shutterstock_108241016 I have come to terms with making difficult decisions.  I accept the possibility of committing a mistake that will cost a life.  But I never signed on to bankrupting my patients.   Never! I had been up all night tossing and turning.  The stat CT scan was deemed unnecessary by the insurance company.  My patient called crying saying he couldn't afford the thousands of dollars in charges.  Never ...

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I had a most surprising visit with a patient last week; she came to say goodbye, because she was dying. The surprise was that while she does have a terminal illness, she is not actively dying; I would put her prognosis at four to eight months.  She was bidding me adieu, because I had referred her to hospice. There is confusion about the role of the primary doctor, when a patient ...

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An excerpt from When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Tests. Danielle is a 20-year old college student at the New England Conservatory. She came to the ER because of a ...

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Lots of people are using complementary and alternative medicine (CAM) these days—things like vitamins, homeopathic or herbal medicine, chiropractors, acupuncture or massage therapy. But they don’t always tell their doctors about it. In a study in the journal Pediatrics, researchers in Canada found that among kids with chronic health problems, 64.5 percent of them were using some form of CAM—but more than a third didn’t tell their doctor. That’s ...

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Recently, there was a bit of hue and cry regarding Mayor Bloomberg's report on the matter of prescription drug abuse and restrictions on new prescriptions for painkillers through the emergency department. Initially, I was concerned. I completely agree with the comment from the linked article: “Here is my problem with legislative medicine,” said Dr. Alex Rosenau, president-elect of the American College of Emergency Physicians ... “It prevents me from being ...

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My membranes ruptured at 22 weeks during my pregnancy. It was the evening of July 5th, 2003. Two days later my first son was born and died. The task before me was bed rest and squeeze as many more days (hopefully weeks) out of the pregnancy as possible to save my other two sons. It was, to put it mildly, a very low time. To pass the hours I read, slept, ...

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The American Journal of Surgery had a nice little (38 patient cohort) study from the VA database that tried to determine the process by which patients make informed decisions on elective surgery.  The results were rather surprising, at first glance.

Sixty-nine percent of patients decided to have surgery before meeting their surgeon, and 47% stated that the surgeon did not influence their decision. Although the surgeon was an important source of information ...

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shutterstock_108854663 Sometimes, I feel like I belong in law enforcement. There was a time in my life that I seriously considered a career where I would haul in the bad guys and make society a better place. Of course, every American male youngster fantasized that he would one day drive the Aston Martin, get the girl, defuse the bomb, and sip on a ...

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For most people, anesthesia is one of the more mysterious branches of medicine.  What we do for patients is done, generally, when they are asleep.  You the patient don’t exactly know what we are going to do, or how it’s done, but you put yourselves in our hands willingly.  It’s sort of a weird relationship we have with other humans.  We have done our job right if our patients don’t ...

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I was recently speaking to the clinical leaders of a mid-sized hospital, and a senior administrator posed the question, “should we require our doctors and nurses to get flu shots?” The answer, I said, is yes, and it isn’t just to prevent the flu. It’s to get into the habit of making our folks do the right thing when it comes to patient safety. Preventing the flu is very important. In ...

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