A case of abdominal pain in the ER. And a surprising cause.

Conditions
July 6, 2016

(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.)

Dr. Stephen Cluff is like Yoda. Judging by body hair, he’s more like Chewbacca. But he’s short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet’s voice. If I’m stumped on a case, I’ll ask him. If I’m pissed off about department politics, I’ll call him for advice. If I want …

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A case of abdominal pain in the ER. And a surprising cause.

The end of residency means difficult goodbyes

Physician
July 6, 2016

“It is easy to see the beginnings of things, and harder to see the ends. I can remember now, with a clarity that makes the nerves in the back of my neck constrict, when New York began for me, but I cannot lay my finger upon the moment it ended.”
– Joan Didion, Goodbye To All That

So it feels at the end of residency. Of course, there is a graduation date. …

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The end of residency means difficult goodbyes

Your daughter is going to medical school. Please don’t worry.

Education
July 3, 2016

Dear parents,

Congratulations on your daughter’s acceptance into medical school.  Like the first day of kindergarten, this launch is notable for parents as well as children.

You may have some concerns about the stresses she will face. Having been there, I can tell you there will be many.  Not to worry, though. Times are changing.  You daughter is free to learn among the brightest of the bright while avoiding problems women before …

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Your daughter is going to medical school. Please don’t worry.

Don’t remove your own IUD. Please.

Conditions
July 2, 2016

Removing one’s own IUD is apparently “a thing.” There are even YouTube videos of women sharing their experiences. If you can get a medical degree from Google then why not get your OB/GYN residency from YouTube?

All kidding aside, I’m a gynecologist and I’m going to explain why you shouldn’t.

It’s not that people can’t technically pull out their own IUDs. It does happen accidentally, albeit rarely. An occasional …

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Don’t remove your own IUD. Please.

Open access endoscopy raises potential ethical issues

Conditions
July 2, 2016

Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance.

Why do we do this? We offer it as a convenience, so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring …

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Open access endoscopy raises potential ethical issues

New doctors may be more unprepared than ever

Education
July 1, 2016

July is back, and clinical faculty at teaching hospitals have again braced for the annual deluge of new residents just beginning their specialty training. Unfortunately, our new doctors may be more unprepared than ever.

The gap between medical school (the four years leading to the MD degree) and residency (advanced training in a particular field) has widened over the past several years. Changes in the health care system, shifting patient expectations, …

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New doctors may be more unprepared than ever

It’s time for physicians to demand a national medical license

Physician
June 30, 2016

The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice.

Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any …

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It’s time for physicians to demand a national medical license

We need to show empathy for patients who miss their appointments

Physician
June 29, 2016

I have a love-hate relationship with the no-show patient.  Like most doctors, I’m a reasonably good multitasker, adept enough at charting while emailing while waiting on hold with insurance companies and planning what to prepare for dinner when I get home. But there are days, more than I’d like to admit, when I feel like I need just a little bit more time, and I find myself compulsively refreshing my …

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We need to show empathy for patients who miss their appointments

A culture of misogyny at a VA hospital

Physician
June 28, 2016

This is a very controversial essay, but I am going to express how some women physicians, like myself, feel at the VA hospital.

I came home one day after my clinic and was perturbed. I called my significant other and the emotion of the day unraveled. I was reporting an uncomfortable interaction I had with an older male patient. During this patient encounter, his tone and comments became sexually charged and …

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A culture of misogyny at a VA hospital

Some doctors do it for the money. Here are some reasons why.

Finance
June 28, 2016

If you stay in medicine long enough, you will encounter physicians who seem to care more about the paycheck than the patient in front of them: think Dr. Farid Fata.  You may find those colleagues revolting; I know I did.  I despised these physicians and felt nauseated even to be in the same room as them.  But as time went on, I realized that almost nobody starts a career …

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Some doctors do it for the money. Here are some reasons why.

Why not make antibiotics over the counter?

Meds
June 27, 2016

Bacteria are rapidly becoming resistant in our antibiotic-loving society. This statement is a fact. We are facing a threat not only to our country, but to the world.

I have a proposal to make: over-the-counter antibiotics.

(Insert tongue-in-cheek here.)

Will this help us deal with the falsely popular notion that antibiotics are a cure-all? I don’t know, but here’s something I do. I’ve had patients storm out because I’ve said no, and I …

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Why not make antibiotics over the counter?

How do you define success after residency?

Physician
June 27, 2016

Residency is a time of immense learning. You learn from your attendings, your patients, and your colleagues. Of all the teaching moments during my residency, one that frequently stands out in my mind now is the day when one of my co-residents told me about the “post-training phenomenon.” He had previously completed a different residency and practiced in that field for a decade prior to switching to our specialty.

“Once you …

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How do you define success after residency?

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Physicians have a duty to respond to emergencies if they can

Physician
June 27, 2016

“Someone else will lend a helping hand,” a physician told me once, when asked to help with an emergency in public.  As a PALS instructor for more than a decade, I have always responded when possible.  In the last decade, there have been three in-flight emergencies, two elderly individuals who passed out in church, and a host of other less serious maladies.  A week ago, I discovered the best reason I …

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Physicians have a duty to respond to emergencies if they can

If you are admitted to the hospital, will a specialist see you?

Physician
June 23, 2016

Most primary care physicians (PCPs) who admit patients to a hospital are family practitioners or internists. Since medicine becomes more complex each day, PCPs must remain up-to-date on the latest treatment related to drugs, surgery, procedures, risks, complications, and costs. This might require your PCP to be a quarterback bringing together a team of consulting specialists to guide you through your hospital stay.

The economics of hospitalization are changing, and since …

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If you are admitted to the hospital, will a specialist see you?

The death of a child is an abomination

Physician
June 23, 2016

When, aged thirteen, my best friend died of complications from sickle cell disease, her parents could not attend her funeral or find out where she was buried. My mom explained to me that in the Yoruba culture because parents are not expected to survive their children, it is considered an abomination for a parent to know where their child is buried. So, the young adults in the extended family attended …

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The death of a child is an abomination

How can patients accept cash-based practices?

Physician
June 22, 2016

A primary care physician named Ashley Maltz recently discussed advantages and disadvantages of a cash-based practice. I appreciate her evenhanded tone: She prefers this model yet expressed concern for patients who can’t use it. In the comments section, several physicians extolled the virtues of cash-pay, but patients were mixed. It’s attractive for those who can afford it, while it worries, and maybe angers, those who can’t.

I enjoy the personal and patient benefits of a mostly cash-pay psychiatric practice (I …

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How can patients accept cash-based practices?

Don’t do these 5 things with your medical school personal statement

Education
June 21, 2016

Your medical school personal statement is one of the most important components of your application. This short essay can be the deciding factor as to whether or not you will spend the remainder of your life practicing medicine.

To be honest, most personal statements will be similar enough that they’ll fit right in with the rest. There will be a handful that stand out above the majority, and if you can …

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Don’t do these 5 things with your medical school personal statement

When doctors and patients secretly record each other

Physician
June 20, 2016

A JAMA Viewpoint suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, “the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any …

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When doctors and patients secretly record each other

My attending is throwing scalpels. What do I do?

Physician
June 16, 2016

PamelaWiblePostcard283-copy

Dear Dr. Wible,

Thank you for the work that you do. I have been following your push for humane medical education for several months now. I finally decided to contact you after reading your article about how “burnout” is actually abuse. I am a med student entering my third year. I have been consistently hearing horror stories from other students about the …

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My attending is throwing scalpels. What do I do?

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