D.J. is a 55 year-old woman with recently diagnosed early-stage left-sided breast cancer. She just had a lumpectomy to remove the tumor, and now has to decide whether to undergo chemotherapy after surgery. Her oncologist carefully discusses the clinical and pathologic data about her tumor, in terms D.J. can understand. She discusses the risks, benefits, and side effects of chemotherapy, and recommends treatment. D.J., having learned about the risks and ...

Read more...

In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back. What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and compassionate humanitarians. Soon, we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? Attention, medical ...

Read more...

“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other. “Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave ...

Read more...

When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability of allowing a patient who refuses necessary blood products to die. For this reason, these institutions are not welcoming to Jehovah Witnesses. This is of special concern in surgical specialties ...

Read more...

Decisions regarding medical care are often not very straightforward due to the uncertainties, risks, and limited options involved. But, above and beyond the actual choices to be considered, the process of how the choices are made has become a red-hot topic. And the value of the patient -- as opposed to the doctor -- as the driver of medical decision is, quite curiously, just beginning to be recognized in a ...

Read more...

"Ice! Ice! I need ice!" Paul yelled, rushing into a store. It was a skate shop. They looked at him like he was crazy. "Ice! Ice! I need ice!" he continued to yell. The store employees looked at Paul with a blank stare. They pointed to the restaurant next door and suggested that he try there to get ice. They had no idea what was going on. Paul's girlfriend had overdosed on heroin and ...

Read more...

"Wait. When did you say you started that medication?" "Two weeks ago." "And when did you say you started having those symptoms?" "Uh ... about ... let me think ... it was — two weeks ago." This kind of circumstance is my holy grail. It is the ultimate moment where I connect the dots. It has happened several times recently where patients have had chronic symptoms and have related to me that they have ...

Read more...

Over 1 million virtual doctor visits were reported in 2015. Telehealth companies have long asserted that increased access to physicians via video or phone conferencing saves money by reducing office visits and Emergency Department care. But a new study calls this cost savings into question. Increased convenience can increase utilization, which may improve access, but not reduce costs. The study has some obvious limitations. First of all, ...

Read more...

Before I started my residency program at Boston Medical Center (BMC), I had no idea that residents were unionized at 60 hospitals across the country. I actually didn’t know much about unions or the labor movement until I got involved in contract negotiations between my own union, the Committee of Interns and Residents (CIR), and Boston Medical Center administration. Through this process, I now know what it is like to ...

Read more...

Recently, I heard from a student in her third year of medical school. To date, she has borrowed more than $100,000 to fund her education. She is in the top 10% of her class, with honors in all of her subjects and high scores on her national exams. She would be a valued resident in the most competitive specialty training programs. Her goal is to become a primary care physician ...

Read more...

582 Pages

Most Popular