A primary care physician named Ashley Maltz recently discussed advantages and disadvantages of a cash-based practice. I appreciate her evenhanded tone: She prefers this model yet expressed concern for patients who can’t use it. In the comments section, several physicians extolled the virtues of cash-pay, but patients were mixed. It’s attractive for those who can afford it, while it worries, and maybe angers, those who can’t. I enjoy the personal and patient benefits of a mostly cash-pay psychiatric practice (I ...

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Mrs. Liu, who was only 58 years old, had metastatic ovarian cancer. Despite radical surgery and chemotherapy, her disease persisted. Worse yet, her PET scan from a few months ago revealed that she had carcinomatosis -- numerous deposits of cancer showered throughout her abdomen. This particular night, she starting having more nausea and couldn’t eat or drink anything without vomiting. So, she came to the ED. I was called into ...

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The opioid (painkiller) epidemic, with its seemingly indiscriminate reach, has embraced an alarming number of Americans. In the most recent statistics available, two million Americans either abuse or are dependent on prescription opioids. Even the death of internationally acclaimed artist, Prince Rogers Nelson, has now been attributed to fentanyl overdose, a strong prescription opioid whose illicit version has become ...

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I recently saw the movie, Captain America: Civil War.  If you haven’t seen it yet (no spoilers), the United Nations decides that because of civilian fatalities during previous Avenger battles, the world would be safer if all superheroes voluntarily subjugate themselves to the authority of an organized government body. Sounds good to some of the Avengers; after all, innocent people have died, and maybe some form of supervision will minimize collateral ...

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Those of us who work in emergency medicine have all had these patients. They present with a complaint that started two years ago and for whatever reason now deem it an issue that needs immediate attention in the ER. I had a patient like this recently who not only had the issue for two years, but also had a primary care provider. Not only did the patient have a PCP, ...

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I remember a warm September day at the playground 22 years ago. I was there with my 19-month-old daughter and newborn son. Zack was hungry, so I sat down on a bench to nurse him -- but every time I got him settled, Michaela ran away from me. Far away, out-of-view away (she was a quick little thing). The playground was fenced in, but there were lots of ways for ...

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A JAMA Viewpoint suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, "the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any ...

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Doctors have become a profession of whiners.  Meetings, dinners, doctor lounges and the blogosphere are flooded with physician complaints, tirade, and anger. The volume of pained voices suggests that health Armageddon is only a few moments away. It was not always so.  Medicine is a career where idealism runs rampant.  In medical school interviews, young students really do answer that they want to help their fellow man.  Nonetheless, in recent years ...

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I am known by my patients and friends for my calm, imperturbable manner.  Yes, I am equipped with the full range of human emotions, but few folks have ever seen me raise my voice or demonstrate bulging next veins.  I am not suggesting this is a virtue or a character flaw, but is just the way I am wired. Sure, I get irritated and frustrated with the absurdities of life, as ...

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My last column told the stories of two patients from whom I learned important lessons about gratitude and compassion.  In this column, I share stories about patients who taught me critically important lessons about truly listening and the power of acceptance. Samantha -- or Sam, as she preferred to be called -- was a young surfer recovering from a serious car accident, and Paul a young father with cancer. ...

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