Most physicians recall the medical school ritual of unboxing our first stethoscope. From the first physical diagnosis course, we were all solemnly instructed as to the importance of the physical examination in the diagnosis and of management of illness. Given that perhaps the most notable use of the stethoscope is cardiac auscultation, it would seem that this should hold particularly true for cardiology. And yet, on moving from classroom to bedside, ...

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A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject? In emergency situations, patients often arrive at the hospital unconscious or with severely impaired decision-making capacity. Progress in medical practice depends on results from carefully designed research; yet in these emergency cases such patients are unable to fulfill one of the ...

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My path to medicine is tied to my family’s experience with poverty, and with the profound economic fallout a major illness can bring in such circumstances. I grew up on the Couer d’Alene reservation in Northern Idaho. My mother was a single parent who had to rely on government assistance to raise three children in subsidized housing. As the eldest, I was expected to help care for my younger siblings ...

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When I started medical school, a wise professor likened the amount of new information I was about to learn to trying to drink water from a fire hose.  It didn’t take long until I understood exactly what he meant.  After sitting through the seemingly endless hours of lecture, lab and small group sessions required in the first two years of medical school, my head was spinning from information overload.  The ...

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My business ethics class recently discussed the case of Cipla Pharmaceuticals, an Indian generic drug manufacturer drawing the ire of big pharma by blithely ignoring international patents or employing workarounds to manufacture low-cost generics in direct violation of the patents. Cipla’s founder, Dr. Yusuf Hamied, stressed that Cipla’s goal wasn’t to steal from the bottom line of the likes of Merck and Eli Lilly, but rather to serve its mission ...

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My father who was a junior doctor in Britain’s National Health Service (NHS) in the seventies would have been grateful for the match scheme, an algorithm that places medical students in residency programs in the U.S. The training in the NHS was unstructured. Physicians carved their own training by joining a patchwork of hospital positions in disparate places. Over a few years we lived in Yorkshire, East Anglia, Wales, East London ...

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Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms. The patient ...

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There is a tremendous amount of handwringing among students, workforce researchers, and medical school deans about the record amount of debt that medical students incur -- more than $175,000, according to the Association of American Medical Colleges. This has unintended consequences, including student selection of more lucrative specialties and placing medical education beyond the reach of low-income and minority students. The average household income for a matriculating medical student is ...

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Earlier this year, I started teaching a course to first year pediatric residents at Stanford. In it, I challenge the trainees to identify the structural contexts in which patients and families make choices that may impact their health and well-being. Termed structural competency, the goal is to enable young physicians to understand and confront stigma and inequality as key determinants of health. We talk about ...

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In his commencement address at Sarah Lawrence College, international affairs journalist and author Fareed Zakaria defended the value of a liberal arts education.  "At its essence," explained Zakaria, "a liberal education is an education to free the mind from dogma, from controls, from constraints.  It is an exercise in freedom."  His speech, I imagine, was well received and much appreciated by the over 400 graduates earning liberal arts degrees that ...

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