Mandela_2_0 If I had to choose the way I could die, I would probably like to go peacefully in my sleep. It seems that Nelson Mandela no longer has that option. He may have had, and perhaps even been on that trajectory when he was rushed to hospital in the middle of the night more than two weeks ago. It would not have ...

Read more...

I recently followed a brief spat on Twitter between a journalist and a doctor.  It did not go further than a few irritable tweets, but I had to agree with the doctor’s point of view. The journalist had written an article about the death of a South African shack fire victim, admitted to hospital with 100% burns, and the contrast in perceived care he received compared to that of a ...

Read more...

The phone conversation, as my dad, in the bed next door, recalls it, went something like this. “Hello?” “Hi, is this Jim? Where are you?” “No, it’s not Jim.  I’m John, and I’m in hospital.” “Oh sorry, John, I was looking for Jim the refrigerator mechanic.  Wrong number.  Hope you’re okay!” “I’m not okay. Just had both my knees replaced and I’m very sore.” “John, I’m sorry.  I got problems too.  I run an ice cream ...

Read more...

How many times as a doctor do you ask the same questions over and over again as part of the routine process of taking a history from your patient?  And how often as a patient do you have to answer those same questions each time you see a new doctor? How long does this take, given that doctors and patients both complain that there is too little time for the ...

Read more...

Here's a devil’s advocate position. Historically doctors have held power over patients as compensation for the responsibility of that position, and the epatient and other patient advocacy movements seek to address that imbalance with good reason, arguing that the doctor-patient relationship should be equal.  I don’t mind that. But let’s be truly equal partners then. The patient’s right to choose a doctor and be informed of the best ones via doctor rating ...

Read more...

In about 1985, as I remember it, my training hospital underwent a pivotal change. In Cape Town, at the southern tip of Africa, Groote Schuur Hospital was world famous for being the place where in 1967 an arrogant, brash and brilliant surgeon by the name of Christiaan Barnard stunned the world by performing the world’s first heart transplant. Nearly twenty years later, Groote Schuur (Dutch for "Big Barn") still retained ...

Read more...

I noticed something different about my driving habits lately.  At a traffic light I used to accept the green as an open invitation to drive through unconcerned, confident that other drivers would see the red and do what they are supposed to do: stop. I don’t do that anymore.  I always look to see if the road is clear, and other drivers have indeed stopped.  And then I go.  I have ...

Read more...

As I greeted my next patient of the morning, I knew from the early folder number that I had seen him six or seven years before.  I no longer expect to remember everyone I have ever met professionally. The man before me was tall, fit and well built. There is usually some inkling of recognition, but nothing about him was familiar to me at all. We made small talk for some ...

Read more...

In 1978, as I neared the end of high school and readied myself for medical training, a book called House of God was published by a doctor under the pseudonym Samuel Shem.  By the time I read it as an intern eight years later it had become a cult classic among doctors.  Everyone I knew in my hospital read it, passing around the single copy we had, writing our names in ...

Read more...

Things have been a bit tough of late, the bad economy is starting to bite, and you’re feeling the pressure.  To top it all, your body has been acting strangely in ways it never has before.  Your muscles twitch in funny areas for hours at a time, you tire easily, and you have fleeting pins and needles in your limbs.  Over the weeks these symptoms have become worse. The last ...

Read more...

In 2009 I posted a blog here on videotaping of surgeries and the issues and challenges this would present.  I did not say I am in favor of this as a means of policing medical practice, but for documenting surgeries the technology can be very useful.  I do video as many of my surgeries as I can, and I offer to show these recordings when appropriate to my patients.  ...

Read more...

I was sick the other day. A bout of gastroenteritis that had me vomiting with diarrhea for 24 hours and feeling weak for another 48. I felt rough for a while, but got over it pretty quickly.  My family gave me just the right amount of care, and avoided me appropriately because I get grumpy when I am sick. Had they dared approach me with the suggestion that my state of ...

Read more...

Every now and then a tonsillectomy patient bleeds after arriving back on the ward after surgery.  On this occasion, there was nothing remarkable in the event itself.  What was remarkable was the efficiency of the response.

I got the phone call from the ward sister at 11:05 am, and immediately drove the short distance back to our local hospital.  I checked on my patient in the ward, confirmed the bleed, ...

Read more...

Dear "Robin," Nothing in my career in medicine has prepared me for being a friend to someone with such a terrible disease.  As a doctor I dispense advice on a daily basis, but those interactions remain strangely impersonal.  With you, cancer has invaded our inner circle, and we all share your shock and despair. No one can know exactly what it feels like ...

Read more...

Here are the three most useful words for a doctor: "I don’t know." A close second would be "I’m not sure," another three that have got me out of trouble more times than I can remember.  The older I get, and more experience I have, the more useful it becomes. Pattern recognition is essential in effective medical practice.  So often patient complaints are vague and nondescript, and in the absence of physical ...

Read more...

The Theresa Brown furor has got me thinking.  To be honest, I don’t think the doctor’s apparent offense was really that bad.  I remember giving and taking worse. When I was at medical school and in specialist training, there were senior doctors and nurses of legendary temper and bad disposition.  Tiptoeing around them, and working to their satisfaction, however unreasonable, was an accepted part of the job.  But the ...

Read more...

"She’s a really interesting patient!" The doctor visiting the lady in question at home is correct.  Nothing about her illness either has been routine.  The progression of her disease has confounded her regular doctors for months.  Nothing about her condition is normal.  Medications have not worked as expected.  The original diagnosis -- Parkinson’s -- is in question.  All my training and expertise is inadequate, for I am an ENT surgeon, not ...

Read more...

I read an interesting link via Reuters about how students have developed a smart phone application with a microscope attachment to diagnose malaria. The article shows a picture of a child at risk somewhere in Africa. This is a great idea, and one that can go a long way to help people who really need it.  But the last word from the project’s software engineer in the article was the one that was ...

Read more...

I am a self-taught bass guitarist in a church band, and, to be honest, it sometimes shows. I know I need to improve my skills, but time commitments make formal lessons difficult.  So two days ago I opened up YouTube and entered "bass guitar lessons" into the search box. 19,000 hits registered.  I selected a few that looked good on ...

Read more...

One of the benefits, or aberrations, depending on your point of view, of the fee-for-service model is that we surgeons are remunerated for correcting our mistakes and complications. At first glance this seems wrong. But perspectives differ, and when a doctor has to deal with serious, undeserved complications and is self-employed he deserves to be compensated adequately.   So what really is the difference between the two? A complication may be described as ...

Read more...

2 Pages

Most Popular

✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.