a reconstructed knee) I’m thrilled to have the opportunity to interview Team USA’s chief medical officer, Dr. Gloria Beim. As we enjoy the Sochi Olympic …
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An interview with Team USA’s chief medical officer
Recently, I had the fortune of hearing the tale of Bob and his bum knee.
It all started when Bob picked me up at the end of a busy clinic day in his neon orange Subaru. Given that this particular shared car service promotes friendly conversation, Bob started up the gab by asking me what position I held in the medical center. After describing my work as a …
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Declining care from physicians in training
The doctor at the summer camp I attended as a kid believed that calamine lotion and time cured just about anything that ailed campers — and he was right. Time still heals most wounds, but patience is a tough sell to people whose visits to my office often involve taking off work or getting a babysitter, fighting traffic, and shelling out for parking and insurance co-pays.
After all that, time doesn’t …
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When it comes to back pain, time is an underused treatment
As an incurable compulsive introspect, I tend to brood, ponder, contemplate, and (of course) muse on “big ideas,” such as:
- What makes people choose things which cause themselves harm?
- Are some people better people than others, or are they just more skilled at hiding their problems?
- Is pain really a bad thing, or is our aversion to it a sign of human weakness?
- Does God ever wear a hat?
- Do dogs watch Oprah?
- Why did I …
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Empathy: How an idea forever changed my approach to patients
