All of us come to the study and practice of medicine through different pathways: some because of family members who were doctors or patients, some out of our own illness or woundedness, some out of intense drive to achieve and serve. I came to medicine because of my grade school classmate Michael. My grade school represented a grand social experiment of the early 1960’s.  It was one of the first schools to ...

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Some things are just so damned hard to write about. People often ask me, "Why do you have so many animals?" The current count is 4 dogs, two horses and a cat. I used to say, "Because it’s good for my children to learn responsibility. Having a dog, whose life is so much shorter than our own, teaches them about love, and about death. They get to practice parenthood, before ...

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Questions such as this from proactive, increasingly knowledgeable patients place a physician on the horns of an ethical dilemma.  Although fellows are closely supervised and trained under a gradually increasing responsibility principle (based upon subjective evaluation), a time will come when there is no one available to back you up in the catheterization lab. Fact: Someone has to be a physician’s first case of any given type. However, no one really ...

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I remember a short lecture I received in my medical officer's course when I joined the Air National Guard around 1988. The room was full of young medical students, physicians, nurses, and other health care folks who were beginning their service. The topic was appropriate documentation in the medical record. Among the notable examples of what not to do was this gem, written by a medical officer about another officer's wife: ...

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Doctors are already busy, but do they need to do more in a day? If you think a physician’s job is to take the best possible care of patients, then the answer is a resounding yes. But additional responsibilities do not necessarily mean more work—they just require different training. It doesn’t take unique insight to understand that doctors, in many ways, act as social workers. They help patients schedule follow-up appointments, ...

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In my office, every new patient encounter starts the same way.  I walk in and say, "Hello."  Then I put down my computer (which I take from room to room), wash my hands (which I purposely point out that I do before I touch anyone or anything else), and then I turn to the family and greet the child first.  Depending on the age, I might be squatting and gently ...

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Some of you may know that I started out in an internal medicine residency and quit for physical medicine and rehabilitation (PM&R). Switching residencies? Not recommended. But entirely doable. I spent most of my first half of internship being really, really miserable. I remember sitting in the call room during my ICU month, talking to my mother about how badly I wanted to quit and what my options would be if ...

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There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone. In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more. Then, in the 1970s, 80s, 90s, ...

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He was just a kid. Fifteen I think, something like that, too young to have experienced too much in life at that point, but old enough to die by his own hand. His father, only a year and change older than me, had already dealt with some issues of his own. Diabetes, a member of his family on both sides for generations, had already taken its toll on him by the time ...

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Today's healthcare consumer is constantly barraged with conflicting information. Does wine prevent or predispose to cancer? Should I eat certain foods or avoid them? Is this new medication going to hurt me or help me? Many issues are still controversial, but there are some things that have a large amount of evidence behind them. 1. Antibiotics will not help the common cold. Colds are caused by viruses, and antibiotics kill bacteria, which ...

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