Specialist

I’m a physician, not a provider

Physician
July 27, 2022

Your parents likely spent months searching through baby name books, polling the family, and looking through the photo albums of ancestors to pick the perfect name for you.

Maybe your parents had to see your face before they could pick the perfect one. Names have history, they have power, and they embody your personality.

My daughter was officially named Daniela, yet we called her Bimbi months before she was born. That is …

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The unsung heroes: respiratory therapists

Conditions
November 6, 2021

Working day after day, year after year, in a busy high acuity ICU, we all have become a “second family.”

The public doesn’t hear much about respiratory therapists, especially during this COVID nightmare. But they have been the unsung heroes.

So who are the respiratory therapists, and what do they do?

Respiratory therapists are specialized health care professionals trained in critical care and cardio-pulmonary medicine. They work therapeutically with people suffering from acute …

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Burnout and bias? Or medical gaslighting?

Physician
July 29, 2021

Five years into my practice as an academic allergist/immunologist, my perceptions continue to evolve. Though once primarily informed by my mentors’ wisdom, I continue incorporating my experiences as both physician and autoimmune patient to guide my practice. Though we all know medicine isn’t like it used to be, nostalgia is bittersweet. In its wake, the real question remains: how are we going to respond to ongoing changes and fight for …

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Let’s talk about hierarchy and priorities in medicine

Physician
July 23, 2021

Life is full of hierarchies — whether you are the older brother in the family, the supervisor in a company, a chief resident in medicine. There is always a hierarchy. It is a pecking order that keeps our society organized. You know where to look for guidance. Who is the person above your title that can help you with a challenge you are facing?

Even within surgical specialties, there is a …

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The expanding role of specialists in value-based care

Policy
June 13, 2021

Value-based care has become a buzzword over the past decade with early experiments in Massachusetts, followed by creating Medicare accountable care organizations (ACOs) as part of the Affordable Care Act. As commercial insurers jumped onto this bandwagon, most providers became familiar with the concepts of gainsharing, upside and downside risk, and bundled payments.

Much of the activity in this space has focused on primary care, particularly for ACOs and ACO lookalikes. …

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Will separating obstetrics from gynecology help specialist burnout?

Physician
August 30, 2019

At the end of a long table covered with hors d’oeuvres and a birthday cake, I struck up a conversation with three primary care physicians.

I was hungry for their opinions.

Inside the crowded apartment, we spoke for some 20 minutes about the systemic and cultural causes of burnout in primary care—a conversation that informed the first article in this series.

As I was about to leave, I …

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Is it OK for a physician to retire early?

Finance
August 17, 2017

This is a tough post to write. I struggle with this issue daily. Is it OK for a physician to retire early? The obvious answer is: yes. Each individual should live their life as they see fit. But with a continued shortage of physicians (granted this is more in rural areas and not big metropolitan cities), and the time, money and resources required for training physicians, is it selfish to …

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The decline and fall of informed consent

Physician
July 21, 2017

Margaret Edson’s 1999 Pulitzer Prize winning play, Wit, tells the story of the final hours of Vivian Bearing, PhD, an English professor dying of cancer.  Early in the course of her disease, one of her doctors sees the value of her case from a research point of view and asks her to enroll in a clinical trial of an investigational therapy.  In the film version of the play, which stars …

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The best places for a doctor to practice: It’s more than money

Physician
June 30, 2015

I would think that when physicians decide where to set up practice, there are things that they would want to think about other than how much money they’ll make.  Yet if one reads Medscape’s current list of the best and worst places to practice, it would appear that money trumps everything else (although Medscape said it also considered factors like “cultural attractions”). What Medscape apparently did not consider …

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Do medical scribes threaten patient privacy?

Physician
April 27, 2014

Medical scribes are a burgeoning field with many institutions and practices exploring their use while the many commercial enterprises who lease out scribes are pushing for their widespread acceptance. There is no accepted definition of what scribes do or what their background or training should be. There is no mechanism for licensure of them in any state. They are poorly defined medical assistants. The field is in its infancy and …

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To put patients’ interests first, we have to put our own aside

Policy
November 23, 2013

I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student — bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my …

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Calling a consult: Disrespect from specialists hurts patients

Physician
August 26, 2013

A while back I was working in pediatric urgent care and had occasion to do something I have done many times since starting out in medicine. I called a consult. The reason, like many consults, was an abnormality on a study that required a specialist’s opinion. I paged the resident on call for this particular specialty.

When they called back I was treated, right from the get-go, to some serious attitude. This was a legitimate …

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Anesthesiologists are victims of their own success

Physician
April 18, 2013

New research just out in the journal Psychology and Aging says pessimists live longer and healthier lives. If this is true, then contemplating the future of anesthesiology ought to make us immortal, because our professional prospects don’t look bright.  As we teach residents to do what we’ve always done, shouldn’t we ask ourselves honestly if we’re training them for a future that doesn’t exist?

Especially here in California, it seems …

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5 ways to adapt to an evolving healthcare workforce

Physician
February 15, 2013

Once upon a time a doctor first attended 3 or 4 years of college, then finished 3 or 4 years of medical school, trudged through 1 to 8 years of residency training to hang out “a shingle,” and finally begin to practice medicine, usually in solo practice.  Those days are long gone.  Time has expanded—schooling and training are longer.

Breaks are taken between and during this once but no longer traditional …

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Mean doctors and nice nurses: It’s time to change our brand

Physician
November 26, 2012

In my hospital’s preoperative area, upright on her bed, sat an unhappy middle-aged lady who needed an operation to treat complications from her previous bariatric surgery.  She hadn’t lost weight and clearly was feeling discouraged about practically everything.  She was physically uncomfortable, couldn’t even keep down her own saliva because her lower esophagus was obstructed, and was in tears.

As her anesthesiologist, …

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Oral board exams: A window into how you behave in the operating room

Physician
October 26, 2012

When I clicked on the “View Your Exam Results” link on the American Board of Anesthesiology website, I thought something rashly exuberant would engulf me. I thought that everyone in the lunch room would turn suddenly, throw their reheated pasta and cafeteria sandwiches high aloft with glee and balloons would gush from the cracks between the fluorescent lights on the ceiling as the whole world burst into song.

But instead, there …

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