The day after the 2016 election I went to work, and from medicine, I better understood the outcome of the election and the next goal of America. Driving into the hospital, I called the ICU of an acute rehabilitation hospital to check on a patient. He had sepsis from a very complex urinary tract infection which exacerbated his chronic hypotension. He already had renal failure on dialysis and was on chronic ...

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“It won’t be the last sacrifice you make for medicine.” These were the words my surgical intern said between yawns as I expressed regret at having to miss a distant cousin’s wedding. The digital wall-clock read a blurry 3:15 a.m. as we sat together in the on-call room, the coffeemaker dripping black gold into the pot. She had three pagers affixed to her scrub pants which would beep intermittently in turn, signaling anything ...

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I made it through the rigors of pre-med. I made it through (almost all of) med school, with a few scars to show for it. And now that I’m a big, bad MS4, I finally have the time and the distance to reflect on all the literal blood, sweat, and tears it took to get here. I am a loud and proud Duke Blue Devil. It was my dream school despite ...

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Guess what America?  If you pay for health insurance, you’re giving billions upon billions to health insurance CEOs, hospital administrators, pharmaceutical company CEOs.  So, if you’re obeying the law, you’re contributing to their astronomical salaries. In fact, Cigna’s CEO made around $49 million this past year, if you read the various reports on the Internet.  The CEO at a non-profit hospital in New Jersey (Morristown Medical Center) made some $5 million ...

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Dear future doctor, Please remember. Remember what it feels like to be a patient. Remember the pain, remember the anguish of the unknown, remember the detours of being referred from one physician to the next, and how you hoped that this doctor would  finally be able to diagnose you and empathize with your suffering. Remember the agony of not knowing what caused the mysterious, writhing pain; however, at the same time being ...

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A 67-year-old patient, whom I'll call Herb, recently came to see me for a check-up for his diabetes. He has suffered from complications from diabetes in the past, and his most recent numbers -- including his A1c -- were poor. I sat down to talk with Herb, but before I could say anything, he got straight to the point. Herb lives on a fixed income. Although he has Medicare coverage, his ...

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Cleveland took a major economic hit a few years back when United Airlines cut most of its flights from our city. An airport is the heart of a metropolis. Lack of direct flights means that business meetings, leisure travel, conventions and trade shows will likely opt for more convenient locales. This was a business decision for United which I am sure was rational. Nevertheless, their gain was our loss. As a ...

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I dreaded Mr. L’s office visits. His mouth half vacant of teeth and his clothes reeking of hand-rolled cigarettes, he regularly demanded medicines he didn’t need. He was pushy and thankless. I frequently declined his requests. He stuck with me anyway. Over the years he grew in orneriness. Divorced, childless, and unemployed, he declared one day that he was tired of living. He was reasonably healthy. He disavowed depression. Would I ...

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Guns and gun control are divisive topics. Talking about them often ends in frustration and both parties walk away feeling unheard. A not-so-debatable point, however, is that there are over 30,000 gun deaths per year in the United States. About 80,000 people are non-fatally injured. Gun violence in this country is a public health crisis. This public health issue is caught up in political fervor, often being controlled by politicians ...

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Over the past month, I’ve slowly rediscovered my love for writing. Though I have never considered myself a strong writer, I have fond memories of it providing an outlet for my thoughts. The history essays that everyone dreaded writing in high school were some of my favorite assignments. I spent days wording and rewording my sentences while my classmates wrote them quickly the night before they were due. It felt ...

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Spend time talking with non-medical friends and acquaintances. Ask them about their medical experiences. Imagine what they want, or ask them what they want. People want to feel that their physician has spent adequate time talking, examining and explaining. They want to look into the physician’s eyes. They want the best possible care, but caring matters. Our “system” discourages such care implicitly. Physicians do not get paid to spend time with patients. ...

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In a recent PBS interview, Mayo Clinic CEO Dr. John Noseworthy suggested patients should “change physicians” when faced with non-empathetic doctors suffering from burnout.  His cavalier resolution to our occupational struggle feels like a betrayal, to both his esteemed colleagues across the country and our profession.  In my opinion, firing your physician is a risky proposition in light of the looming physician shortage. Burnout is an overwhelming sense of ...

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After finishing three years in medical school, I recently moved over to Stanford’s Graduate School of Business. I decided to pursue an MBA in addition to my MD and will graduate two years from now with both degrees. I’m not alone. There are 11 MD/MBA candidates in my business school class, including nine from Stanford. Our cohort is part of a small but growing trend towards doctors obtaining business training. The ...

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Codeine is a terrible choice for treating children’s pain and cough, and we ought to just stop using it. It’s like an old yogurt container, way at the back of your fridge -- sure, it was once tasty, and then for a while, you held on to it for sentimental reasons. “Remember that yogurt?” you’d say to your spouse. But it’s well past time to throw that stinky stuff away. For ...

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According to recent research, a hug a day could keep the doctor away. According to another study, Twitter can predict the chance that people will experience heart attacks. A normal blogger would look at these two findings and tell a story about the relationship between stress and health. I’m not normal. I looked at these two studies and came to a different conclusion -- that we ...

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“Listen, when I was your age, I did the same thing …” The words came out of my mouth too fast for my frontal cortex to weigh them or to monitor, let alone modulate, the intensity of my delivery. He was a relatively new patient, 17 years old, scheduled for a well-child exam. A tall, athletic young man, he was alone in the exam room. His right arm was in a sling. “What ...

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"If my father dies, you're going down with him." The words pierced the air, and suddenly there was silence. I hadn't noticed Frank’s son at first. He'd been pacing in the back of the family group gathered in our ICU waiting room. Now, up close, I could appreciate how large and intimidating he was. And I'd just had the thankless job of telling him, along with the rest of his family, a ...

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I have written before about predictions of the actual costs of Obamacare and the probable death spiral of increasing costs and decreasing participants. Several recent reports have brought more clarity to the cost realities. Recently regulators across the country approved rate hike requests by Obamacare insurance companies even greater than they originally asked for. For example, Pennsylvania regulators approved rate hikes of 33 percent, which was ...

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asco-logo Milly* was 82 years old and had been diagnosed with a recurrent ovarian stromal tumor — one that is typically seen in much younger women. Surgery was ruled out, and a colleague from outside of Boston sent Milly to me for an opinion about medical treatment. I reviewed her case before I met her: no significant medical problems, ...

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asco-logo My background in nursing has given me a perspective that many physicians don’t have. From the beginning of my career, I have valued the information that patients have provided me about the context of their lives, family, work, and beliefs. I have never cared for a knee or a prostate, but rather I have cared for a person whose life experiences ...

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