Moving from paper death certificates to an online process called the Washington State Electronic Death Registry System, or EDRS. Sounds like a simple 21st century process that should make the process of completing a death certificate faster and easier right?  Oh, the government designed the system.  Oops. I’ve been so frustrated by the unintended consequences of a new state governmental process for completing death certificates. Beginning in early 2012 Washington state started ...

Read more...

We had one of each in our house: one baby that we let cry for periods of time to self-soothe and one where I simply couldn’t bear to hear the crying in quite the same way. You’d think it would have been just the same for both of our boys, but it wasn’t. Clearly I wasn’t the same parent each time around. There are many things that go into the equation ...

Read more...

Probably the hardest part of making the change from a traditional to a direct-care practice is the effect it has on relationships.  I am only taking a maximum of 1000 patients (less at the start) and will be no longer accepting insurance.  These changes make it impossible for me to continue in a doctor-patient relationship with most of my patients. For some, this transition will be more hassle than anything.  Some people ...

Read more...

I vividly remember the first day my medical school classmates and I met our cadavers in the anatomy lab. Large body bags lay on metal tables that had been bolted to the floor. I remember the sheer size of the bags best. No doubt existed in my mind that dead human bodies indeed lay within them. And yet part of me couldn’t quite grasp that I was actually going to ...

Read more...

I wouldn't call myself a palliative care expert.  I kind of happened into the job.  The nursing home had a need, and the local hospice/palliative care program didn't have the available staff.  I had always been good at handling end of life and pain issues, so I stepped up.  Of course, there are finer points that I could have learned in a fellowship program.  I don't want to pretend that my ...

Read more...

Charlotte Scott had an eye for madness—for just the right amount of madness. As a booker for The Springer Show, her job was to find—and forgive me if I’m getting too technical here—minor nut jobs, the kind of people who were just unbalanced enough to make for entertaining T.V. but not so wacky that they would pull an Uzi out on the audience. I learned about Scott while reading Jon Ronson’s ...

Read more...

There are times when it is necessary to step up to the plate and go the extra mile on behalf of your patients.  There is no job description for doing this and there is no manual that gives you instructions on what action you need to take on behalf of your patients.  However, when you have the opportunity to do the right thing, at the right time and for the ...

Read more...

It’s natural: when you see someone doing something you long to do, you automatically search for reasons to justify why they’re doing it and you’re not. Maybe they had encouraging supportive parents and yours belittled you. Maybe they got their start at a younger age and it’s probably too late for you now. Maybe they got a great education, or were blessed with more opportunities in life. My coaching clients won’t ...

Read more...

The recent New York City law restricting portion sizes of sugary beverages offered in restaurants has stirred much controversy among policy makers, scientists, the media and consumers. Opponents support the freedom of choice in selecting beverage portions and contend there is insufficient evidence that legislation will change behavior or body weight. Proponents contend that something should be done to reduce the ever-expanding receptacles in which sugar-laden beverages ...

Read more...

She was in her late thirties when her medical oncologist asked me to see her.  Five years before, one of our community surgeons had removed part of her colon for cancer.  She also had a recognized, single metastatic tumor in her liver at the time of that original surgery. The contemporary standard of practice was to treat for a prescribed period of time with chemotherapy and then re-evaluate for the appearance ...

Read more...