His eyes were as wide open as his mouth as he slowly placed his beer on the bar without looking away from me.  Making no effort to wipe the thick foam from his upper lip, the man continued to stare in disbelief, “That’s the coolest thing I’ve ever heard.” The thirty-something C-something-O was blown away by what I did for work.  By this time a small crowd had gathered, standing in ...

Read more...

1. Quit taking care of yourself. There is no upper limit to the needs of patients. There is always more medicine to learn and do. Add to this the needs of children, aging parents and a partner -- your time for yourself quickly becomes zero. Want to get burned out quickly? Quit exercising. Eat on the run. Have disrupted sleep. Don’t set professional boundaries. Miss enough first steps, parent’s medical ...

Read more...

This post is purposely controversial.  I write it because I believe that mounting evidence suggests that we should encourage “out of the box” thinking about this issue.  This post is hypothesis challenging.  I may be right, or I may be wrong.  I hope we get some debate on my speculations. The latest blow to the cholesterol hypothesis: "Dashing Hopes, Study Shows a Cholesterol Drug Had No Effect on Heart ...

Read more...

He had loved her with all his being for more than six decades. In the last two years of their 61-year marriage, he had watched helplessly as dementia wrapped its noose around her, slowly tightening its grip on her mind and pulling her away from him. When I met him, I knew the injury was irrecoverable. Her brain was consumed by hemorrhage that had filled the space (cerebral atrophy) left behind by progressive dementia ...

Read more...

Over the past few months, the federal government has mobilized against what is being called "the opioid crisis": a national epidemic of fatal overdoses that in 2014 claimed more than 14,000 lives, the most ever recorded. Since most of these opioids were originally prescribed by physicians to treat pain, the Centers for Disease Control and Prevention recently finalized a guideline containing recommendations for appropriate opioid ...

Read more...

A decade ago, electronic health records were aggressively promoted for a number of reasons.  Proponents claimed that they would facilitate the sharing of health information, reduce error rates in health care, increase health care efficiency, and lower costs. Enthusiasts included the technology companies, consultants, and IT specialists who stood to reap substantial financial rewards from a system-wide switch to electronic records. Even some health professionals shared in the enthusiasm.  Compared to the ...

Read more...

When I had my first baby, one of my friends coordinated a meal train where coworkers could sign up to bring our new family a dinner every other night. Those first few weeks of motherhood were such a chaotic blur that I do not even remember how many weeks this meal delivery went on for except to say that it was both long enough and over too quickly. There was ...

Read more...

Evidence-based medicine is at the heart of what we physicians do. It is the basis for professional decision-making, and a focus of most journal articles we read. Using solid evidence to practice good medicine has been a foundation of clinical practice for decades. There are consequences for failing to follow evidence-based guidelines. If patient harm results from straying from a more loosely defined “standard of care,” which tends to be evidence-based, ...

Read more...

Evolution is part of life, something we accept as a fact and evidenced by the changes we see and know compared to hundreds of years ago. No one can dispute the great technological advances that have been made; transport has been revolutionized from the animal power of horse and cart to the mechanized systems of train, plane and automobile we have today. Communication systems once reliant upon the written word and ...

Read more...

“One can dream.” That’s often a quote we hear when we talk about winning the lottery or landing a job that lets us do something great like being a taster of new ice cream flavors for a living (I wish). However, what’s sad is that many American moms utter those same words when they think about life after baby. A year of paid maternity leave. Access to a good lactation consultant. Family members who ...

Read more...

There you are in your father's arms. He is practically running to keep up with the triage nurse. The nurse is walking quickly toward the room that we leave open for true emergencies and the sickest patients. Your father's eyes are full of fear, and the nurse’s tone is worrisome. I look down at you all snuggled up to your father's chest. You are beautiful. So small and bright-eyed. You don't ...

Read more...

A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed ...

Read more...

I took a fantastic emergency medicine (EM) job when I finished residency.  There was no question in my mind that it was the best job within a hundred mile radius, maybe more.  When I first started, my expectations were met.  My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed.  The hospital was independent, ...

Read more...

Of life’s two certainties, death, and cataracts, it seems statins defer one and prompt the other, although not necessarily in the same person. If you blindly love life, you may be blinded by your love for life. In the HOPE-3 trial, ethnically diverse people without cardiovascular disease were randomized to 10 mg of rosuvastatin daily and placebo. The treatment group had fewer primary events: death from myocardial infarction (MI), non-fatal ...

Read more...

Whether big questions or small, medically related or otherwise, social media users love to take their ponderings and perplexities to their friends to gather advice. Certainly, social media is a great place to poll opinions about the latest movie or book. Sure, some might find asking friends for medical advice online easier than going to the doctor. Some might even feel that this collective problem solving protects them if they believe ...

Read more...

Today’s restless society has taken its toll on modern medicine. Among all the strategies for protocol optimization and health insurance improvements, doctors get to spend less and less time actually talking to their patients. Each check-up needs to be performed in a certain amount of time, and every procedure needs to be completed as quickly as possible so that hospitals are efficient and profitable. While this makes perfect financial sense, it ...

Read more...

I am about to place my plate in the sink, until I see a single pea left on my plate. I recall a recent article in National Geographic that stated that one-third of all the food we produce is wasted. I have a Zen moment, and think of the journey the pea made to reach my plate. A farmer in California sowed the seeds six months earlier. A farm worker harvested ...

Read more...

If you are a doctor, everywhere you hear or read about all that is wrong in medicine.  Please do not get me wrong, the medical profession is under assault.  Change is occurring all around us, and much of it has the potential to be disastrous to not only us and our families, but more importantly to our patients.  For many of us in the profession, we feel helpless.  We feel ...

Read more...

Fidgeting in my seat, I waited nervously in one of the most crowded waiting rooms I had ever been in. Suddenly, I felt like a bucket of ice water had been dumped down my back; my legal name was being called over the dozens of waiting room sniffles. My instinct was to remain glued to my seat, not to let anyone know that I was the person attached to that ...

Read more...

I learned that the 148-year-old community hospital that I did my residency at will be closing, and I am angry. Who am I angry at? Myself. Oh, and you. I’m angry at us because we as a country have turned our backs on one another. And in the end, your relationship with your own doctor is in jeopardy. Pawtucket, Rhode Island, home of Memorial Hospital, used to be a prosperous mill ...

Read more...

Most Popular