POLST stands for "Physician Orders for Life-Sustaining Treatment". It is a next generation replacement for an Advanced Directive and DNR ("Do Not Resuscitate") order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting. The ...

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I was a third-year medical student in the first week of my obstetrics rotation. The obstetrics program was known to be high-pressure, its residents among the best. Mostly women, they were a hard-core group--smart, efficient, motivated--and they scared the heck out of us medical students. I remember the day clearly: Not only was I on call, but I was assigned to the chief resident's team. I felt petrified. We'd started morning rounds ...

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An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives. by Rosalind D. Cartwright, PhD

We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions. All of this takes a toll.  Fast food is blamed for the epidemic of obesity, fast cars for motor vehicle accidents, and the wish for fast service and decisions ...

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There’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications. Lifestyle changes may consist of stopping unhealthy behaviors such as tobacco and excessive alcohol use, or starting healthy behaviors such as moderate daily exercise and eating adequate amounts of fresh fruits and vegetables. As anyone who has ever ...

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I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician. When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, ...

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Dealing with an incurable illness or terminal condition is an inevitable reality of the practice of medicine. Not uncommonly, especially in the intensive care unit, we care for the patient with no chance for recovery and survival. Keeping that patient comfortable and allowing him or her to die with dignity becomes the priority of care. Occasionally, I hear requests from the family members of the dying patient – “Can you give ...

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A few years ago, a patient of mine was diagnosed with lung cancer.  A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst.  But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it.  Due to scheduling issues, we couldn’t get it done for seven ...

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by Brad Stuart, MD Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together: “People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say ...

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As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement. I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains.  The link also adds “and experts” and here I have a problem, not because I don’t think patients should have access to knowledge or know a lot about their own disease, but because knowing one pattern of pathology, i.e. your own, does not make you an expert. No more ...

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by Edward Stevenson One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being. I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the ...

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