asco-logo She had come to see me in consultation. A professor at a local university, she was well until four years earlier when she developed abdominal bloating and pain — telltale signs of ovarian cancer. Surgery followed, then adjuvant chemotherapy with intraperitoneal treatments. (“Terrible regimen,” she said.) She was fine for two years, until the bloating recurred heralding ...

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In medical training, each morning begins with pre-rounds, a sort of prologue to the work day that gives us a preview of our patients’ conditions. Like a daily ritual, we arrive in the hospital as the sun begins to peek over the horizon and proceed to visit each of their rooms. Some of them are still sleeping, but we wake them up anyway to needle them with questions. Any pain? ...

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“Then it’s me and my machine For the rest of the morning, For the rest of the afternoon And the rest of my life.” - James Taylor, “Millworker” It’s Friday afternoon, 4:30. I am sitting in front of my computer. My last patient is gone, my prescriptions are done, my messages answered, my office charges submitted and my office notes completed. Now, it’s time to tackle the incoming laboratory results. Opening up the list of completed ...

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Vaginal yeast infections are common, up to 75 percent of women will have at least one and 5 percent of women suffer from chronic yeast infections (meaning four or more a year). Many women out of frustration with allopathic medicine (preventing recurrent yeast infections can be challenging) or because of their beliefs turn to alternative medicine options. More and more I am hearing about vaginal garlic. The problem with many alternative ...

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Four years ago, I was having a conversation with a friend of mine. We had graduated residency the same year and our careers had taken us to different parts of the country. It was ACEP 2012. We’d been mingling with old friends and current colleagues, and the conversation turned to kids. I told him my wife and I were getting ready to start having children. He said he and his wife ...

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Americans spend more per capita on medical care than just about any other country and, yet they often have little to show for it. Americans have worse access to care than people in other countries, and are often less likely to receive primary care services, like preventive therapies and screening tests. Determined to address these problems, Medicare leaders have been testing out new models of primary care, hoping to find ...

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What is one of the rules that medical people comply with the least? My vote goes to "translation." The rule is that you must use a qualified medical interpreter for any interview or discussion with a patient who does not understand English. How is “lack of understanding” defined? It is usually fairly obvious. If you aren't sure whether the patient gets it, he probably doesn't. Why can't family members act as translators? There is ...

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“Being able to feel safe with other people defines mental health; safe connections are fundamental to meaningful and satisfying lives.” - Dr. Bessel van der Kolk On my last day of rotation in the psychiatric emergency room, we received a new patient. The keywords and phrases rang through the air: “teenager,” “transgender,” “homeless,” “assaulted recently,” “says she feels a full-grown baby kicking.” I immediately asked if I could see this patient, and was ...

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The mouse is a piece of technology that we’ve all got very used to working with over the last couple of decades. They actually go back longer than we might expect — the British Royal Navy first used a version of the mouse in the 1940s. With the personal computing revolution of the 1990s, they entered almost every single American household. Go back ten years, and nobody could have imagined ...

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As with most everyone else, I am watching the presidential race with something akin to amusement and horror alike. And as with many people, I feel that the U.S., as a nation, failed to find a suitable candidate for this presidential election. While there does need to be some test for fitness for office, I remain aghast at the medical speculations and facts being leaked about the presidential candidates. Reading this ...

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Classic rock music lovers who think they don’t like poetry, and literary purists who think they don’t like popular music, may have been equally baffled to hear that Bob Dylan is a winner of the Nobel Prize in Literature. As an unrepentant English major, I’m delighted. I can’t remember a time when Dylan’s music wasn’t a part of my growing up, from the rebelliousness of the anti-Vietnam era to ...

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A recent issue of the New England Journal of Medicine once again questions two practices that used to be almost the backbone of primary care. One article is about the low likelihood that prostate cancer detected through PSA screening will shorten a man’s life, even if he chooses just to keep an eye on it. The other article is about how repeated mammography screening mostly leads to the diagnosis of small and ...

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I recently spent an evening with a group of medical oncology fellows as part of a small panel discussing career alternatives. There were doctors who worked for pharma, academic medical centers, hospitals and a couple of us representing private practice. The questions and comments taught me more than I could contribute. I was surprised to learn not just about jobs and personal futures, but about something basic: the difficulty in ...

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I answer every phone call from every patient myself. I have no staff to respond to issues that come up during the day. There are no colleagues that take my calls after hours. This was my choice in response to what everyone knows: Health care is broken.  I needed a radical change from the bureaucratic system that I experienced daily as a physician however I had no idea how to ...

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How many calories are in a pound? This seemingly simple question stumped me on my family medicine board recertification exam seven years ago — twice. (I think they asked the question in two different ways. I hoped they were experimental questions that didn’t count.) Later that day, I found the answer: 3,500 calories equals one pound. I don’t remember which multiple-choice answer I chose, but I do remember choosing the same answer ...

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Martha arrives for an appointment with her new primary care provider. She hesitantly hands over her pill boxes at the nurse’s request; it seems to take forever to enter them all into the computer. “You are taking a lot of blood pressure pills,” he comments. The doctor comes in and after a brief introduction, notes that she is taking five medications for her blood pressure. “Five?” Martha exclaims in disbelief. She hadn’t ...

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A few months ago I wrote an article about a 28-year-old MBA who attempted to tell an experienced physician where to round first. The article was widely circulated and went a bit viral. Clearly, the scenario resonated with thousands of physicians across the country. It was interesting that afterward, I received many messages from various people who had read it. The majority of these were messages of support and ...

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I am constantly in awe of the patients I want to treat. I cannot fathom their strength to embrace their identity while overcoming prejudice and discrimination. I do not know what it must be like to fear being your true self everyday. But I do know what it’s like to be told to keep my career interests quiet. When I was interviewing for residency, my goals of serving transgender ...

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"Good morning, Sandy. How was work?” How do I answer that in a normal way? Any given shift in any given ED is comprised of the gamut of emotions playing out behind the calm facade of physicians and nurses. Afterward, we often don't articulate or even process the roller coaster of feelings. The story of a recent Monday overnight illustrates the wild ride of emotions most people don't realize that emergency ...

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One very late spring evening during my last year of residency, I was driving home and got stopped at a police DUI checkpoint. I was exhausted from being up all night from being on call the night before and having been very busy had no time to shower, shave or change into my street clothes. I also got called in at 4 a.m. the previous day and had not showered or shaved that ...

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