A Finnish group randomized patients with acute appendicitis to surgery and antibiotics and found that antibiotics were successful in 73 percent of patients. Depending on how this is framed, you can celebrate a 70  percent success or lament a 30 percent failure. Much of the debate in health care is a battle of framing.  The study has limitations. Finland is not just a land of the
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Recent research shows improvement in long-term survival rates for childhood cancer patients, but also highlights the challenges that remain for many of the almost 400,000 survivors in the United States.  Among these survivors are women facing gynecological health issues from the late effects of their treatment. What follows are several areas of concern that gynecologists and obstetricians should consider when treating women who had cancer as girls. 1. Treatment ...

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Let me be the first to admit that my mind’s internal and unspoken dialogue produces scathing critiques of the people whose behavior or ideologies are divergent from my own. This isn’t to say that I intentionally treat anyone differently because of personal differences that I observe. On the contrary, I make a conscious effort to make my actions and spoken words consistent among everyone with whom I interact, particularly when I’m ...

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As a pediatrician, I get lots of questions from parents -- but sometimes I wish they would ask different ones. That's what check-ups are for, really: questions. Aside from questions about illnesses (obviously my purview, as a doctor), I get questions about just about every aspect of a child's life. The parents of babies and young children ask the most -- here are some of the most common: Should my baby's poop ...

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A colleague complained that during a particular type of critical conversation his advice is ignored. Women with breast cancer deciding whether to have mastectomies disregard his guidance and seem to have reached a conclusion before he discusses the issue. Given that this physician has committed his career to the study and treatment of breast cancer, communicates clearly and patiently, projects caring and compassion, I thought that his observation warranted discussion. Some ...

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asco-logo I am often asked by friends and acquaintances how I am able to do what I do for a living, which is care for patients with advanced lung cancer. Depending on the setting and how well I know the person asking, I might say that the treatments are improving all the time (i.e., the casual dinner party response), that the ...

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It was only a matter of time before Kim Kardashian posted a picture on her Instagram account with a bottle of Diclegis, basically announcing her brand partnership with Duchesnay, the manufacturer of the prescription medication for nausea and vomiting in pregnancy. Duchesnay had been tweeting for ages that they were so relieved Kim had found help with Diclegis -- so much so that I was wondering if Ms. ...

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“I want to explore employment opportunities with you.” He is looking at me. Trying his hardest. Passion, yet anger, in his eyes. Everything I know about him and his tenure in the community helps me understand how difficult this conversation is. Everything I see in his eyes helps me understand how painful this is. Private practice is dying, on the vine, in America. The practices fold or reach a critical point, and they come ...

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Ladies, the moment you have all been waiting for is here!  No, not affordable childcare.  Not equal pay for equal work. Not gun control.  Not abortion rights or paid maternity leave or a female majority in Congress or a constitutional ban on the words “chick lit.”  Girls, it is so much better than all that.  We got pink Viagra! Flibanserin.  Catchy name.  Addyi for short.  Approved by the FDA for hypoactive ...

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"I'm just the night doc," you said. You said it with emphasis as if that explained everything and dismissed your incompetence, your lack of compassion, your failure to care. Unfortunately my sister was "just the patient," who lay suffering hours before her death and the RN was "just the nurse" withholding the morphine that the daytime doctor had ordered for air hunger and agitation. The nurse called you in to ...

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I just finished my first call weekend as an attending. It was a 96-hour bender. I had 4 vaginal deliveries, 1 cesarean, rounded on 20 patients on Saturday (mostly new), 14 on Sunday. I admitted 5, transferred 2 out --one for persistent ventricular tachycardia and one for a possible liver abscess, all while juggling full days of clinic on Friday and Monday. After the call, I felt tired, but still felt ...

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A few weeks ago, after feeding my face with rich, dense chocolate cake brought by a truly awesome nurse (for no particular reason other than a warm and generous spirit), I walked back into a room to check on a post-cardiac arrest patient. After surveying his vitals on the monitor, I turned my attention to two nurses and a pharmacist who were discussing the management of his six drips. He was ...

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shutterstock_124488283 As a relatively young physician, I always enjoy my conversations with the older members of our profession, who’ve seen so much change over the last few decades. I’m fascinated with their stories about how different the medical world was when they were residents, how treatments were so novel, and how they used solid clinical skills to get to the diagnosis. Those were the ...

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I have a long history with family medicine as my father was an early pioneer – heading up the family medicine program at Chicago’s Cook County Hospital in the 1970s. Even back then my dad was using physician assistants (PAs) -- many of them former military medics in the Vietnam War era -- who were part of what was at that time a brand new profession. Family medicine as a whole ...

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“A good surgeon has the eye of an eagle, the heart of a lion, and the hand of a woman …” – 15th century English proverb #ILookLikeASurgeon, a hashtag on Twitter and the movement it has inspired, has resonated deeply with me. I look like a surgeon. There is so much more behind this seemingly simple statement of fact. I am not just stating that I have excelled and I have achieved and ...

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Dr. Google has been the brunt of numerous jokes and various denigrations from the medical community for some time.  The most recent such offering to come to my attention was from Tanya Feke who seems to want Dr. Google sued for malpractice.  As one who was instrumental in the construction of the Internet, which allowed the creation of Dr. Google, I read these attacks with mixed emotions.  I ...

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The vast majority of physicians enter medicine with an inborn sense of compassion. Junior residents, however, are the logistical workhorses of teaching hospitals — their north star is efficiency and they are measured largely on their capacity to “get things done.” The consequence is often a slide towards unwitting apathy. I, like all residents, have witnessed this reality first-hand. By reflecting on my experiences, I hope to discover insights we ...

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The job of being a doctor can sometimes be like that of your favorite sidewalk juggler. It used to be that a good family doctor would have to show up in the clinic for a couple of hours, make a few house calls, and be available if anyone needed him while he played a round of golf in the afternoon. (Really, this is quite an exaggeration but it sets the ...

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About a year ago, I wrote a piece on my blog called “How to Welcome Incoming Residents.” It was about my struggle with getting the right messaging, messaging about the reality of stress during residency and the necessity of incorporating self-care and outreach to others. This year at orientation, in addition to adding the great suggestions posted by readers of the article, I took a different tack. It ...

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unnamed Heath care documentation is done for three reasons:

  1. health care delivery (that’s the obvious one)
  2. regulatory compliance (checking all the boxes our government and payers think are important)
  3. malpractice avoidance (no one wants to get sued)
These three categories actually apply to every task we do in health care, but let’s confine this discussion to documentation. Note in the accompanying figure, our three basic health care work ...

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