photoshoot-770x457 Have you ever had a professional photo shoot? I have had many, but not because I particularly enjoy being photographed. Actually, it is quite the contrary. Photo shoots have always been a traumatic experience for me. You see, for some reason, likely as a creative form of cruel parenting punishment, my family of five siblings had a photo taken every year while growing up. ...

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“Dr. Gunter, I think, uh, there’s a fetal skull in the abdomen,” my resident said with that hesitancy that says I want you to tell me I’m wrong. The first time you diagnose something that is very bad you actually hope you are mistaken and want someone more senior to reassure you that you are overreacting and tell you that this is just an odd presentation of something benign. “I’ll be ...

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asco-logo "Why did this happen to me?" That question is perhaps the most common one raised by patients facing a diagnosis of cancer for the first time. There are so many campaigns about how to “avoid” cancer: no white sugar, no chemicals, all-plant diets, regular exercise, don’t smoke, don’t drink. I can see how one can get the impression that if ...

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asco-logo One day in clinic, recently, I reviewed my daily schedule with the oncology fellows who were working with me that day. With the exception of the new patients on my schedule, I recognized all of the names on my list. I opened the electronic chart of the first patient to skim the problem list, a handy spot where I ...

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growth-in-administrators_opt I’m taking back medicine. If you didn’t know it left or that someone stole it, I’ll give you a pass. Medicine has been disguised for a long time now. And, when you leave the scene in camouflage, you often go unnoticed. Medicine is supposed to be the science or practice of diagnosing, treating, and preventing disease. I love medicine. There’s so much to learn. Lots ...

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Being a doctor is one of the most emotionally and physically demanding professions out there. The health care landscape may have changed a lot over the last decade, but the basic unavoidable grueling nature of medical practice has been the same for time immemorial. I remember reading a careers advice book when I was a teenager telling me just that being a doctor was “the most challenging of jobs,” and ...

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shutterstock_284306441 How do we measure a doctor? Hospital length of stay? Infection rate? Flu shot compliance? Waiting time? These reality surrogates do not tell us how a patient feels or the quality of life. They are complex to measure, require major data crunching and may not focus on an individual physician. This week, two patients reminded me of a basic screening tool for ...

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Fecal microbiota transplantation (FMT) is the process of administering a preparation of healthy donor stool to a patient with a certain disease, usually Clostridium difficile colitis, in an attempt to treat the disease.  I covered some of the basics about the microbiome and FMT in a previous article, so this will just be a cookbook-style post on how we do FMT with colonoscopy. First, a healthy donor must be identified.  The donor ...

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When it comes to physician wellness, I’m type A noncompliant. That realization struck me midway through my last vacation, which was notable because I didn’t travel anywhere, and the most extraordinary activity involved sleeping through the night. Shift work, especially overnight shifts, has a way of inflicting sneaky havoc upon the body and minds of the delusionally hearty. After twenty years as an emergency physician, I should know better ...

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shutterstock_159719039 This past March, thousands descended on Austin, TX, home to the famous and much celebrated South by Southwest (SXSW®) conferences and festivals. This year, I decided to attend the education-focused festival, SXSWedu®, a relatively new addition to the SXSW® family of events.  A four-day conference chocked with interactive workshops, panel sessions, and even play summits, SXSWedu® is designed to showcase the creativity ...

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One theme has gripped the collective conscience of the nation for the last year. One theme has connected Ferguson, Missouri, to Staten Island, New York, to Charleston, South Carolina. One theme has destroyed neighborhoods, incited riots, and terrorized churches. That theme is racism. Unfortunately, it’s also found a way into our health care system. Black and white In 2003, the Institute of Medicine (IOM) released a groundbreaking report stating African-American individuals ...

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Now we’re giving star ratings to hospitals? Does anyone think this is a good idea? Actually, I do. Hospital rating schemes have cropped up all over the place, and sorting out what’s important and what isn’t is difficult and time consuming. The Centers for Medicare & Medicaid Services (CMS) runs the best known and most comprehensive hospital rating website, Hospital Compare. But, unlike most “rating” systems, Hospital Compare ...

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Have you ever been a patient? Yeah, me too. Many newly insured Americans will visit doctors’ offices this year. The average time you -- or anyone -- has with a primary care provider is 15 minutes. What’s a sick person to do? Happier patients make happier doctors. Here’s a helpful list that I’ve developed to help patient visits go smoother: 1. Pick three questions or concerns that you have for your doctor and write ...

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Smitty greets Sully as they meet to head to work, “Hey there, Sully! How’s your wife?” Sully answers, “Oh, geez. She’s up in bed with laryngitis.” Then Smitty says, “Laryngitis?! That damned Greek!”
As you may have guessed, I am nursing a case of laryngitis, my voice muted and strained. This time, it has not stopped me from attending to my work responsibilities or other activities. It has required some adjustments though, ...

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shutterstock_208716340 Ever since Medicare started using patient satisfaction surveys in 2012 to calculate hospital reimbursements, the healthcare system has been looking to the hospitality industry to learn how to make patients enjoy their hospital stay. Hotels do have the answer, but hospitals are looking in all the wrong places. What hospitals are doing wrong The concept behind Medicare’s HCAHPS survey -- a short questionnaire asking ...

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Part of a series. Patients need doctors that take time to listen which means a limited number of patients under care. Employers need programs that reduce costs and ideally improve the health of their staff. These apparently disparate needs can come together in a new model for effective company-sponsored primary care programs. Those of you who have followed this series know that I am an advocate for PCPs finding ways to ...

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For years, and especially as he entered his nineties, my father kept begging me not to "dump" him into a nursing home. He had seen too many of his cronies abandoned in this way by family members; his visits with these friends left him feeling depressed and hopeless for days. I assured Dad that I'd never put him in a facility. It was an easy promise to make. I didn't want ...

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Throughout the course of a physician’s career, many patients come across the path with numerous complaints and medical conditions requiring interpretations and actions, respectively. In a field with little time to see everybody at length, pattern recognition becomes important to make efficient decisions with regards to patient care. Usually, it involves focusing on the patient’s condition exclusively, but at times, the social aspects of a patient come into play with ...

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maxresdefault Sir William Osler (1849-1919) is universally considered the father of modern medicine. “He belongs to medical students of all time, as Lincoln belongs to the common man everywhere.” - Wilder Penfield, eminent Canadian neurosurgeon, who met Osler while at Oxford “His energy, productivity, and humanity blossomed out of a deep vulnerability. Between the pages of his books, we can still encounter an Osler who is … ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his weight. Medical history is significant for prediabetes and elevated cholesterol levels. He smokes one or two cigars a week. He drinks one or two alcoholic beverages a few nights each week. He does not get ...

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