In my home, we have two conversations: politics and medicine. The most vociferous discussions are around their product, health care.  We know doctors on the right and left, Democrat and Republican, boisterous blues, rebellious reds and garrulous grays. Respecting opinions and debate, we love ‘em all.  However, no matter on what side of the aisle they stand, which lever they pull, they share one trait.  All physicians are deeply conservative.  ...

Read more...

Man has been dying on a regular basis for millions of years — should we not be end-of-life experts by now? Why do I feel the need to devote pages and hours to this depressing topic? Is there a goal to my project, beyond venting the shared suffering which soaks my soul? What is my purpose? For humans, denial of death and marginalizing its effect on our lives is a major ...

Read more...

Fall brings school buses, a freshening breeze and an avalanche of meetings.  There are seasonal sales, myriad projects and the splendor of colored leaves.  The season is also announced, again and again, by a particular peculiar and perilous decision, which, no matter how much I try, I do not fully understand. Frankly, I just don’t get it.

“Jane, it is time to start chemotherapy.” “What are the side effects?” “Well, this is powerful ...

Read more...

I recently spent an evening with a group of medical oncology fellows as part of a small panel discussing career alternatives. There were doctors who worked for pharma, academic medical centers, hospitals and a couple of us representing private practice. The questions and comments taught me more than I could contribute. I was surprised to learn not just about jobs and personal futures, but about something basic: the difficulty in ...

Read more...

David was 42 when he died from stomach cancer. He spent the last year of his life receiving useless chemotherapy and debilitating radiation. David was in terrible pain all of the time. He stayed in bed for months as cancer destroyed his ribs, back and lungs. Finally, David was rushed to a hospital, plugged into a breathing machine and pierced by countless IV drips. He died despite a battery of tests, ...

Read more...

Smoking and drinking caused the cancer, which Ed ignored for a long time. By the time a doctor looked at the hole in his neck, the mass had congealed the base of the tongue to the right side of the jaw and burst through the skin. A steady drip of pink tinged, foul saliva ran down the side of Ed’s neck. Ed, not being able to chew for months, was ...

Read more...

2:15 a.m., July 2, 1981. Its 83 degrees outside in a loud, humid Chicago night, but here the scrubbed air is chilled, dry, while white tiles reflect the occasional nurse, who appear and vanish, and the rhythmic sighs of the machines, gasping somewhere down empty halls, are occasionally interrupted by a frantic chime. My first night in the unit and my first patient’s chart.  Papers spill from the accidentally opened binder ...

Read more...

Autonomous dissection by the internet. We all do it, but is taking an online medical selfie really a good thing? Disease, prognosis, and treatment explained in exquisite, exhaustive, confused, nonspecific and erroneous detail, which often yields the wrong diagnosis, recommendations for irrelevant therapy and wildly inaccurate conclusions, resulting in confusion and fear. Given this common reality, should patients avoid computer self-investigation entirely and leave e-research to the “professionals?” The bad Patients, left ...

Read more...

Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, ...

Read more...

Doctors have become a profession of whiners.  Meetings, dinners, doctor lounges and the blogosphere are flooded with physician complaints, tirade, and anger. The volume of pained voices suggests that health Armageddon is only a few moments away. It was not always so.  Medicine is a career where idealism runs rampant.  In medical school interviews, young students really do answer that they want to help their fellow man.  Nonetheless, in recent years ...

Read more...

Get KevinMD's 5 most popular stories.