“Doctor, what do you think of alternative medicine?” a patient with chronic fatigue syndrome asked me the other day. She was interested in doing something more for her severe fatigue. “Would acupuncture help me?” I paused and, as I have done many times before, answered that my training and most of my clinical experience has been in Western, allopathic medicine. (Ironically, the word “allopathic” was first used as a derogatory term ...

Read more...

If a doctor doesn’t do excess testing, he isn’t going to be able to live An excerpt from Doctored: The Disillusionment of an American Physician. After the blowup with Rajiv, I committed myself to changing my standoffish ways. Rajiv had been urging me for some time to meet socially with his physician friends in a relaxed atmosphere away from the hospital, and so there I was a few weeks later at a doctors’ party in Manhasset, a tony ...

Read more...

As I begin another year teaching EKGs to our new residents, I find I am increasingly asking myself, "Where to teach?" I do not mean to imply a geographic sense to the word "where" (although this is difficult, too, as residents move from hospital to hospital in large health care systems like ours as they change rotations), but rather as more of a "level." What level do I teach our residents ...

Read more...

My brother and I, both optometrists, had a heart-to-heart discussion about the loss of one of our patients. We discovered he was not taking his medications as prescribed, which was leading to vision loss. When pressed, the patient said he had a choice of eating, supporting his family, or purchasing his medication. He was under the impression that the $150 price for his generic Lipitor was “about the same” at any ...

Read more...

MedPage Today recently tackled a very controversial issue in medical practice.  The piece explored the ongoing battle between dermatologists and allied health professionals (AHPs) over the performance of dermatologic procedures.  As independent NPs and PAs begin to bill for more and more procedures (thus potentially talking revenue away from board certified dermatologists) specialists are beginning to argue that the AHPs are practicing beyond their scope of practice. According to the 
Read more...

He left a little early to stop by the cath lab to see his patient before her procedure.  Cordial "hellos," "good mornings," and "any last questions?" were mentioned before she signed her consent.  The team was working feverishly to prepare her for her procedure.  "Have you met the anesthesiologist yet?" was next, and almost on cue, the anesthesiologist arrived and took over for a bit. He hurried upstairs to the conference ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old man is evaluated during a medical examination for health insurance. The patient is a weight lifter. He has no medical problems and takes no medications or illicit drugs. On physical examination, blood pressure is 128/73 mm Hg, pulse rate is 56/min, and respiration rate is 16/min; BMI is 30. Increased skeletal ...

Read more...

"Dad, you have the nicest patients!" She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what's important in medicine.  In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives. It had been over ten years since I had my first "bring your daughter to work" experience.  Her first time ...

Read more...

Chest pain and what we can learn from changing flat tires “Daddy, I think we have a flat tire.” I just rolled out of the garage with my 4th grade daughter. It was Tuesday morning. Usual daily routine. Drop her off at school then go to work. A little different today as I was to lead an important meeting. How could she possibly know what a flat tire sounds like? Now? Right now? She’s ...

Read more...

No medical resident looks forward to working night float. The initial glamour of doing chest compressions in the rising light comes up against a litany of administrative tasks. As the glamour wanes, the gulf between the objective curriculum and actual practice widens. On paper, residents learn how to manage acute emergencies and learn deeper clinical reasoning. Actual practice, or the “hidden curriculum” of training, can be a different experience, involving ...

Read more...