I haven’t counted how many times this happens every month, but I find it annoying.
I send a prescription for a drug (sometimes not even expensive) to the pharmacy and soon after, I get a fax asking me (or my medical assistant) to go online and print a prior authorization form to complete and fax to the insurer, or answer numerous qualifying questions on the screen, or (worst of all) Read more…
We need RVUs for obtaining a prior authorization
A excerpt from From Reading to Healing: Teaching Medical Professionalism through Literature (Literature and Medicine).
There are several traditional ways to teach about professionalism. Some training programs have didactic lectures on this issue. These typically focus on principle-based ethics and “rules” about professionalism. “Do this. Don’t do that.” Most educators …
Teaching medical professionalism through literature
Burnout is a myth. Dedicated clinicians, working under circumstances that connect their skills and compassion with opportunities to impact patients, won’t experience burnout any more often than they might by doing other jobs. The story we tell — the one that dissatisfaction is this system’s inevitable byproduct — perpetuates more harm than we know.
This is what I’d like to believe. I’d like to write about the many opportunities to do …
Refuse to accept that burnout is a natural experience in health care
I didn’t become a primary care doctor to treat opioid addiction.
I wasn’t trained for it. To be honest, it scared me.
But when you work, like I do, at a clinic that serves a lot of people who have little money or who struggle with mental health and substance use issues, there comes a point when you have to step up.
When I started seeing patients in 2009, I knew that opioid …
Physicians can choose not to be powerless against opioid addiction
More than two-thirds of Americans use social media, and 90 percent of adults in the U.S. have a cell phone. With these tools surrounding us, we must be more connected with one another than ever before. Right?
It doesn’t feel like we are. At least, the people who engage with the health care system don’t feel connected to the rest of us. They feel lonely. It feels like we send them …
Social isolation is a health risk
The FDA has given official approval to market eskatamine as a treatment for depression. As expected, there has been great fanfare (press releases, morning TV talk show guests, NPR segments and so on). The news leaves me salty. The esketamine story reveals so much of what is wrong about how we get useful medical science findings into clinical practice.
Esketamine is not a new drug
Esketamine is being promoted as a new …
Esketamine is not a breakthrough new drug: Why the nasal spray for depression is old news
Life experience gives one an intimate appreciation for the meaning behind the saying “just the tip of the iceberg.” Everyone’s encountered something that turned out to be much larger and more complex than was initially understood. In my experience, medicine has yet to submerge its head underwater to discover the true depths of the sordid underside of what I’m calling the “iatrogenic benzodiazepine iceberg.” My own boat capsized on that …
The tip of the iatrogenic benzodiazepine iceberg
As a behavioral pediatrician, I see children with behavior problems. Kids with aggression, kids who have been kicked out of multiple daycares or schools and kids who are not doing well at home or school.
One of the things I always look for are clues as to why. Behaviors, while stressful, are not a diagnosis. They are symptoms of something else. For example: Just because a kiddo is not completing homework …
Here’s why pediatricians ask about trauma and violence
“In any given moment we have two options: to step forward into growth or step back into safety.”
– Abraham Maslow.
The New York Times recently published the op-ed “Dr. Google is a Liar,” written by cardiologist Haider Warraich, MD. Dr. Warraich describes the rise of fake medical news and the adverse consequences of a population who gets their medical information from social media. He shares that when …
How social media can advance humanism in medicine
In hindsight, I should have never accepted a Xanax prescription from my doctor. What followed was catastrophic — rapidly developing tolerance and physical dependence on the drug and a prolonged illness. Three-and-a-half years later, I am still slowly tapering off Valium (having transitioned to a longer-acting benzodiazepine to aid in tapering) and experiencing debilitating symptoms daily.
I was unprepared for what happened to me by my medical …
A Xanax prescription that should have been rejected
My response to a colleague who says, “I am depressed,” is critical for many reasons. As doctors have tough masks, it has been difficult for my colleague to disclose this. Due to mental illness stigma in the medical profession, this doctor may have been suffering quietly for some time and could be at risk, perhaps self-medicating with antidepressants, benzodiazepines or alcohol.
When I am the treating doctor of another doctor, listening …
How physicians should respond to the words, “I am depressed”
I don’t want to go back. Starting at 6 a.m., the intern entered the hospital with coffee from the bodega down the street, anxious about the patients that were admitted to the ward the previous evening.
I deserve it. At 8 a.m., he had already rounded on his nine patients, one of which was an angry male with dementia who spewed expletives at any healthcare provider that dared cross his path. …
A psychiatrist’s attempt to stop burnout
The United States will be short 120,000 doctors by the end of next decade, according to the latest research from the Association of American Medical Colleges.
That shortage will become permanent unless medical schools make the path to becoming a doctor a bit less arduous.
Some medical schools seem to take pride in imposing a heavy emotional and physical toll on their students. Toughen up aspiring doctors early on, the thinking goes, …
Medical schools need to cut their cutthroat culture
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“I feel like a caged animal” — My patient offered me this lens through which to view his life seeped in chronic pain. For him, pain dictated his entire sense of being — it was something that simply could not be distilled down to a single value on a 10-point scale. The cage represented the restriction of life and the boundaries within which he was allowed to experience, let alone …
How opioids can destroy the most beloved of personalities
The chief complaint was belly pain. He described the pain as both dull and crampy. It came and went, but bothered him the most on the same night of each week.
The notes from the primary care doctor show a thoughtful search for the underlying cause. There were comments about activity logs, blood tests, and imaging studies. Months later, it remained a mystery: He still had belly pain. The investigations did …
The questions clinicians never think to ask
I remember September 27, 2018 like it was yesterday. When Ashley* picked me up from my apartment Thursday morning, I thought it would be like the 138 past Lyft rides I’ve taken since 2017. I was wrong.
After I waived to Ashley from the curb, I got settled into the right back seat. The doors locked, and she asked me the usual question.
“You from here?”
“Yes, I’m a local.”
“That’s great! I’m from …
When you identify your Lyft driver as potentially having bipolar disorder
Studies have shown that video games and other addictions, such as alcohol and nicotine, affect neural pathways in similar ways: They all lead to an increase in dopamine levels in specific pleasure centers of the brain.
While drugs increase dopamine levels far more than video games, gaming can have a similar deleterious effect of “taking over” a person’s life.
One of the key ways that gaming addiction differs from other addictions is …
Is gaming disorder a real addiction, and how can I tell if it’s affecting my child?
I lost my attending to suicide. A lot of things about life changed that day.
In the days of grief that followed, I was consoled by my mentor who suggested we meet outside on a patch of grass near the hospital. As we shrinks say, we needed time to emotionally process. I remember being grateful that I was going to get fresh air. The hospital felt suffocated by the all too …
I lost my attending to suicide: a story of loss and ladybugs
“I drank beer with my friends. Almost everyone did.”
Alcohol has become constitutional to American culture: “grabbing a drink” after work, happy hour, cheers before meals, on New Year’s, or just because. Our society’s normalization of drinking creates a slippery slope toward excessive alcohol use. Unhealthy alcohol use is rampant: one in six Americans drinks excessively four times a month, according to the Centers for Disease Control (CDC). Almost thirty percent …
“Ms. Taylor*?”
“Yes, it’s me. I’m so deeply sorry to you and the team. You all helped me so much when I was here. But I started drinking a day after I left and blacked out.”
Two weeks ago, Ms. Taylor was found by her sister lying unconscious on the bathroom floor after a week-long alcohol binge. Next to her was a suicide note.
“My depression is robbing me of my freedom. I …
Do whatever it takes to conquer this depression. Now and forever.
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