The notion that dying is a right seems nonsensical to argue: death is given to all of us equally without the need of anyone’s sanction. The right to die well, on the other hand—well, that’s another matter entirely. A good death is, in many cases, something our fellow human beings have great power to grant or deny, and is therefore, sadly, a right for which we must indeed fight.The ...
Alex Lickerman, MD
How early closure can cause doctors to misdiagnose
I had a patient once—a fellow physician—who came to see me complaining of mid-back pain. When I examined him, I found I could reproduce his pain by pressing firmly on the spot he said was hurting him. He said pressing there also made the pain radiate around to his stomach, a phenomenon known as “referred pain” that meant his pain was almost certainly caused by a trigger point. I ...
Why doctors can’t screen patients for every disease
I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion). I argued vociferously against it. However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway. To our surprise and dismay, it came ...
Alternative medicine problems patients need to know about
Americans spend an astounding 34 billion dollars on alternative medicine annually. Given that so many of us put our faith in alternative care, I wanted to clear up some common misconceptions about it to help people make wiser choices when and if they turn to it.What is alternative medicine? In general, alternative medicine is used to describe practices outside the bounds of conventional medicine. ...
Doctors play a role in helping people through transitions with rituals
When I was an intern in internal medicine, I admitted a patient to my service with pancreatic cancer.Pancreatic cancer is a bad one; back then, only ten percent of patients with it would be alive within five years after being diagnosed. My patient was a farmer in the full bloom of late middle-age health when he began rapidly losing weight. An abdominal CT scan ordered by his primary care physician ...
First aid rules that everyone needs to know
First aid is defined as the immediate care given to an acutely injured or ill person. It can literally be life-saving so it behooves all of us to know some basic principles.What follows are some rules that cover common conditions and general practices:
- Don’t panic. Panic clouds thinking and causes mistakes. When I was an intern and learning what to do when confronted with an unresponsive patient, a wise resident advised ...
Using denial to control a patient’s anxiety
A few years ago, a patient of mine was diagnosed with lung cancer. A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst. But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it. Due to scheduling issues, we couldn’t get it done for seven ...
Positive reinforcement can motivate preventive behaviors
Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult. It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life.Wouldn’t it be nice if the most pleasurable things ...
Costs of communication on email, Facebook and Twitter
Email, Twitter, Facebook, MySpace, YouTube, Delicious, Digg, LinkedIn, blogs (of course), and scores of others—all part of the new and wonderful ways we can now connect with one another electronically, each with its own culture and unique set of rules.In one sense, the planet has never been more interconnected. And yet, this interconnectedness, while wonderful, hasn’t come without cost.IsolationMuch has been written about the dangers of Internet addiction. From pornography ...
Difficult needs to be embraced in medicine
When I was a second-year medical student I remember thinking, after meeting with an attending physician in a physical diagnosis class, how impossible it seemed that my brain would ever contain as much medical knowledge as his.And even if somehow one day it did, how would I ever be able to call on it, manipulate it, twist it, bend it, and turn it upside down with the same apparent ease ...
6 reasons why people commit suicide
Though I’ve never lost a friend or family member to suicide, I have lost a patient.I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret makes for a bitter drink, the taste of which ...
Help doctors to best care for their patients
Part four of a series. See also parts one, two, and three.When dealing with your doctor's biases, you have on your side a fact I firmly believe to be true: most doctors want to do a good job and help their patients as best they can. So what exactly can you do to maximize your doctor's ability to help you?1. Position your symptoms and requests carefully. Don't demand medications ...
How doctors allow bias to affect patient care
Part three of a series. See also parts one and two.Previously, I have suggested that patients should do their best to get their doctors as free from the influences of their biases as possible. In order to do that, patients (and doctors) need to recognize what forces are working against them.Here's what negatively influences a doctor’s decision making:1. They fall behind in clinic. Your doctor may be naturally ...
What doctors do when they don’t know the answer
Part two of a series. See also part one.Previously I’d discussed how most of the time diagnoses are relatively straightforward. But what do doctors do when a diagnosis isn’t immediately clear to them?Likely one or more of the following:1. Revert to "novice" thinking. Which, in fact, is completely appropriate. We're taught in medical school that approximately 90% of all diagnoses are made from the history, so if we can't ...
When doctors can’t figure out what’s wrong with a patient
Part one of a series.The first patient I ever saw as a first year resident came in with a litany of complaints, not one of which I remember today except for one---he had headaches. The reason I remember he had headaches isn't because I spent so much time discussing them but rather the opposite: at the time I knew next to nothing about headaches and somehow managed to end the ...
