I want to tell you a story about dying that ended up being a story about living. A few years ago, I was an eager-beaver third-year medical student, and relished the opportunity to finally work on the wards. One of my patients was Mr. Taylor, a middle-aged man with pancreatic cancer—a disease that, of course, carries a bleak prognosis. He was emaciated, ...

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Outrage #1: Wasting time of skilled caregivers. Everyday skilled nurses and physicians’ assistants waste hours of time on the telephone either getting approval for medications that we prescribe for our patients or trying to fight a rejection for a medication we requested. Outrage #2: Choosing a medication for cost, not effectiveness. A child cannot breathe because the acid and other nasty stomach ...

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An excerpt from Pet Goats and Pap Smears. I’ve been practicing medicine nearly twenty years, but I’m still a doctor-in-training. Every patient who passes through my life teaches me something. Now doctors-in-training follow me around, but I think I learn more from my students than they do from me. Today Brooke is here. She is two years away from applying to medical school. She has a degree in natural ...

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Waking before dawn, I scurry into the study.  Sitting in front of the computer, I wiggle the mouse, bringing the screen to life.  Hesitantly, I call up the site for the major local newspaper.  Since being notified by my attorneys one week prior that a reporter was hunting me down for comment, I am on heightened alert.  Every day spent awaiting a story that could potentially decimate my life. The home ...

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I have a lovely pen. It's a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice. It's a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window ...

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Most modern American are familiar with the classic political novel, Atlas Shrugged.  Love or hate it, the novel had a great impact on political thinking in the West.  If you haven’t read it, or aren’t familiar, one of the fundamental questions author Ayn Rand asks is this:  what if the producers and innovators of society simply stopped trying?  What if they ...

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I can’t stop thinking about a drive-thru. Not the one for burgers and shakes but the one for ear checks, sports forms, quick med refill visits or a lingering rash. For those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving. For those things that really make you worry as a parent. Instead of the millisecond-mall-type clinic, we all want ...

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I strolled into our noon-daily resident conference, a little late, my free burrito in hand, and noticed that “cost awareness” was the topic. The conference seemed to have the same format as our other lectures: an attending was presenting a clinical case and asking us what steps we could take to best diagnose and manage the patient. The case seemed straightforward enough—a 65-year-old healthy Caucasian gentleman with right-sided chest pain—and ...

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Healthy patients think that they are not at risk for serious medical problems. Though maintaining a healthy weight, exercising regularly, not smoking, and eating plenty of vegetables and fruits while limiting meat, fat, and fast foods does decrease the risk of developing diabetes, high blood pressure, heart disease, and cancer, it doesn’t completely eliminate it. The chance is there, just a ...

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“Doctor’s office; please hold.” You’ll never hear that when you call me. Never. You’ll also never get an automated answering system (I’m just referring to office hours, of course. Evenings and weekends the phone goes to Google Voice. More on that below.) We are also in the middle of a communication revolution. There are now so many other ways patients ...

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