Hospital at Home
Mr. Smith was a sixty-eight year old man who came to the Veterans Affairs hospital where I was a medical student complaining of chest pain. “With chest pain, it’s all about the story,” my resident, the physician in charge of our team, said. We talked to him to find out what he was doing when … Continue reading
Morbidity & Mortality Conference, a post mortem
When things go wrong in medicine, as they invariably do, we try to figure out what went wrong, and why. We try to learn if there’s anything we could have done better and what we should do next time. It used to be, in the days of the Giants, that the physician responsible for the patient … Continue reading
A New Therapy for Asthma
I first met Carol* (name and identifying details have been changed) when she came to my clinic after a severe asthma attack had sent her to the Intensive Care Unit. After a few days, she had been extubated and had acquired a new diagnosis, asthma. When she saw me in clinic, she felt better than … Continue reading
What I Learned at the ATP Reunion Conference February 2014
I. Capitation is coming Although Brent was careful to stress that despite this being gospel among those who “have drunk the kool-aid” it is not universally accepted. Still, the alternative narrative is just more of the same – more efficient fee for service – or aspirations for competing as one of a handful of fee-for-service … Continue reading
Physician Compensation
Doctors are burned out and they don’t enjoy their job as much as they used to. But looking broadly, physicians are still spared the economic difficulties and loss of autonomy that are present in most other sectors where people are still lucky enough to be employed. There are issues that doctors rarely face: unemployment, inability … Continue reading
The State Fair
“I got run over by a golf cart at the State Fair,” my five-year-old cheerfully says to the Emergency Department technician who is checking us in. A utility cart knocked him down – he is a five-year-old running along the grass by the path, and some asshole wasn’t looking as he turned into my kid … Continue reading
Evidence-Free Pregnancy Advice
I know why the hoopla around Emily Oster‘s new book, Expecting Better, bothers me, it’s because she hasn’t let you in on obstetrics’ big bad secret… and here it is…. from a pulmonologist. What Ms. Oster points out, and where she is absolutely correct, is that the data to support most pregnancy advice, indeed, most … Continue reading
The Women’s Table
Oh, no. I’m at the loser table, I thought walking into the large room for our summer intern lunch. I sat at my assigned table with the other female bioengineering summer interns and the one female manager, while looking around enviously as the male interns I worked with sat elsewhere with the men. Every woman who works in a male dominated field wants to be sitting at the table with the highest level leadership, and we know, just as everybody … Continue reading
Judging by the Source
“Mom, who made the first people?” he asks me sweetly. It is already nine o’clock and well past his bedtime. Blah, blah, blah, I stumble a bit then build up to “people came from monkeys.” “Nah,” he says and gives me a sly smile as if I’m trying to trick him. My “really, they do!” … Continue reading
Gorilla Glue and Heartbreak
“My friend said to tell you everything when I come,” she says as she opens a little zippered bag full of flakes. “My teeth are falling out and I can’t afford a dentist, so I use Gorilla Glue to glue back the pieces,” she says. She was referred to me for severe asthma, but she … Continue reading
