It takes its toll on me, being a doctor.
I think as I wait in the Indian restaurant buffet. My son is curled on my lap. Uncharacteristically tired. Later he will develop a fever and I will realize why he is so warn out.
It takes it toll on me. I wouldn’t say I am a stressed out person but I certainly live with stress. Most of it is self inflicted.
It’s …
There seems to be an inverse relationship between the amount of spin one hears about “the next big thing” and reality. First it was EMRs and virtual e-visits, then social media, and now patient portals seem poised to be next big thing. The drumbeat of vendors and pundits is unmistakable: physician that don’t adapt will be toast. It can all sound pretty convincing until you ask to see the evidence. …
Joe Frisch is a staff scientist at the SLAC National Accelerator Laboratory at Stanford University. Dr. Frisch writes: “I wonder when we will start seeing really addictive games banned? I don’t know what makes games addictive though. Angry birds is a mystery to me – there is no ongoing story line, you don’t really gain any abilities as the game …
Over the last two weeks, I have been engaged in an email discussion with a young woman who is trying to decide where to attend medical school. I shall call her Ms. X.
Ms. X has been accepted to numerous schools and has narrowed her options to two: School 1 is a private school in Boston (not Harvard), and school 2 is a public school in suburban New York City …
Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too.
Turns out that there are two decent published studies from reputable places that report that a person may rub a cream on their skin over the fat spots and make the fat go away.
Wow, what a deal.
The first study addresses fat thighs, with each …
We all know that outdoor aerobic exercises like running and biking are good for your health. But during the hottest days of summer, it’s not just excess heat we have to worry about, but smog, the concentrated air pollution you can often see hovering over the cityscape. During the hot summer months, smog can become a serious health problem in the Boston area. We are often downwind from the Midwest’s …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 76-year-old woman is reevaluated after results of thyroid function tests performed 2 weeks ago are abnormal. The patient otherwise feels well. She has a history of hypertension, atrial fibrillation, gastroesophageal reflux disease, and depression. Current medications are metoprolol, amiodarone, warfarin, omeprazole, and sertraline.
On physical examination, …
The scene was picture perfect, an absolute characterization of a tropical island paradise. White deserted beach, overhanging palm trees, crystal clear, gentle lapping waters, and a blood red sun sinking slowly into a Fijian ocean.
I found no pleasure in it. Perhaps it was the heat, or that my new wife and I had been travelling for six months? Or that we had been on many other tropical islands and amazing places in …
Recently a good friend asked me to recommend an excellent primary care physician in New York City. When no one immediately came to mind, I asked a couple of doctor-friends who trained in New York. One friend, a cardiologist, gave me two names—one was a rheumatologist, who also practices general medicine, and the other an infectious disease doctor by training. My initial reaction to my cardiologist friend’s suggestion that …
When you and your gynecologist have decided on hysterectomy as the treatment of choice for your gynecologic diagnosis, there are several routes by which a hysterectomy may be accomplished. A total hysterectomy is the surgical removal of the uterus, and when indicated, the additional removal of the fallopian tubes and ovaries (termed salpingoophorectomy) may be recommended.
There are several routes by which a hysterectomy can be performed. You and your gynecologist …
One of my readers astutely pointed out in the comments section of my blog that “nurses will make your life a living hell” if you treat them badly. Some will make your life a living hell, no matter what. As in every profession, there are nurses with a chip on the shoulder, as well as those who are simply counting down to retirement. But for the most part, nurses …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 33-year-old man is evaluated because of the recent appearance of stretch marks in his groin that extend to his thighs. He has a history of long-standing psoriasis that at times has involved much of his body, including his intertriginous areas. His topical treatments include tar-containing …
Do you cringe when you hear the phrase “office meeting”? Some medical practices meet too frequently and some seldom meet, but others have it just right – routine meetings with preparation, an agenda, and follow-up. Your practice can get it right, too.
And make no mistake, meetings are important. Medical practices, regardless of size, have a variety of positions that are not interchangeable, but do interact throughout the day.
To make …
Most psychiatrists and primary care physicians who work in corrections long enough will end up being named in a lawsuit or having a complaint filed against them with their licensing board. So, from a risk-management standpoint, is it worth the potential hassle?
Yes, in most cases I think it is.
It is a fact that physicians who treat inmates are at greater risk of litigation. I don’t have specific figures to give …
One of the skills I really wanted to learn in med school was how to suture. It’s just one of those things that I felt like you’re supposed to know if you’re a doctor. How can you be a doctor if you don’t know how to suture?Anyway, by fourth year of med school, I had totally failed at my goal. I had already done a surgery rotation, but while …
Consider the explosion in the rate of C-sections and inductions. They satisfy the requirements of assurance behavior.
Reducing adverse outcomes? Check.
Deterring medical malpractice claims? Check.
Pre-empting liability? Check.
Consider the precipitous decline in the rate of VBAC. That’s avoidance behavior: malpractice insurers have forced providers and hospitals to refuse to participate in VBACs.
There’s an important subtext that undergirds defensive medicine that often goes unrecognized and therefore unanalyzed. Defensive medicine is driven …
There is no “right” answer to the healthcare reform issue. There are facts, opinions, myths, politics and reality, all in no particular order of magnitude. Unfortunately, thus far and likely in the future, the reform will be political and thus costly and painful and will not address the core issues involved in fixing the inherent systemic problems.
There have been many things written with regard to this topic and I …
Perhaps you’ve heard the news: psychiatrists no longer have time to listen to their patients. It’s all about writing prescriptions for medications and the days of “tell me about your mother” are long gone, or so we’re told. The current perception is that large volume practices where patients are seen in a matter of minutes are now standard and acceptable in psychiatry; that it’s how many — if not …
Sometimes you just don’t want to be right. Over the past 5 years, I have seen an alarming pattern arise in my profession. Many of my patients have heard me talk about Soylent Green, an old Charleton Heston movie. The premise of the movie seems absurd. Can you imagine the government of the United States providing for all the needs of its people including healthcare, food, clothing, and even death?
David …
Health care is a team sport, and one of the most important members is the office receptionist.
Receptionists are often the first people patients see when the visit the clinic. And those first impressions count.
In a recent piece from the New York Times, Pauline Chen notes a study of the responsibilities of the medical receptionist, and finds they impact …
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