I can always use money. Regardless of what the public seems to think, doctors are generally not phenomenally wealthy.
So I hate turning business away. But tonight I refused a hospital consult. Why would I do that?
Because.
The consult was for an 88-year old lady with advanced Alzheimer’s Disease. Her sad life was reduced to lying in bed staring at the ceiling. The patient had been seen by 2 other neurologists during …
You are now out of the Gray Zone, and you are now a member of an exclusive club.
But membership to this club comes at a steep price. Membership is not offered, it is not dependent on your income, title nor your social status. Membership is granted simply by surviving or living with a grave or potentially fatal illness or injury and realizing just how fragile life is and how quickly …
I had been running late on another busy summer day. The type of day where you gain one step and lose two. Meetings and paperwork had filled up another summer morning. Baseball games, swimming practices, and soccer scrimmages had filled up another summer afternoon. And for this particular summer evening, I was scheduled to work an odd emergency room shift from eight p.m. to four a.m.
While driving to work, I …
by Keith Humphreys, PhD
When my friend Paul Costello left the Carter Administration, he wrote a funny New York Times article suggesting a special course for departing staffers:
There ought to be an “outward bound” course for White House employees facing exile. Must we face this cruel and unusual punishment cold turkey?
Maybe people were tougher back then – I personally would have collapsed five minutes into the first day of the …
by Brian McMichael, MD
The NEJM recently published an interesting case in the ongoing series: “ A Request for Retrieval of Oocytes from a 36-year old Woman with Anoxic Brain Injury.” Usually these cases are diagnostic dilemmas. This one focused on an ethical dilemma at end-of-life.
The Case
A 36-year-old woman, in overall good health taking oral contraceptive pills (OCPs), was on a prolonged international flight, and …
An excerpt from CyberSafe: Protecting and Empowering Digital Kids in the World of Texting, Gaming and Social Media.
by Gwenn Schurgin O’Keeffe, MD, FAAP
Screen Time and Childhood
Have you ever tried to go “screen-less”? I often tell the story of taking my girls to New York City on an April vacation, looking forward to Turnoff Week. This is a semiannual event that encourages families to flip off the screens …
October is breast cancer awareness month. There are pink ribbons and wristbands to wear, pink products to buy, and pink races to run — all to improve awareness about screening and raise money for a cure. And rightly so, because breast cancer affects 250,000 American women every year.
Fewer people know that October is also intimate partner violence awareness month. Purple is the color representing the more than 1.3 million women …
One of the most common complaints that I hear from people attempting to lose weight is, “I don’t know how to deal with my triggers.” Most of us have had the experience of eating just one bite of something and suddenly wanting to devour the entire thing. Sometimes we do, even though we know we won’t be happy with ourselves when we finish.
I am familiar with the experience of insisting …
There is a white board in every patient’s room. This is used to keep patient oriented and provide them with basic information. You would see some data on it, most of the time there is a date scrolled on it, name of the nurse and maybe physician’s name.
I recently read an article “Getting the most out the humble white board” by Deborrah Gesenway. This is an excellent read …
[Editor’s note: Please visit part 1 of Dr. Harpham’s take on OpenNotes.]
“Our” Chart
Does the opportunity for patients to read their medical charts help or hurt patients’ ability to become Healthy Survivors?
Open notes can facilitate Healthy Survivorship for some patients.
Unfortunately, other patients may learn something about their condition that makes it more difficult to get good care or live as fully as possible. Or they may experience feelings that threaten the physician-patient bond. …
POLST stands for “Physician Orders for Life-Sustaining Treatment”. It is a next generation replacement for an Advanced Directive and DNR (“Do Not Resuscitate”) order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting.
The …
I was a third-year medical student in the first week of my obstetrics rotation. The obstetrics program was known to be high-pressure, its residents among the best. Mostly women, they were a hard-core group–smart, efficient, motivated–and they scared the heck out of us medical students.
I remember the day clearly: Not only was I on call, but I was assigned to the chief resident’s team. I felt petrified.
We’d started morning rounds …
An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives.
by Rosalind D. Cartwright, PhD
We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions.
All of this takes a toll. Fast food is blamed for the epidemic of obesity, fast cars for motor vehicle accidents, and the wish for fast service and decisions …
There’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications. Lifestyle changes may consist of stopping unhealthy behaviors such as tobacco and excessive alcohol use, or starting healthy behaviors such as moderate daily exercise and eating adequate amounts of fresh fruits and vegetables.
As anyone who has ever …
I’ve worked in hospitals since I was 16 years old — 42 years ago now. I was first an orderly, then a nurse’s aid, then a practical nurse, and a finally a surgical technician before I became a physician.
When I started, female nurses wore caps, the details of which identified which nursing school they had graduated from, as well as a pin that gave the same information. They wore starched, …
Dealing with an incurable illness or terminal condition is an inevitable reality of the practice of medicine. Not uncommonly, especially in the intensive care unit, we care for the patient with no chance for recovery and survival. Keeping that patient comfortable and allowing him or her to die with dignity becomes the priority of care.
Occasionally, I hear requests from the family members of the dying patient – “Can you give …
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 …
by Brad Stuart, MD
Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together:
“People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say …
As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement.
I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains. The link also adds “and experts” and here I have a problem, not because I don’t think patients should have access to knowledge or know a lot about their own disease, but because knowing one pattern of pathology, i.e. your own, does not make you an expert.
No more …
by Edward Stevenson
One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being.
I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the …
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