They said, "Do everything." She knew something was wrong. And by the time she was 85 she had forgotten the names of her children, the town she raised them in, even the name of her deceased husband. In her 70s she was diagnosed with Alzheimer's. Still coherent, she talked to her physician about becoming a DNR: do not resuscitate. She did not want to live on a machine that would breathe ...

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CMS announced that they will remove questions related to pain from the hospital consumer assessment of health care providers and systems (HCAHPS), commonly known as patient satisfaction survey.  This means that hospitals would continue to use the questions to survey patients about their inpatient pain management experience, but these questions would not affect the level of payment hospitals receive. This is a big victory for patients and the house of medicine. Here ...

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There’s no doubt physicians entering practice today leave their residency programs with a tremendous amount of medical education and training; what seems like a lifetime’s worth of knowledge crammed into just a few, intense years of instruction. Unfortunately, all the time residents spend on rotations, lecture, journal club, and myriad other obligations leaves little opportunity for getting oriented to the more mundane, yet absolutely critical components of practice. As a result, ...

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Did you know that the majority of medical schools only interview about 15 to 20 percent of the applicants that submit an application to that school? Albert Einstein College of Medicine, for instance, had 8,138 people apply for entrance. 1,324 were interviewed. That's only 16.27 percent of the applicants. If you have an interview, that means that the medical school likes you well enough to give you one of their coveted ...

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Recent events seem to be signaling an increasing sentiment toward hitting the metaphorical “pause button” on immigration or perhaps even adopting more anti-immigrant postures in the US and in many other places around the world. The Supreme Court of the United States (SCOTUS) issued its deadlocked non-decision in United States v. Texas, No. 15-674 which will prevent Deferred Action for Parents of Americans and Lawful Permanent Residents or DAPA from ...

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If you want to understand what ails the U.S. health care system, look no farther than the dialysis industry. A recent New York Times article, "UnitedHealthcare Sues Dialysis Chain Over Billing," provides a pre-made case study. In brief, a chain of dialysis clinics, American Renal Associates, pushed poor people out of government coverage and into private insurance with UnitedHealthcare so that the clinics could bill $4,000 per treatment rather than $200. A ...

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Ms. C was one of my first patients with schizophrenia. I saw her on the inpatient unit of a psychiatric hospital where I was training as a psychiatry resident. Ms. C suffered terribly from what we call the negative symptoms of schizophrenia; she sat mute for much of the day in her bed, staring out of the window. She would occasionally respond to a question with a one-word response, but ...

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Once upon a time long, long ago there lived a man who could see things that other people simply could not see. He was not born with this skill but cultivated it slowly and continuously with years of focused attention. He worked as a physician in a large hospital and would sometimes have students go with him to see patients. As far as the students were concerned, he could really see ...

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It is too easy to lose your way as a physician when faced with the daily stress of real medicine. Spending time with the next generation of physicians gives me faith that we will always have a few doctors who stand out as not just competent, but caring healers. My son is currently a surgical resident. After the break, is a letter I wrote to him when he was an intern. A ...

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The chief medical officer for Press Ganey Associates, Dr. Thomas Lee, recently posted a blog article in the New England Journal of Medicine, "The Pain That Results From Pain Management." It is no surprise that Dr. Lee takes a stand in defense of patient satisfaction surveys. His company is one of the leading companies in the medical survey industry. With the emphasis placed on the opioid epidemic ...

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Say the words, "drug addiction," and most of us think of heroin, alcohol, cocaine, or opiates. However, lurking in the shadows is a less talked about epidemic: addiction to benzodiazepines, commonly known as "benzos." I should know because after taking a nighttime dose of lorazepam (Ativan) for about ten years; I finally weaned myself off this and all other prescription sleep medications. About twelve years ago, my father died and then ...

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A letter to my nephew, who is just starting residency. There will be days ahead when patients will bring you their most prized and flawed possessions -- their broken bodies, their flagging spirits, their waning hope.  They will wonder: "Can I get back to my loved ones, my life, my dreams?  Will you help me? Do you care?" You will not have all the answers, though you will have read a forest ...

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A few months ago, I was on my general surgery rotation on the colorectal service as a medical student. It was in the late afternoon that we started a case of a robotic rectopexy to repair a rectal prolapse. Our patient was a kind and warm 89-year-old woman. The operation finished without a hitch. As we undocked the da Vinci machine, the resident and I began to suture closed the multiple ...

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Treating pain is a notoriously tricky business. But it’s even harder if the medications on which we rely are inappropriately marketed. Last month, a Los Angeles Times investigation of Purdue Pharma asserted that for years, the company falsely elevated the efficacy of its twice-daily OxyContin, a powerful opioid pain reliever. The Times’ review of evidence -- including three decades of court cases, investigations, patient and sales rep ...

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asco-logo Most times, I feel excited to be an oncologist. Oncology research is accelerating and every week brings more news, whether it be a deeper understanding of tumor genomics, a broader understanding of cancer genetics and risk, and, it seems, more ways to provide precision therapy. Studies are coming out showing gains in survival in many different cancers, and ...

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The question, asked to me by a new first-year medical student, seemed simple enough: “There are a lot of different types of reflex hammers out there -- which one should I buy?” As with so many things in medicine, however, I knew that my answer wouldn’t be so straightforward. As I prepared to answer, I flashed back to one of my first days in medical school, when one of my clinical ...

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The term “old school” in many facets of life has negative connotations. We live in a modern, technologically advanced and fast-paced world -- and there’s no room for certain people who appear to hold us back. Last year I wrote an article about an experience I had with an “old school” physician. That experience really caused me to reflect on the situation the medical profession finds itself in, and ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A ...

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As I sat next to her bed in the intensive care unit, I wondered if she knew that today was her last day when she woke up this morning. I didn’t think she knew that it was her last day now. I was sure that she knew that something was wrong but did she know that she’d be dead in a few hours? One of the most profound things about being a ...

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I make my way down the aisle of the plane, squeezing past my fellow passengers and plop down in my assigned seat.  Sitting next to me is a middle-aged woman with a kind smile. As the plane takes off, she begins making small talk: ”What do you do?” I silently debate, do I adopt my travel persona or answer truthfully?  Answering honestly will result in one of two things; either we ...

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