shutterstock_100033454 I want to wake up feeling restless and uncomfortable. It’ll be neat to drag myself out of bed to open that first bottle of wine. I’ll drink all of it within an hour. Then I’ll go to the liquor store. The guy behind the counter will know that, everyday, I will buy a pint of vodka from him. He will look at ...

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A sample agenda as the consulting psychiatrist with a homeless outreach team: 8:17am. Arrive at the office, which is in a tall building that is a short walk from the New York Stock Exchange. Speak with the case managers and social workers about who should be seen that day. 8:55am. Walk with a case manager to the ferry terminal meet Paul (note: all patients described here are composites of people ...

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Radiolab recently aired a show called “The Bitter End” that discusses the end-of-life care preferences of physicians and non-physicians. Physicians are much more likely to decline “heroic” measures, such as CPR, mechanical ventilation, feeding tubes, etc. This comes as a surprise to the hosts and, presumably, to other non-physicians. It’s a good show. I recommend it. (Full disclosure: I like Radiolab.) In the show, Ken Murray argues that physicians ...

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A sample agenda as the consulting psychiatrist at a geriatric adult home: 8:20am. Arrive at the concrete building. Wave through the locked glass door at the woman sitting behind the desk. She pushes a button and the door buzzes. Pull the door open. Say good morning. She never sounds cheerful when she replies, “Good morning.” Because there is no open stair access, take the elevator up one floor. It travels ...

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Dear Patient(s), Thank you for educating me. Thank you for letting me shine bright lights into your eyes and place Q-tips up your nose. Thank you for not shooting me a dirty look when I ask you to lift up your pendulous breast so I can listen to your heart. Thank you for letting me ogle at your protuberant belly—whether it contains a baby, a liver tumor, or liters of fluid inside. ...

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It had been about two years since I last saw a primary care doctor. I was still living in New York City. My initial—and only—appointment with that physician lasted nearly an hour. The front desk clerk had a round, pale face. Behind her was a textured wall over which ran a thin sheet of quiet water. Lush leaves spilled over the brim of the planter onto the marbled countertop. “I’ll let the ...

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Two weeks had passed before I learned what happened. I hadn’t seen him in several months. At our last meeting, the trees were full of red and orange leaves. He, as usual, was not interested in talking to me. He was sitting in front of a closed shop. “Hi. How are you?” “Fine.” People in the neighborhood took care of him. Surrounding him were several plastic bags holding neatly stacked styrofoam containers filled with soup. ...

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Editor's note: Please read Dr. Yang's entire Red Herring series for background prior to reading this post. *** The patient really is fine. She returned to the gastroenterology clinic several times for treatments to widen her esophagus. (It’s a neat procedure: The GI doctors insert a small balloon into the esophagus. They gently inflate the balloon to stretch the stricture a few millimeters. With repeated stretching, the esophagus will remain open.) The patient ate ...

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During my time at PPOH, I spent one day a week working at a geriatric adult home. An adult home is a residence that generally houses people with psychiatric conditions. They can be run by either public or private agencies. At best, they provide services and supports for the residents so they can live independently. At worst, they provide very little other than shelter; they just take people’s money. (The latter ...

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In New York, I worked for an organization called Project for Psychiatric Outreach to the Homeless (PPOH). It has a humble history: Over 20 years ago, a group of psychiatrists were sitting around and discussing the need for psychiatric services for the homeless. They decided to volunteer their time and skills to this population. The organization grew and, for both administrative and financial reasons, eventually became part of another social ...

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