She sat in her crisp, white coat, probably not much older than I am now, leaning back with all of the assurance of someone who recently completed a cardiology fellowship, newly hired by the academic medical center to which I was applying for residency. One of the first of many interviews for me, the conversation was anything but smooth. She clearly …
What doctors can learn from working at Starbucks
The patient had arrived for a urology procedure with a blood glucose in the 400’s. He suffered from a recent stomach bug and had gotten off schedule with administration of his meds. While his GI symptoms had subsided, he was feeling crappy overall. I decided to cancel his case and went about initiating treatment to get his blood sugar under control. When I informed the urologist of my findings and …
The transition from resident to attending physician
Along with about 8.4% of the US population, I have asthma. To promote good doctor-patient communication, I can’t sit too far away from you. To perform a high-quality physical examination, I must enter into your personal space. Several minutes of inhaling that strong scent, however, can cause me to have trouble breathing.
I’ve never been brave enough to bring this up before, …
Please don’t wear perfume to the doctor’s office
Let me tell you a secret. Examining eardrums in a squirming, angry child is really difficult—if not impossible. If the doc in your screaming, struggling child’s ear for a half-second, it’s unlikely that anything useful was seen.
Sometimes, it is just impossible to get a decent exam. But there are ways that parents (and doctors!) can help at least increase the chance …
Tips to examine the eardrum of the squirming, angry child
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 42-year-old woman is evaluated for recurring pain and swelling of the left knee and right ankle that began 5 months ago. At that time, she also had an episode of conjunctivitis as well as dysuria, both of which resolved spontaneously. The joint pain and …
MKSAP: 42-year-old with pain and swelling of the knee
Accepting a promotion in the workplace is never easy task. One must take on a higher level of responsibility, carry out new job objectives, and must quickly form new working relationships with colleagues at the office.
Taking on the role as a newly-branded doctor after years of being a medical student is no different in this aspect from becoming a junior partner …
Doctors: How to improve your workplace relationship with nurses
I have a lovely pen. It’s a Mont Blanc Meisterstück fountain pen. My group bought it for me on my tenth anniversary as a partner in our emergency medicine practice.
It’s a luxury I would never have paid for myself, though I have loved and used fountain pens since I was in college. Ironically, about the time I got it, the window …
My experience with a scribe in the emergency department
Parents worry when their children do not eat vegetables.
And, I understand why.
Parents know that vegetables are an important part of a healthy diet, and get frustrated when they are consistently left on their child’s plate.
The result? Parental “veggie-stress.”
Although veggie-stress begins at the family dinner table, it can be amplified by the rather faddish way parents talk about poor vegetable eaters within playgroups. Conversations among parents can …
Your child hates vegetables: 3 tips from a pediatrician
I’ve been thinking lately about all the great advances in medicine over the years. There have been lots of them. And despite everything you’ve heard about looming cuts in healthcare, I have no doubt that the hits will keep on coming. Since I seem to be on this Top 5 thing lately, I figured I would continue this ride and rank my top 10 medical advances over the years. There …
10 advances that have changed medicine forever
The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system.
In the wake of Hurricane Sandy, the visual has become more familiar than we’d like – the young and the old slumped forward on rigid plastic chairs in the waiting room, occupied stretchers lined up in tandem in the hallway. Some of these patients are sick enough to warrant a hospital admission but languish …
ED boarders: A new focus to mitigate overcrowding
Traditionally the patient is supposed to come to the doctor to get some sort of help with a problem. That’s what people pay us for, I guess. Patients bring us their various miseries, we help them figure out what they mean and what causes them and prescribe potions or recommend they do something that will help make them better, if there is such a thing. But in the normal give …
It’s amazing what I’ve learned from patients
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, …
Mean doctors and nice nurses: It’s time to change our brand
Medicine, like law, the military, and many other professions, has its own language–a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.
Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients’ understanding of their medical care. This article discusses the extent to which clinicians overestimate patients’ “health literacy“–with potentially dangerous results.
But sometimes, medical lingo has …
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As medicine moves forward in its most technologically advanced era yet, we continue to struggle with basic concepts such as record keeping. The medical record is vital to the care of the patient. It tells the story of each patient’s journey through the medical system. The idea of centralizing all pertinent medical information is, in theory, a step in the right direction. In utopia, there would be one medical record …
What are the biggest issues with EMR today?
A patient who was minutes away from his colonoscopy, asked me how many colonoscopies I had performed. Before I could answer, he quickly followed-up asking if any of my patients developed perforation of the colon after the procedure.
I satisfied his initial inquiry when I informed him that I have intruded into at least 20,000 colons in the past 2 decades. With regard to his second and more ‘penetrating’ question, I …
The difference between complications and negligence
Is it possible to ignore a cancer? Prostate cancer infests almost 250,000 men in this country each year and will kill 28,000 men in the United States in 2012, over 200,000 around the world. Many lose their lives “too soon”, dying in their 60s or even their 50s. Nonetheless, authorities do not recommend the PSA blood test for routine screening of this disease. How can this make sense? Partly this …
Is it possible to ignore prostate cancer?
I had an interesting twitter chat the other day with one of my colleagues, a young ER grad studying healthcare policy by the name of Seth Trueger. The Twitter conversation wound up involving about a dozen ER docs and nurses. You can review an edited summary over at Storify.
The point in contention is an interesting one: we know the nation’s ERs are overwhelmed and overcrowded. That’s old news. We also …
The volume of low acuity patients in the ER is not a myth
Let’s start with a disclaimer: I am not complaining; I’m just stating the facts.
Honest fact: The morale of doctors in the real world is low–and sinking lower.
I know what you are thinking. “Come on Mandrola, you are nuts if you expect us to feel sympathy for doctors–of all professions.”
Well, you can think that if you wish, but I’m calling it as I see them. And here is why it matters:
Because …
The growing culture of hostile dependency towards doctors
The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”
The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.
The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.
Let …
Reasons why doctors overtreat and overtest
Much of what passes for debate on health care during this election year is focused on the macro side, on big issues like how do we cover the uninsured or restructure Medicare and Medicaid financing. But for all of the talk about vouchers and block grants and insurance mandates, the candidates are missing the micro issues that really matter most to doctors and their patients, which is how health care …
The micro level of health reform cannot be ignored
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