I’m not sure why my parents were surprised when I told them that I was applying to go into family medicine. It seemed like a logical transition after spending six years working in public health and primary care before medical school, but from the perspective of Taiwanese immigrant parents, I couldn’t have made a more absurd career choice. I was confronted with comments such as, “Most people choose careers to make …
Am I smart enough for family medicine?
Al Franken, the humorist-turned-senator, once published a book that was titled “Oh, the Things I Know!” Indeed, by the time we reach parenthood, it is truly amazing what we keep up there in that attic of a brain.
Here is a brief selection of things about the practice of medicine that I have had to discover for myself or never quite figured out, including clinical pearls, aphorisms, dictums, platitudes, mysteries and …
Clinical pearls that you don’t learn during medical training
There are many ways to write about health, medicine, and health care. And there are many people – patients, caregivers, policymakers, pundits, thought leaders, and health professionals – in a position to do so.
Fortunately, the world also offers a similar and growing diversity of places in which to publish this sort of work.
My focus today is more, well, literary.
I know the word “literary” often …
Where can doctors publish literary writing?
Most professional business enterprises nationwide understand that they could never expect to compete in the marketplace if they shut down their phones 20 – 25% of important business hours every day. Yet that is exactly what your medical practice is doing if you are shutting your phones down for a “lunch break”.
You might be wondering how important can this really be for a medical practice? Can’t patients just wait an …
8 reasons why your practice needs to stay open during lunch
I was watching Jon Stewart recently, and he had Michelle Rhee on. For anyone who doesn’t know her, she’s the superintendent of schools in Washington D.C. who made a bunch of reforms that caused some controversy and resulted in her being one of the main spokespersons for education reform in this country. Her conversation with Jon made me realize the similarities between …
Measuring quality: What doctors and teachers have in common
A few months ago I wrote a post about the 159 page digital fax that I received, containing records for a patient’s recent lengthy hospitalization.
I’ve now discovered something even more time-consuming and annoying: a 202 page paper record mailed to me by a major medical system. (I won’t name names right now; suffice to say this system uses Read more…
My workflow for going through old paper charts
I have it on good authority that it’s not easy being green. But I’m willing to wager that it’s a whole lot easier when you have a lovable name like “Kermit.” Imagine being green (or brown) with a name like “Ramachandran”? Growing up with a name like mine certainly had its disadvantages. While most neighborhoods have a local bully who kicks ass and takes names, in my case, he would …
Doctors: Pronounce the names of your patients correctly
I recently received this email message from one of my residents who has moonlighted in a local commercial urgent care center. This message is reprinted with his permission just as I received it, except I removed the brand name.
Hey Dr. Young, I’m looking for some basic mentoring advice. I’ve been moonlighting at ZZZ Urgent Care for about a year. Not my favorite work, but oh well. I don’t routinely prescribe antibiotics …
Working in an urgent care center: An assault on the soul
There are surprising misconceptions about what family physicians actually do in practice.
Americans maintain a fond respect for the classic image of the family physician, making house calls with black handbag in tow. They admire the Marcus Welbys of the world. While this classic image is endearing, it should not be confused with the 21st century family doctor. The modern family physician is trained to engage in the adaptable world of health …
You may be surprised at what family physicians do
A version of this column was published on February 3, 2013 in USA Today.
I’m seeing more patients than ever consume so-called “energy drinks,” a rapidly emerging class of beverage which promise to increase energy, improve alertness, and boost attention span. The energy drink business is booming, with more than $12 billion sold last year, eclipsing established beverage categories like iced tea …
Why energy drinks should be considered stimulant drugs
“Discrimination against heavy people, by the general public and medical professionals, might be a greater health and social problem than any extra pounds they may be carrying” argues UCLA Professor Abigal Saguy, PhD, in a provocative essay in the Washington Post.
“Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their …
Stop blaming patients for not doing enough to stay healthy
Would it be silly to ask, “Is the history and physical examination worth performing anymore?” especially in this era of high-technology medicine? Does it matter if the diagnosis is made by the bedside in contrast to CT or echocardiography? Someone did ask, and the answer is intriguing and was debated. Let’s look at the data.
Four hundred and forty-two consecutive patients were admitted from the emergency department to an …
Is the history and physical examination worth performing anymore?
Once upon a time a doctor first attended 3 or 4 years of college, then finished 3 or 4 years of medical school, trudged through 1 to 8 years of residency training to hang out “a shingle,” and finally begin to practice medicine, usually in solo practice. Those days are long gone. Time has expanded—schooling and training are longer.
Breaks are taken between and during this once but no longer traditional …
5 ways to adapt to an evolving healthcare workforce
Have you ever gone to the doctor and felt like he wasn’t listening to you? Have you tried to tell your story, only to have him interrupt with a checklist of questions: do you have chest pain, shortness of breath, fevers, cough, and so forth? Have you ever felt ignored, and left thinking that your doctor never understood why came to him in the first place?
Studies show that Read more…
6 tips for getting your doctor to listen to you
Back in the day, coal miners always carried a canary with them in a small cage whenever they would go down in the mine. The canary is a very talkative bird, always singing and tweeting in a constant background noise. Canaries have one more characteristic important to a miner.
When there is bad air in the mine, the canary’s sensitive lungs will cause …
Doctors are the canaries in the coal mine of medicine
A version of this column was published on January 13, 2013 in USA Today.
Like many other primary care doctors across the country, I’m seeing my fair share of patients with runny noses during this winter season.
I recently saw a patient for a sinus infection whom asked, “Why did I have to come in to see you? Couldn’t you have given me an …
A virtual office visit for your cold is not a good idea
I saw 17 patients in my primary care practice yesterday. Six of them were coughing.
One of the most basic parts of my job is sorting out who’s a little sick from who’s very sick, or in danger of getting very sick. How do I do that when so many people have the same symptom? And, as a patient, how do you …
How to know whether your cough is serious
A common rebuttal to any discussion about of gun control is motor vehicle accident deaths. We don’t blame the car, we blame the driver. Regardless of the object’s intent (the car is for transportation and the gun is shoot people, targets, game, and skeet), neither a car nor a gun can kill or maim without human touch.
And I agree. Comparing guns and cars is fair, after all they kill about …
We can learn a lot by comparing guns to cars
You need a doctor, and I love what I do. But this work just isn’t sustainable.
In 2009, I finished medical training and joined a clinical academic practice. For those not in the know, doctors can — very generally speaking — work in one of two domains: in private practice, or on faculty at a medical school where they see patients, teach, and/or do research. Some docs manage to keep a …
Don’t make me leave primary care
Chatting with some med students, a good question was raised: how do we, as doctors, deal with the emotional baggage we encounter in our profession? It’s high stress, we see disturbing things, and sometimes we make mistakes that can result in harm to patients. The pressure and responsibility can be very hard to handle.
These stresses, if unmanaged or poorly managed, can …
Dealing with psychological stress of being a doctor
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