In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back. What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and compassionate humanitarians. Soon, we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? Attention, medical ...

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“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other. “Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave ...

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When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability of allowing a patient who refuses necessary blood products to die. For this reason, these institutions are not welcoming to Jehovah Witnesses. This is of special concern in surgical specialties ...

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Decisions regarding medical care are often not very straightforward due to the uncertainties, risks, and limited options involved. But, above and beyond the actual choices to be considered, the process of how the choices are made has become a red-hot topic. And the value of the patient -- as opposed to the doctor -- as the driver of medical decision is, quite curiously, just beginning to be recognized in a ...

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In a few weeks, new medical school graduates will take their turns saying the words of the Hippocratic Oath. In theory: This is a noble tradition where they promise to fulfill their duties as wonderful physicians: Autonomous, wise, humble, prevention-focused, and active members of their communities. In reality: The health care system in which they’re entering makes it next to impossible to keep any of these commitments. It is a ...

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"Why don't you talk loud enough for the whole damn hospital to hear you?" I've just greeted my eighty-four-year-old grandmother, and now this irascible voice has erupted from behind the curtain that separates us from whoever is sharing Grandma's room. The nursing assistant whfo showed me in glares across the curtain at the other inhabitant. "You shut up," she tells the person firmly, "or I'll smack you with a bedpan." Then, she leaves us ...

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Sean MacStiofain said, “most revolutions are caused … by the stupidity and brutality of governments.” Regulation without legitimacy, predictability, and fairness always leads to backlash instead of compliance. Here’s a prediction for you: If something is not done to stop MACRA implementation, more physicians will opt-out of Medicare and Medicaid than is fathomable. Once DRexit begins, there will be no turning back. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is ...

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Dear Me, MD: Now that you have opened this letter, you may have graduated or maybe you just matched into residency — somewhere, anywhere, hopefully?! As you read this, it should be some time during spring 2017. But, you never know, sometimes the train derails, and it takes a little longer than expected, so forgive yourself if that is the case. You learned a while back that the fast lane is ...

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"Ice! Ice! I need ice!" Paul yelled, rushing into a store. It was a skate shop. They looked at him like he was crazy. "Ice! Ice! I need ice!" he continued to yell. The store employees looked at Paul with a blank stare. They pointed to the restaurant next door and suggested that he try there to get ice. They had no idea what was going on. Paul's girlfriend had overdosed on heroin and ...

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"Wait. When did you say you started that medication?" "Two weeks ago." "And when did you say you started having those symptoms?" "Uh ... about ... let me think ... it was — two weeks ago." This kind of circumstance is my holy grail. It is the ultimate moment where I connect the dots. It has happened several times recently where patients have had chronic symptoms and have related to me that they have ...

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More than a decade ago, the job of the pharmaceutical rep was enviable. Direct-to-consumer advertising pre-sold many drugs so doctors already knew about them. Medical offices welcomed the reps who were usually physically attractive and brought lunch. In fact, reps sometimes had their own reception rooms in medical offices. By 2011 thanks to drug safety scandals and new methods of marketing, the bloom had fallen off the pharma reps’ roses. ...

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Most doctors are very bright people. I believe that what often sets apart those who perform well on the job and on exams isn't raw intelligence but rather the ability to learn effectively. In the MCAT and USMLE steps 1, 2, and 3, I did poorly and barely passed. In 2009, I took my family medicine in-training exam and fell below the minimum passing score. After taking almost five years away from residency ...

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Over 1 million virtual doctor visits were reported in 2015. Telehealth companies have long asserted that increased access to physicians via video or phone conferencing saves money by reducing office visits and Emergency Department care. But a new study calls this cost savings into question. Increased convenience can increase utilization, which may improve access, but not reduce costs. The study has some obvious limitations. First of all, ...

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Before I started my residency program at Boston Medical Center (BMC), I had no idea that residents were unionized at 60 hospitals across the country. I actually didn’t know much about unions or the labor movement until I got involved in contract negotiations between my own union, the Committee of Interns and Residents (CIR), and Boston Medical Center administration. Through this process, I now know what it is like to ...

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Recently, I heard from a student in her third year of medical school. To date, she has borrowed more than $100,000 to fund her education. She is in the top 10% of her class, with honors in all of her subjects and high scores on her national exams. She would be a valued resident in the most competitive specialty training programs. Her goal is to become a primary care physician ...

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The toddler was a curious, rambunctious, talkative three-year-old who loved to explore. Every week, he’d wait for Sunday to come, because Sunday was he and his dad’s special day. Mikey and his father adored each other. Whether Mikey and his dad were doing “horseback rides,” playing basketball, or just sitting on the rocking chair for story time, whenever they were together there was fun, love and a forever bond. Mom called them “the ...

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asco-logo One of the nurses knocked on my door on a quiet Monday morning. “Hey, can you see this patient? I guess it’s not urgent but he’s here now, and I think what the doctor told him just threw him for a loop.” Of course I had time. In my role as clinical nurse specialist in a busy uro-oncology unit, I see men who ...

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So there I was — in deep denial. Maybe you’ve been there: Ignoring the symptoms. Hoping and praying that it would just “go away.” A little knowledge is a dangerous thing. And as a doctor, I like to think I can Google with the best of them. So when I had a persistent scary symptom (full disclosure: it was bloody discharge from my left breast. Not subtle. Not intermittent. Not OK, even ...

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There is an interesting article from ProPublica called “When Evidence Says No, but Doctors say Yes" making the rounds. It's about the number of doctors who disbelieve, don’t know or don’t care about medical evidence to the detriment of patients. I do not find any fault with the article. I rail against this daily. I have my whole professional life. It is actually a big reason ...

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4.9 million — yes, million — people are diagnosed with skin cancer every year in the United States. It costs an estimated $8.1 billion —with a “B — to treat those skin cancers, according to the Centers for Disease Control (CDC). Do I have your attention? I hope so. The problem is we don’t have enough attention. There is no other way to ...

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