A little over a year ago, I found myself burning out and realized that my worklife was unsustainable. I’d been working at an FQHC clinic, and had become the site’s medical director a few months before. I was practicing as a primary care doc, trying to improve our clinical workflows, problem-solving around the new e-prescribing system, helping plan the agency’s transition from paper charts to electronic charts, and working on our ...

Read more...

The medical arena, like society at large, is permeated with self-interest. This reality makes me very skeptical that comparative effectiveness research, which I support, will get airborne. In medicine, every heath care reform, new medicine, new medical device or revised medical guideline is at some constituency’s expense.  Recognizing and dismantling conflicts of interests is one of our greatest challenges and threats. When I ...

Read more...

Yesterday I had office hours: 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day.  However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve.  I really hate it when patients are late. Now, I have to admit this is a unique ...

Read more...

I did not want to go to the emergency room. I really didn’t.  Resisting the idea, I lay doubled over with the worst abdominal pain of my life for 12 hours, unable to eat or drink or move, and finally vomiting before I considered it. I was well aware that this sequence of symptoms made me a textbook case of appendicitis, but I still consulted an ER doctor to ask: was ...

Read more...

When I was young and foolish and just starting out in my career, I found it very hard to take “no” for an answer.  If a patient needed radiation therapy, and he or she didn’t want to have it, I did my very best to talk that patient into it.   I have always been a very persuasive person—if I didn’t get the go ahead on the first formal consultation, there ...

Read more...

When you work in an urban hospital, sometimes it’s difficult not to become jaded. There are certain neighborhoods that generate a disproportionate number of patients for some emergency departments. Meth is rampant. Marriage pretty much nonexistent. More bars than there are restaurants. Domestic abuse frequent, but prosecutions rare. Police know people more by their street names than by their real names. South Heights was one of those neighborhoods. The emergency department frequently treats ...

Read more...

As I walk onto any one of the locked psychiatric units at our hospital I am immediately struck by the hum of intense activity. It’s like the startling feeling of stepping out of an air-conditioned apartment into the steamy height of a New Haven summer. Across from the nurses’ station, a psychologist interviews a patient retelling the story of constant childhood molestation as rivulets of mascara run down her cheeks. ...

Read more...

The baby boomers are strictly identified as being born between 1946 and 1964. The boom lasted 19 years and delivered 76 million total births. "Leading edge" boomers were between 1946 and 1955. They were the generation that were the wealthiest, most active, and most physically fit generation that had ever lived. They were special and expected to have better lives than their parents. Well, those leading edge boomers are now middle ...

Read more...

I read the recent popular posts from Matthew Moeller (Dear lawmakers: this is what it’s like to be a doctor today) and Nick Rademacher (Lawmakers shouldn’t care about the personal hardships of doctors) with great interest. They reflect perspectives from two interesting turning points for most medical careers- medical student, and established attending physician. I’m a U.K.-based surgeon and though the healthcare systems in the UK ...

Read more...

MD002313 Despite the fact that many papers have identified the problem, inappropriate blood transfusions continue in hospitals across the nation. This topic was featured at the recent Patient Safety Science and Technology Summit that was held in Orange County, California. Transfusion of packed red blood cells is very common. Over 2 million patients or 5.8% to 10% of inpatients are transfused every year with some ...

Read more...

Most Popular