Every time there is a terrorist act or a mass murder, reporters start calling with questions on the psychiatric diagnosis of the perp. The default position seems to be that every religious extremist or political fanatic or mass murderer must be crazy. How else to account for their weird behavior? Naming a diagnosis somehow satisfies a deep human need to explain what otherwise seems an unexplainable act. But names can only ...

Read more...

Its time to tell fast medicine to slow down Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals ...

Read more...

Money has always been and will always be a big part of medicine Medicine is not about money, except when it is. When I was in my residency training, pharmaceutical reps still roamed the land. Vast herds of gorgeous young women in tight skirts and stilettos traveled through doctor's offices, clinics, hospitals and residencies all over creation. Their appearance was always a thing of joy, especially for sleepy, hungry physicians-in-training. Someone would run to the ...

Read more...

I just recently attended a meeting where there was a panel discussion on caring for Holocaust survivors. The person who opened the meeting spoke about how she felt inadequate when dealing with this population because she had no personal place of reference -- she had no family members who died during the Holocaust, and so she couldn’t truly understand what the survivors went through. I have a different thought. Although every experience ...

Read more...

Fall in love with medicine againFall in love with medicine again An excerpt from Remedy for Burnout: 7 Prescriptions Doctors Use to Find Meaning in Medicine. A doctor’s self-worth can be tied up with a lot of issues. How well can we make a diagnosis? How elegantly can we perform the surgery? How happy are our patients? Our staffs? Our families? How many articles ...

Read more...

The documentation I get from everyone is terrible.  Seldom does it tell me what I actually want to know, and if there is useful information it is buried in an avalanche of yada yada.  The main reason for this is that documentation is driven by our ridiculous payment system, which requires us to follow arcane rules to generate notes that justify the obscure codes we submit for money from the ...

Read more...

I am currently a pharmacy student, and although I have not yet dispensed a medication, I had my first experience concerning the cost of care a few months ago. My ear hurt very badly when I woke up in the morning, and being that I had to go to work later that evening, I decided to go to the local clinic in order to get my ear treated. The physician was ...

Read more...

While studying for my recertification exam as required by the American Board of Pediatrics, I came across this question:

 A 7-year-old girl is having difficulty establishing relationships with other children despite repeated opportunities to do so. The girl prefers to stay near her mother or her teacher and will avoid other children. She sometimes cries and can be difficult to calm down after being dropped off at school, so her mother frequently remains ...

Read more...

Another day, another pacemaker, at least so it seemed at first. The usual greeting the patient, answering the last questions, consent signing, placement of the IV, EKG leads, prepping of the surgical site and initiation of the preoperative antibiotics were all recent memories.  He laid there, smiling, knowing he'd made the right decision after years of struggling with his arrhythmia in other ways.  His heart was showing signs of slight weakening and ...

Read more...

5 ways to ease the integration of NPs and PAs I talk a lot with different physicians about integrating NP/PA providers into their practice.  I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians.  Many times a doctor will have a medical “horror story” with the NP/PA  playing  the  villain.  One bad encounter or event seems to  justify a complete rejection of the many positive ...

Read more...

Pamela sits on the examining-room stool, looking at me expectantly. I am in my first year of medical school. I do as I've been told to do in medical skills class: I observe my patient -- without judgment or assumptions -- and try to figure out what questions to ask, based on the information I am given. Pamela has curly, strawberry-blonde hair and looks to be thirty, just a few years older ...

Read more...

As people select health insurance during open enrollment, what many don’t realize is how the creation of the health insurance exchanges or health insurance marketplace via the Affordable Care Act (a.k.a. Obamacare) will ultimately result in Americans becoming less healthy and more insolvent. Let’s review the pros and cons. Although the Affordable Care Act provided important benefits of expanding and ensuring coverage with preventive benefits, insurability of all regardless of prior ...

Read more...

Glory days: Is a golden age of medicine on our doorstep? The practice of medicine is changing faster than anyone can keep pace with. As a hospital physician at a relatively early stage of my career, I’d say that a sizeable number of physicians that I work with are towards the latter end of the spectrum. I find that these doctors, typically over the age of 50, are struggling the most to keep ...

Read more...

Life is full of choices and each choice has the potential to open certain doors and close others. I choose medicine. It is a demanding career, but even as a 7th grader, I knew what I was signing up for. What I didn't know was how much this profession could influence the trajectory of my personal life and the types of relationships I’m able to maintain. I grew up genuinely thinking ...

Read more...

In the midst of a lumbar puncture: Thinking of Stevie Nicks Like most second-year medical students, I have the MP3 files of Goljan’s high yield pathology review lectures on my phone. Unlike most medical students, I rarely bring myself to listen to them, always opting for their Motown or punk counterparts instead. I often feel guilty about this -- listening to them would make for more efficient car rides and walks home -- ...

Read more...

My journey in the specialty of family medicine started in 2004 during my third year family medicine clerkship. I was assigned to an office located in the southwestern town of Yauco, Puerto Rico. The practice had two providers who saw patients of all ages. My family medicine attendings made me appreciate the way our specialty approaches patient care. We treat our patients taking into account their psychosocial framework and partner ...

Read more...

Medicine cannot be reduced to just a job. Heres why. A few months ago I was paged by a medical student in the emergency room at ten o'clock. I had just changed my clothes, and before my pager went off my attention had been squarely fixed on the newest Jack Reacher novel. You can usually tell when someone is going to ask you to come into the hospital from home, because there ...

Read more...

Brittany Maynard has passed from this life.  This brave but unfortunate 29-year-old woman with incurable progressive brain cancer drew public attention by choosing to go public with her choice about end of life care. "Brittany suffered increasingly frequent and longer seizures, severe head and neck pain, and stroke-like symptoms," according to a statement Sunday night from Sean Crowley, spokesman for Compassion & Choices, a national nonprofit working to expand end-of-life ...

Read more...

The highest rated doctors may not provide the best care A version of column was published in USA Today on September 14, 2014. The public can rate and review most things today: books, hotels, and restaurants, to name a few.  Even doctors.  There are more options than ever where patients can rate their doctors online, and hospitals also routinely survey patients about how satisfied they are with their physicians. But while you're pretty much ...

Read more...

Every physician is public and has an audience An excerpt from The Public Physician -- Practical Wisdom for Life in a Connected, Always-On World. What you do, where you live, and what you intentionally create as a physician in public should be determined by what you want to accomplish. What are you trying to get done? Perhaps you want to …

  • build a strong public presence to keep your ...

    Read more...

Most Popular