Giving the Doctor a Second Chance
“Someone had said you were a good doctor,” my patient said derisively, “but I was not impressed.” What had I done? More
Medical Memoirs
Given the epidemic of doctor-writers out there, one could be forgiven for assuming that a book titled “Internal Medicine: A Doctor’s Stories,” written by a practicing physician, would be a work of nonfiction (and indeed, it is being marketed as such). But in the introduction, Holt writes that he is “recreating experience as parable,” More
Adventures in ‘Prior Authorization’
“Dear Doctor. We are writing to inform you that a prior authorization is required for the medication you prescribed.” That’s usually where I stop reading. More
The Physical Exam as Refuge
There are few situations where we expect to disrobe and have our bodies touched by relative strangers. But the physical exam is often the first moment that patients and doctors can talk directly, without the impediment of technology. More
Our Silence Around Dementia
Dementia is not something we doctors talk much about. We all have many patients with dementia — and more every year — but we never seem to chat about it the way we discuss kidney disease or cancer treatment. Why the silence? More
Doctor Priorities vs. Patient Priorities
The patient cheerfully admitted that he hadn’t been paying attention to his diabetes for the last few years. He’d stopped taking his medicine, stopped seeing his doctors, stopped thinking about the disease altogether. What happens when the patient’s priorities and the doctor’s priorities conflict? More
The Small Costs
We all hear about “health care costs,” a lumbering behemoth that dominates the news. But it is the smaller amounts, literally the pocket money, that often has the strongest effect on the concrete currency of health. Sometimes doctors find themselves in the position of offering their patients a few dollars to help with a co-pay or transportation home. More
Lots of New Patients, Too Few Doctors
Getting a primary care doctor is hard these days, and will only get harder as more people get insurance via the ACA. This is a “problem” that we should welcome, since it means that more Americans will have access to care. But it won’t be an easy problem to solve. Here are some ideas that are being discussed. More
Why Doctors Don’t Take Sick Days
From day one in medical training, the unspoken message is that calling in sick is for wimps. Most doctors ignore their symptoms and resist taking the day off unless they are sick enough to be hospitalized in the next bed over. What explains this toxic brew of denial, ignorance and bravado? More
When Doctors Share With Patients
Doctors often “self-disclose” to patients in an attempt to empathize. But contrary to what might be expected, such self-disclosures often turned out not to be helpful in addressing patients’ concerns or building rapport. More
The Challenge of Diabetes
A diagnosis of diabetes often triggers a flurry of life changes and medical interventions. But diabetes–like all chronic illnesses–is a marathon, not a sprint. More
Doctors’ Bad Habits
We doctors constantly lament how difficult it is get our patients to change their behavior. But the truth is, we are equally intransigent when it comes to changing our own behaviors as caregivers. More
More Power to the Placebo
The hospital ward was quiet for the night, except for “the howler.” The patient and I were both pretty exasperated with each other. He was sullen and cranky; I was exhausted and at my wits’ end. More
Respect and How it Impacts Patient Safety
When we tolerate a culture of disrespect, we aren’t just being insensitive, or obtuse, or lazy, or enabling. We’re in fact violating the first commandment of medicine: Do No Harm. More
When Doctors Feel Fear
I remember the first time I laid eyes on an actual amygdala, after slicing through a brain with a repurposed kitchen knife in neuroanatomyclass. That’s it? I thought. That nickel-size splotch tucked below the temporal lobes was the seat of my fears? It was monumentally underwhelming and even lacked
the poetic almond shape that its Latin name connotes.
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