Chains do not hold a marriage together. It is threads, hundreds of tiny threads which sew people together through the years. - Simone Signoret Allen’s cancer has continued to grow quickly. He raises his chin so I can see. I check my notes from a month ago and pull out my ruler and make new measurements. I jot down my findings and turn to look him in the eye. We both know this ...

Read more...

I work at clarifying obscurity about the human condition daily Be obscure clearly. -E. B. White As a family doctor, I work at clarifying obscurity about the human condition daily, dependent on my patients to communicate the information I need to make a sound diagnosis and treatment recommendation.  To begin with, there is much that is still unknown and difficult to understand about psychology, physiology and anatomy.  Then throw in a disease process ...

Read more...

Physicians are being attacked in many ways and in many places.  It is no longer about how able, available, and affable you are.  It is about how well you toe the line when it comes to going along to get along while being watched by an ever increasing line up of watchdogs.  Many of whom have sharp teeth. Here are a few questions that might indicate you are headed for trouble: Do ...

Read more...

NPO and be merry

It is the holiday season, and all through the hospital, patients are being made “NPO.”  This is the medical term for “no eating or drinking allowed.” Mr. T, silver-haired and newly unemployed, is NPO on account of his pancreatitis.  "We don't want to upset your pancreas," the team tells him when we pass through on morning rounds.  It is nearly breakfast time.  We hover around his bed in a half circle ...

Read more...

Recently, millions of people around the world witnessed a remarkable feat. Daredevil Felix Baumgartner rose to remarkable heights in a capsule tethered to a helium filled balloon. At approximately 128,100 ft (24 miles) and a speed in excess of mach one (faster than sound), he leapt from his capsule and endured a free fall of 119,846 feet. At one point in the dive, he began to spin dangerously ...

Read more...

Mothers who deliver prematurely face serious health risks that are often neglected when we talk about prematurity. Today, in honor of Savita Halappanavar’s death from sepsis that was a direct result of her previable premature delivery, I would like to let the world in on the physical perils faced by mothers who deliver prematurely. Many of us have infections. We rupture our membranes prematurely, and for 40% of us ...

Read more...

Consider the following two clinical scenarios:

1. William, a 62 year-old accountant, has been feeling “depressed” since his divorce 5 years ago.  His practice, he says, is “falling apart,” as he has lost several high-profile clients and he believes it’s “too late” for his business to recover.  His adult son and daughter admire him greatly, but his ex-wife denigrates him and does everything she can to keep their children from seeing ...

Read more...

By now you’ve probably heard of the concept of “concierge medicine.” To me, it’s an idea that’s Win-Win-Lose: Win: Doctors. Those in concierge practices have chosen to forgo the traditional business model in favor of  charging annual fees that range from $1500 to $15,000 per patient. How much you pay depends on the market, exclusivity factors, and amenities, like comprehensive annual physicals with add-ons like a dermatology appraisal and nutrition consultation. Concierge ...

Read more...

Dont overwhelm patients with unnecessary detail It is not an easy time to be a physician in the United States.  Attempt to order an expensive test for a patient and an insurance company is likely to second guess your decision.  Try upholding the bottom line for your medical practice and the government will probably start questioning whether you are overcharging for your services.  To make matters worse, ...

Read more...

I recently saw a 90-year old patient in my cardiology office practice. She was demented, but cooperative with the exam. A devoted daughter, with whom she lives, accompanied her to the appointment. Her dementia was severe enough to make a cogent history from the patient impossible. However, the daughter had something on her mind, and it had nothing to do with her mother’s heart condition. “My mother’s primary care doctor wants ...

Read more...

Most Popular