A friend of mine plays a mean game of poker.  She comes out ahead in Atlantic City, finishing near the top in hold ’em tournaments.  She is a poker savant. Not long ago I asked her secret to playing the game so well. “I learned to play cards when I was being trained to treat cancer.” “Oh,” I said, “the discipline, memorization, patience and statistics?” “No, that is when I learned not to ...

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Recently, my 16-month-old grandson was at a backyard barbecue with his parents. He had been eating some potato chips when he suddenly stopped breathing and turned blue. Having had CPR training, my son started rescue breathing and suspecting aspiration, performed toddler airway clearance maneuvers. No obstruction was found. The child slowly awakened but was very drowsy. Because of the concern for aspiration, an ambulance was called and the child was taken to ...

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There is much to deplore in our medical system.  Atrocities abound in the dark recesses of hospital wards, the overpacked waiting rooms of outpatient offices, and the algorithmic hum of insurance claim denials.  Yet time and again, the most vile of of insults are hurled at one setting in particular.  I'm talking of the place cursed by emergency room physicians when admitting yet another poor soul with a sacral ulcer, ...

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She grasps her chest dramatically and falls to the floor. Her eyes flutter as she tries to hold them closed. Her one arm across her chest the other flailed in theatrical fashion to her side. She’s dead. Her heart is broken. The other jumps from the bed, and after landing, reports her leg is broken. She hops about the room, unable to use the leg and there are no crutches ...

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The public perception of oncologists: Is it really true?I had taken care of her for years. We had faced a new diagnosis, the toxicities of adjuvant treatment, the promises of having no evidence of disease (NED as my friend, Molly, refers to it), only to have it shattered with the first recurrence. Over the next three years, she had undergone treatment -- chemotherapy, a trial of endocrine therapy, ...

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A friend of mine has been living well with lung cancer for five years -- working, running several miles a day, traveling, doing good stuff with his family, and generally enjoying the pleasures of everyday life. He knows the cancer will eventually kill him, but has been making the most of every remaining minute. Then, a month ago, things suddenly turned dramatically south. Severe shortness of breath, constant coughing, sleeplessness, fatigue, ...

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Team-based care is one of today’s buzzwords without real substance, because unless the payment systems change, only the physician members of the team can bill for their work. Few people seem to be concerned with the simple but essential question of how physicians spend their time and how medical offices are paid. As a primary care physician who doesn't do any major procedures, and who in 2014 is essentially paid fee ...

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As a physician, I enjoy listening to non-physicians tell me how to motivate doctors.  I don’t mean this in a totally snarky way (well, maybe just a little).  These conversations often highlight the chasm that exists between physicians and administration. What’s the most common motivator people throw out there? Money.  Certainly everyone wants to make more money, I don’t refute that.  What I take issue with is the notion that the ...

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This post by Paul Levy got me thinking about informed consent, and a case I saw recently got me to take a little time and write about an issue frequently ignored in medical school. A bit of background for non-medical readers. Informed consent is a term in medicine for when doctors get the agreement of the patient to do something to said patient.  For example, before a patient is cut ...

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Motivate patients to exercise more and eat less “Plank? Is that a board?” asked my patient. I had been encouraging her to start doing exercises to strengthen her core in order to stabilize and support her back. My hope was that over time, these exercises would lessen the need for pain medicine. There are times for words and there are times for action. So I got down on the ...

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