Physicians today are increasingly viewed and treated as skilled workers instead of professionals. The difference is fundamental and lies at the root of today’s epidemic of physician burnout. Historically, there have been three learned professions: law, medicine, and theology. These were occupations associated with extensive learning, regulation by associations of their peers, and adherence to strong ethical principles, providing objective counsel and service for others. Learned professionals have, over many centuries, worked ...

Read more...

Hope is a tricky thing. On the one hand, false hope can lead patients to opt for painful, futile treatments at the end of life. On the other, unnecessarily bleak outlooks can lead to depression and inaction. When health is at stake, presenting information with the right amount of hope can guide patients away from both suffering needlessly and/or succumbing to treatable disease. I was reading a sad story ...

Read more...

This question has been circulating in the academic medical world for years. As an intern and resident, I would hear complaints about how "unready" they seemed. The grievances often include adjectives like ill-prepared, lazy,  or uninterested.  The complaints have burgeoned over time, and the examples are numerous in my institution: Students show up late to rounds with coffee in their hands; one med student had the gall to go directly to the attending and ...

Read more...

A nudge is a form of social engineering to make better choices. In the world of patient safety and medical decisions, it shares some of the concepts of  human factors engineering. Richard Thaler and Cass Sustein may be the world’s authority on the nudge concept, and have a great book by the same name. Nudges help people to choose their own best decisions by making the easiest, laziest choices -- the defaults -- ...

Read more...

It is exactly 49 steps from my bedroom to my garage.  It is a 23-mile drive to the hospital and 75 steps to the unit.  It takes 10 seconds to walk to the nursing station.  I can measure what it takes to get me to work each morning with absolute certainty.  I know because I have measured it a million times hoping something will prevent me from reaching my destination.  ...

Read more...

I order pregnancy tests on men. In fact, I do it pretty frequently. Now before you go and question my professional competency, let me assure you that I went to a good medical school. I also completed a four-year residency in emergency medicine at a top-notch residency program. I was board-certified less than one year after finishing and have maintained that status ever since. Despite this, I still order pregnancy tests on men. Perhaps ...

Read more...

Sometimes, it’s difficult to recall that single defining moment or person that sends you on the path you’re meant to take in life. I was fortunate in that I found that experience halfway through my undergraduate career at the University of California, Davis. I had recently lost my grandmother; although I’d wanted to help, all I’d been able to do at the hospital was translate for her. That overwhelming sense ...

Read more...

The observation versus inpatient distinction is rightly getting more media and public attention with each passing month. In a nutshell, for anyone reading who is not familiar with what this is all about, it’s essentially a way of categorizing people when they get admitted to hospital. You are either deemed an inpatient (basically a more complex case) or an observation (a less serious case). The individual reasons and checkboxes that have ...

Read more...

It makes me crazy when I hear things like, “Doctors are to blame for burnout. They need to just be tougher.” Are people really serious? This is like comparing us to people who are eating super-sized fast food meals daily, while complaining about their jeans being too tight. Not the same. Some will say that burnout is a given and just goes with the territory. Many debate whether this is something that needs to ...

Read more...

An anonymous medical student has this post on KevinMD -- A star medical student feels like he made a terrible decision:

And so, medical students learn quickly how to play this game. We enter noble. We leave jaded. We leave seeing that the smart move is to get out of it. And so the smartest of the smartest, the ones lucky enough to have a choice, go into fields where ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old woman returns for a follow-up visit for management of type 1 diabetes mellitus. She reports doing well since the last visit. Overall, she believes that most of her blood glucose levels are at goal, but is concerned about occasional episodes of hyperglycemia occurring in the morning before breakfast. She eats ...

Read more...

There’s been a push lately for more explicit labeling of foods -- to make sure that consumers know that what they’re buying is organic, or free-range, or natural, or GMO-free, etc. But these labels don’t tell the whole story. Sometimes, they’re outright lies. For instance, “organic” veggies still contain plenty of pesticides. There are the natural pesticides that ordinarily occur in food, plus the organic-OK chemical pesticides that are ...

Read more...

Joe had one of the best geriatricians in the city.  So when he got a call from the pharmacist saying his new prescription was ready, he assumed that it had to do with his recent annual visit and blood draw. His suspicions were confirmed, a few minutes later, when he got through to the nurse at the office. Joe was politely informed that he had high cholesterol and was being put ...

Read more...

I saw a patient last week for her chest pain. A 60-year-old woman came into the hospital because her chest tightened every time she went running. The pain would last about 20 minutes, centered on the left side of her chest, and radiated to her left arm. It lasted until she would finally take a break from running and sit down. “This is classic,” I thought. “Stable angina.” I could now ...

Read more...

Please turn on your ringer, you might get an important call! From your case worker. Your housing coordinator. From WIC. A question about your SNAP or TANF or immigration papers or medical application. A potential client for your taxi business. Your boss telling you a shift is available. It could be something important. So please answer your phone! All of these callers work from 9 to 5, with a lunch break, so ...

Read more...

An excerpt from Wishes To Die For: A Caregiver's Guide to Advance Care Directives. The great poet Rumi ascribes, “I should be suspicious of what I want.” Like many others, as I become older I look forward to Medicare paying for health care expenses. Being enrolled in Medicare makes health care available, ...

Read more...

A 42-year-old patient arrived for her annual gynecologist appointment complaining of a self-detected breast lump. She had several questions about her condition and wanted to tell her doctor about a family history of breast cancer.  The doctor was in a hurry and advised her to ask the staff, but the staff was busy with other patients and told her to call them later. The patient did not call. The gynecologist ordered ...

Read more...

You may be aware of Ezekiel Stephan, a 19-month-old boy, who died in 2012, after his parents chose home remedies and naturopathy for the treatment of viral meningitis. The parents currently are on trial in Canada for failing to provide the necessities of life. Over the course of many days, Ezekiel's condition rapidly deteriorated, but his parents chose to "give him as much natural product as possible," including syrup, frozen ...

Read more...

Over the past week, while covering the inpatient gastroenterology service, we cared for three patients who were hospitalized with gastrointestinal bleeding who were found to have large, potentially life-threating, stomach ulcers. All three of the patients had abruptly stopped their acid-suppressing proton pump inhibitor (PPI) medication in the preceding 1 to 2 weeks.  With PPIs being a primary therapy for gastroesophageal reflux and ulcer treatment, why would these patients have ...

Read more...

Pamela Wible, M.D., takes on physician suicide in her TEDMED talk (delivered on November 18, 2015). Learn more about Dr. Wible and her talk at TEDMED.com. Full transcription below: I love the three things that people fear the most: death, disease, and public speaking. Here’s how it all started. At four, I was so talkative (and bossy) no babysitter would stay with me. So I tagged along with Mom, ...

Read more...

Most Popular