Two weeks before my oldest cousin’s twenty-third birthday, he shot and killed himself. It scarred our family. The kind of jagged, gnarled scar, like a poorly-filled pothole, that — even though it’s been nearly twenty years — you still run your fingers across from time to time and feel the sting of a fresh wound.
We weren’t all that close, but as a 14 year old, sorting through my own perceptions …
Our country should keep talking about guns
Talking to health care professionals about the importance of loving your patients and colleagues — as I often do — might raise eyebrows.
How can we be expected to love our patients during a 15-minute clinic visit? How can love form among hospital teams coming together for a surgical procedure but then moving on to other work? Perhaps most importantly, how will this love make any difference in our patients’ lives …
Maybe the key to patient care is a little love
I recently had an enormous kidney stone. Well OK, it seemed enormous to me. But in terms of kidney stones, it was reasonably large; 9 mm, in fact. Large enough that I had to have lithotripsy (the use of sound waves to break up the stone) performed by my friend and most excellent urologist, Dr. Robert McAlpine in Seneca, SC.
As uncomfortable as the whole experience was (and it wasn’t my …
Don’t forget the power of over the counter remedies
Like an anthem, a holy grail, the word appears in every journal, every proposal, and every health strategic plan.
“Quality.”
We say, read and hear it so often we are developing quality fatigue. Like iterative hackneyed phrases such as “out-of-the-box”, “deep-dive” and perhaps even “personalized medicine,” quality has begun to feel like water torture and risks being deprived of flavor or meaning. However, do not so fooled or bludgeoned that you lose …
Quality is another word for absolute control
I was talking with a few friends not long ago. Our conversation somehow got to the issue of authority, and what exactly respect for authority looks like. One of them, trying to make a point, turned to me and asked: “So you surely deal with people who don’t listen to what you have to say. What do you do when your patients don’t take the medications you prescribe?”
I think he …
Why we should welcome questions from our patients
When he turned 45, Mitch Alsup bought a red Corvette.
Mitch is a quick-talking guy with dirty blonde hair and a short, trim physique. He has a ready smile and is willing to share his story.
“As a kid, I use to go down to the Chevrolet dealership and sit in a Corvette,” he recalls. “I wanted one when I turned 18, but I came from a poor family. I had to …
Midlife crisis may be a myth, but midlife purpose is real
When was the last time you used heroin? In the past have you injected heroin or any other drugs? Are you currently using drugs besides opiates like methamphetamines, cocaine, benzodiazepines or alcohol?
After two years of family medicine residency, I ask these questions like they are questions that everyone asks in a casual conversation with a patient. Although these types of interviews are customary for me, I recognize that it takes …
When pregnancy is the cost of getting medical care
For decades and decades we have been counting the number of doctors in America. For decades and decades we have been coming up short compared to other developed nations, and some less developed ones as well. A poorly educated person may be tempted to suggest that we should “make” more doctors. After all, there is hardly a shortage of young people willing and able to undergo the rigors …
The effects of cheap health care hacks will be felt for decades
I thought about the rather corny starfish story when I was driving home after clinic today. You know the one. It goes something like this:
A man was walking along a deserted beach at sunset. As he walked, he could see a young boy in the distance. As he drew nearer, he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again …
What this physician learned from the starfish story
A guest column by the American College of Physicians, exclusive to KevinMD.com.
If the old adage “the pen is mightier than the sword” is true, then the doctor’s note is the most powerful weapon around.
When I entered practice over 25 years ago, I wrote notes when people were too sick or injured to work, or to verify …
The ever expanding list of reasons for a doctor’s note
As a registered nurse and health care writer and editor for more than 25 years, I routinely wrote or assigned stories to other writers about the health of LGBT individuals. I valued these stories not only because I was a nurse, but also because I thought the subject was worthy of coverage. I believed our nurse readers should be aware of the specific health needs of their LGBT patients.
I followed …
There are far too many homophobic doctors and nurses
When I think back about what I learned about drug addiction in medical school in the 1980s, I can’t think of much.
Sure, I talked to plenty of patients who had been snorting coke and injecting heroine. One man with AIDS promised to teach me how to draw blood, if I’d sit by his side and keep him company. He didn’t have any other visitors. Maximum security prison where he was …
Drug addiction is a learning disorder
Physicians have one of the highest rates of suicide of any profession: nearly twice the rate of the general population. 400 physicians commit suicide each year in the United States. The stress of being a doctor is constant and unrelenting. The majority of us are perfectionists with a strong work ethic: your classic Type A personality. Maybe we set ourselves up for failure and then cannot accept when it inevitably …
How a physician suicide 30 years ago affected this doctor today
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Evidence-based medicine is at the heart of what we physicians do. It is the basis for professional decision-making, and a focus of most journal articles we read. Using solid evidence to practice good medicine has been a foundation of clinical practice for decades.
There are consequences for failing to follow evidence-based guidelines. If patient harm results from straying from a more loosely defined “standard of care,” which tends to be evidence-based, …
It’s time for physicians to practice an evidence-based life
Today’s restless society has taken its toll on modern medicine. Among all the strategies for protocol optimization and health insurance improvements, doctors get to spend less and less time actually talking to their patients. Each check-up needs to be performed in a certain amount of time, and every procedure needs to be completed as quickly as possible so that hospitals are efficient and profitable.
While this makes perfect financial sense, it …
Identifying a rare disease: Why proper communication is key
I am about to place my plate in the sink, until I see a single pea left on my plate. I recall a recent article in National Geographic that stated that one-third of all the food we produce is wasted.
I have a Zen moment, and think of the journey the pea made to reach my plate. A farmer in California sowed the seeds six months earlier. A farm worker harvested …
What is food waste and how can we fix it?
If you are a doctor, everywhere you hear or read about all that is wrong in medicine. Please do not get me wrong, the medical profession is under assault. Change is occurring all around us, and much of it has the potential to be disastrous to not only us and our families, but more importantly to our patients. For many of us in the profession, we feel helpless. We feel …
Doctors need to fall back in love with medicine. Here’s how to do it.
Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to …
Doctors can’t see the forest from the trees. And it’s cost them.
Despite all the challenges that we, and every other nation, faces with their health care systems, it’s worth remembering that in the broader picture we really have progressed in leaps and bounds over the last several decades. How easy is it to forget that only 100 years ago the average life expectancy was in the 20s to 40s in most parts of the world (just as it was for nearly …
Communication is the core of many health care problems
“One of the most prominent definitions describes burnout ‘as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.'”
– Maslach, Jackson & Leiter, 1996
In 1974, the year I started medical school back in Sweden, the German-born American psychologist Herbert Freudenberger published a journal article titled “Staff Burnout.” In it, he wrote about the physical and emotional symptoms of …
Burnout is a consequence of the deprofessionalization of medicine
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