DSC5475-2-1024x839 A new patient calls for an appointment. I ask, “What would you like to come in for?” “Depression. Two weeks ago my doctor put me on antidepressants.” “Why don’t you see your current doctor?” I ask. “I feel weird discussing my emotions with someone who doesn’t have any.” When doctors are fully present, vulnerable -- even emotional, patients are more likely to be honest, transparent, ...

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A Catholic nun, who was the administrator of a small hospital once summed up for me the role business plays in patient care: “No money, no mission.” In order for a practice to be successful, it must be run with healthy business principles in place. But the truth is that few physicians have any training in or knowledge about the business aspects of running a practice. A satisfying and successful career ...

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shutterstock_36115612 Should joint replacement manufactures provide a warranty for their products?  It seems pretty logical since most consumer products come with some sort of warranty these days.  Basic warranties are almost universally provided and the market for extended warranties is increasingly popular. Take for instance my recent upgrade to the new iPhone 5s.  At the time of purchase, the AT&T store suggested their extended ...

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In 2007, I wrote a post called "Why Shrinks Don't Take Insurance."  The post is a bit dated, the CPT codes have changed since then, and the reasons to not take insurance have increased.  Many other doctors don't take insurance now, though psychiatry remains the number one specialty where doctors don't participate in health insurance plans.  This is an updated version of that same post. Many psychiatrists in private practice don't ...

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This is a speech I gave recently at our local hospital when I was given a "physician of the year" award for my work managing medical detox in our community for 20 years. At first, when I was told about this honor, I was really unsure why my clinical work in medical detox would warrant "physician of the year." I am not as skilled a diagnostician as many of you. I’m not ...

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Once in a while someone asks me if it is hard to be a mother and a surgeon. Certainly, any surgeon-parent can appreciate that juggling a household full of schedules, classes, meals, bedtimes, and activities with a practice full of office visits, pre-operative clearances, post-operative check-ups, and surgeries has its challenges. And to be sure, before I became a mother I had no idea how this would impact my work. What ...

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Case 1: You have a 94-year-old woman with multiple medical problems in hospice who develops a fever (subjectively hot to the touch), shortness of breath, and a cough producing yellow sputum.  Her daughter asks if she can be treated with antibiotics "to make her feel better."  The patient is not well enough to make decisions, but in earlier conversations had stated a goal of remaining comfortable at home, while also ...

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Elton John had it right: “It’s sad, so sad.  Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.”  Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved? Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double ...

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For many of my out-of-school hours as a child, no adult had any idea what I was doing. This has everything to do with who I am today, in some remarkably good ways. As a parent, I can’t help but wince at the lack of supervision I received, especially given what my friends and I did. We spent hours in really tall fir trees, pretending they were houses. I lived on Long ...

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I trained in internal medicine and cardiology at the tail end of the era of lifetime board certification by the American Board of Internal Medicine. In fact, my timing was perfect -- I was “boarded” in medicine in 1987, and in cardiovascular disease in 1989, which (I am pretty sure) were, respectively, the last years that the ABIM offered certificates without an expiration date in those disciplines. Late last year, I ...

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