My first transgender patient was a teenager who said although he was born female, he’d protested his gender from the time he could talk. He told a story of being asked, “Well, if you are a boy, where is your penis?” and he pointed to his umbilicus (which was an “outie”). OK, no problem, we have a gender clinic I can refer you to.
When he came back and asked for …
A physician is worried about gender transition in pediatrics
Primary care training during internal medicine residency is draining. Physicians straight out of medical school are confronted with the most challenging patients, often in impoverished or under-resourced communities. These factors contribute to decreased levels of humanism and increased burnout. As a recent graduate of a general internal medicine residency, I experienced the positive impact of a home visit narrative program, developed by our behavioral sciences faculty.
The home visit team consists …
A simple way to add empathy to primary care
Arizona Medicaid Director Jami Snyder heard many complaints about enrollees missing medical appointments because the transportation provided by the state didn’t show or came too late.
So this summer she hatched a solution familiar to millions of Americans looking for an efficient ride: She turned to Uber and Lyft.
Arizona became the first state to revamp its Medicaid regulations to make it easier for ride-sharing companies to participate in …
Uber and Lyft are playing larger roles for Medicaid
During our family trip to Walt Disney World this past year, we got the Disney Dining Plan. It turned out to be a lot of food. On the last day of the trip, we each still had two sit-down meals and about five snacks apiece to go through. Needless to say, we ended up leaving with a bunch of soda and cheap candy and still felt sick from all the …
How non-physician practitioners are pawns of large health care organizations
As many of you know, if you’ve read my columns regularly, once a year the whole family escapes from the city, and we travel up to New Hampshire to stay at the lake house that’s been in my wife’s family for over 100 years.
A modest wooden house perched out over the water, situated just right for sunset viewing, for a few …
20 minutes isn’t long enough for an office visit
Religion and spirituality play a role in both patient’s and provider’s lives. Despite this, medical school is usually an atheistic experience. I went to a state-run medical school. No consideration of religion happened throughout my entire medical school or residency curriculum. It was a long apprenticeship to the god(s) of science. A survey in 2015 found that although a majority of people felt doctors asking …
Religion and spirituality are in the exam room
Anyone who has spent any time on the internet knows better than to spend much time on the comments from an opinion piece. The comments section, even one on a site as reputable and respected as the New York Times, is often a minefield of trolls, contrarians, and conspiracy theorists.
But after reading “The American Medical System Is One Giant Workaround” by Theresa Brown, I couldn’t resist. Among …
Is automation the anti-workaround?
To delay or prevent the onset of memory loss, talk to your doctor. It can really be that simple.
Among the diseases that Americans fear most, Alzheimer’s and dementia consistently rank at the top of the list. What people don’t always realize is that many causes of memory loss are treatable and preventable, and the first line of defense is your primary care physician.
I recently had the opportunity to present findings …
Primary care could hold the key to preventing Alzheimer’s disease
The clinic intake form we used had a space for an asylum number. The number assigned when people first presented to the border requesting asylum. It’s not a tattoo, yet.
Refugee Health Alliance (where I worked for much of July 2019) provides care for asylees, refugees, and deportees just across the border from San Diego in Tijuana. On Saturdays, RHA volunteers roll bulging suitcases filled with supplies to migrant’s shelters to …
What it’s really like to be a doctor on the border
Fat shaming has come back into the collective consciousness in a big way, following James Corden’s rebuke of Bill Maher’s comments that “some amount of shame is good.” Corden, as many have pointed out, is spot-on in his assessment: No amount of fat-shaming is going to help solve the current obesity epidemic. It will, in fact, make it much worse.
But perhaps the biggest problem …
The physician’s role in the fat-shaming epidemic
Last year the American Association of Nurse Practitioners announced a $2 million campaign to further expand independent practice, which they already have in 22 states. The relatively new doctorate of nursing (DNP) has led to a confusing scenario where nurses are indeed doctors, just not the kind you think of when you see a white coat. The profession (well, its money-making institutions) has fought hard to keep people confused.
Doctors are …
Do physicians really need such extensive training?
The answer to physician burnout is purported to be resilience training. That’s like glorifying the natural ability of frogs to tolerate gradually heating and boiling water.
Unfortunately, health care today has some toxic ingredients, and physician burnout is directly related to them. Some forms of resilience training I have been exposed to are no more than mental escapes away from medicine, such as art, music, and personal relationships.
Those types of activities …
The answer to physician burnout isn’t resilience training
There is a haze lurking overhead clouding rational thinking. Thoughts wander back to times when my body was unencumbered, and I felt nothing was out of my grasp. Maybe that was an unrealistic thought, but it is how youth and inexperience protect one from the somewhat harsh realities of growing older.
Coming to terms with chronic health conditions is perplexing. There are days when everything goes just right. The sun is …
Doctors, do you really understand?
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Having been an improvement advisor with many quality improvement initiatives and collaboratives, I have observed that stories about successful initiatives too often leave out major relational barriers that got in the way as well as the critical interventions necessary to overcome them.
That important details about relational challenges so often remain hidden is not a small problem. Evidence points to relational issues as a major cause of lack of expected success …
Here’s why health care innovations stay secret
I was in a discussion with a group of patients about how difficult it is for patients to get access to their own medical records. It was initiated after one of my patients was refused copies of her recent hospitalization. There is much confusion out there about who actually owns the record and how it is allowed to be accessed. Most people are aware of HIPAA, the regulation set into …
Who actually owns your medical records?
About once or twice a day, everyone on our hospital’s computer network gets an emergency message that scrolls across the bottom of our screens, highlighted in the colors of danger and warning.
They include things like a notification that a particular data system is down and that a backup on paper will have to be used for documentation, or the hospital …
How pneumatic tubes symbolizes our health system
The storage capacity of the human mind is amazing. One estimate of the size of the brain’s “RAM” is as high as 2.5 petabytes (a million gigabytes). The number is based on the total number of neurons in the brain and the total number of possible connections per neuron. I suspect it is an overestimate, given the vagaries and innate inefficiency of biological systems. Nevertheless, the true figure …
It’s OK if doctors can’t memorize everything
An excerpt from Dottoressa: An American Doctor in Rome.
When I migrated from the banks of the East River to the Tiber shores the path was strewn with bureaucratic boulders, land-mines, and pitfalls. I offer the tale of my odyssey as an object lesson to would-be fellow cosmopolites in that …
Lucas McClain started smoking cigarettes in high school but switched to vaping after he heard e-cigarettes were a safer alternative.
His vape of choice became the Juul, the king of electronic cigarettes — which comes with a king-size nicotine hit.
Now 21, McClain wants to quit so badly that he’s turning back to the problem he fled in the first place: good old-fashioned cigarettes.
“Juul made my nicotine addiction a lot worse,” the …
Vapers may be using more nicotine than they realize
A month ago, during a visit to her doctor’s office in Sequim, Wash., Sue Christensen fell to her knees in the bathroom when her legs suddenly gave out.
The 74-year-old was in an accessible stall with her walker, an older model that doesn’t have brakes. On her left side was a grab bar; there was nothing to hold onto on the right.
Christensen tried to pull herself up but couldn’t. With difficulty, …
Health care facilities are difficult to navigate for older adults
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