Props to medical students at the West Virginia School of Medicine for their slick dance moves.  It all to raise money for multiple sclerosis.

On my recent tour of residency programs, I had the pleasure of meeting many foreign medical graduates (a.k.a. FMGs; not to be confused with international medical graduates, who are U.S. citizens who go abroad for medical school). Almost uniformly, they struck me as confident, mature and articulate. Many were older than me, some by as much as 10 or 15 years. Most had extensive research experience, and a few had even ...

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I would have graduated from medical school this year.  That’s right.  Just like you, I’d be getting ready to move to another city and take up residence at an academic medical center to begin my clinical training. Things don’t always work out the way we planned: like Lenny and George in Steinbeck’s, Of Mice and Men.  Sometimes, the best-laid plans have a way of going awry no matter how carefully we prepare them. Cancer.  I wasn’t worried. It was ...

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Now that I’m getting ready to turn 70, I thought I’d summarize what I’ve learned since I finished my residency, when I was 28. Of course, I didn’t learn all this only by being a psychiatrist, since I would hope that most folks have also learned lots in the last 41 years. 1. Psychotherapy is important, particularly if the patient is on the right medication. I won’t do “med checks,” since I ...

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When asked during a recent ICU rotation if I was considering critical care as a subspecialty, I offended more than one person with my response: “No, I really don’t enjoy torturing old people.”  Granted, that unfiltered comment came at the end of a long and sleepless 28-hour shift, but the sentiment holds true. As doctors, we have a number of tools to assess quality of life in research.  We use fancy ...

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Naturopaths are currently engaged in an intensive lobbying effort at the Capitol in order to gain recognition as medical practitioners and inclusion in Medicare. As a retired naturopath who was licensed in two states, I want to offer a primer to this political maneuver: Naturopaths are not who they say they are. To be fair, naturopaths (NDs) are no longer obscure practitioners. NDs are currently licensed or registered in 18 U.S. ...

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Taxes. Doing taxes feels like a financial rectal exam.  I hate doing taxes.  Yeah, I don't like getting rectal exams either. It's not that I resent paying the government for the fine services they render and the high quality of elected officials we have. It's not the existence of taxes I hate; it's just doing taxes make me feel extremely insecure.  Sharing my personal and business finances with my accountant and the ...

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The following is paraphrased documentation, authored by a physician I know, regarding an intoxicated patient in the ER: 1 a.m.: Patient is telling nurse, “Before I leave, I need everyone’s name for my lawsuit. Tell the phlebotomist that if he’s good, he’ll get a cut.” 1:40 a.m.: Patient is making inappropriate sexual comments and is verbally aggressive with medical staff. He is advised to stay in bed. 2:02 a.m.: Patient (who had been sleeping comfortably) wakes up and ...

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My friend Dawn and I recently attended an evening meeting of the Houston Society of Plastic Surgeons.  Since we were invited guests, and not plastic surgeons, we didn’t stop on the way into the lovely formal dining room to pick up our name badges because the organizers had not made them for us.  On the way out, however, we both noticed clear plastic perfectly formed oval objects sitting on the ...

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When I meet strangers, and they ask what I do for a living, the conversation tends to go something like this: I tell them I’m a physician. They ask what type. I say that I am a general internist, but I focus mainly on addiction…addiction to prescription opioids (painkillers) and heroin. Invariably, people will say something like, “This has become such a big problem.” I agree, but then they will ...

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Virtual visits are increasingly the rage amongst forward-thinking healthcare providers that want to jump on the telehealth band wagon.  Extending the office visit across distance, using the same technology we use to keep in touch with loved ones (videoconferencing such as Skype and FaceTime), is a safe and logical way for providers to venture into a new tech-enabled world that may still be scary for some. One way to think of ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated during a routine appointment and asks for advice on cardiac risk assessment. He does not have any current cardiac symptoms, exercises 4 days per week, and has never smoked. He has no chronic health issues and takes no medications. He has no known drug allergies. Results of ...

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Most industrialized nations have long supported the idea that access to health care is a fundamental right, and have built centrally planned systems to accomplish that goal. The result has been universal coverage that delivers excellent-quality outcomes at lower costs than the United States. In some countries, such as England and Canada, the government controls both financing and certain aspects of health care delivery, while in others, including Australia, Sweden, and ...

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Physicians play many roles in patients’ health care and lives in general. In one encounter we may be the only one encouraging a hesitant or discouraged person to look inside and outside themselves for the strength to move forward with a difficult decision. In the very next appointment, we may be taking charge as a patient develops chest pain and shortness of breath in front of our eyes. We sometimes find ourselves in ...

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Sometimes in my research on physician/patient communication, I come across a doctor who is so good with her patients, I have to share their bedside manner with you. The most recent example is a (to remain unnamed) oncologist in the northeastern United States who practically gave a primer on shared decision making when caring for a patient with metastatic cancer. The patient (I’ll call her Jennifer Decker) had stage 4 breast ...

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Many young physicians in training have asked me, quietly or by e-mail, "Is it possible to be a Christian and practice emergency medicine?"  I think that they ask a good question, and likely for good reasons. In their rotations, they have witnessed, first hand, life in the ER.  They are uncertain, perhaps, because they see the frustration that boils over in the words and actions of otherwise compassionate and caring doctors ...

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With all the changes happening in health care and the increasing weight of federal mandates and requirements, it’s easy to view the Centers for Medicare & Medicaid Services (CMS) as the big, bad enemy. After all, if they just left all physicians and health care institutions on their own, everything would be OK, wouldn’t it? It’s an occasional line of thinking I’ve heard from many esteemed colleagues and also appears to be ...

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Popular shows like Gray’s Anatomy, ER, and House, MD have given the television watching public a good eyeful when it comes to the inner workings of medicine, hospitals, and emergency rooms. They have also shown us how the personalities of those who take up the stethoscope and reflex hammer run the gamut from the sweet, demure, tentative types to the sons of bitches who cut first and ask questions later. I ...

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I remember my first death. He was my patient, a 59 year old who suffered an episode of asphyxiation. His story was tragic, a reminder of the frailty of human life. After choking on a food bolus at home, he had called 911. Unfortunately, he suffered a prolonged cardiac arrest that resulted in irreversible brain damage. He spent two weeks in the intensive care unit in hopes of a recovery, but the ...

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I am forced to attend one of these mandatory continuing medical education (CME) events. My malpractice insurance provider has a deal with the state medical association. To get lower rates, I have to be a member of the association and every 2 or 3 years attend a risk management training session. I make it on time, despite the traffic. As I walk into the lobby of this rather nice building, looking for ...

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