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When Less Is More: Weighing the Consequences of Actions

I was supposed to see a 99 year old man on my schedule. He had been sick for a few weeks with intestinal issues. Initially the doctors tried to treat him conservatively. He did not get better.
His family decided he should have surgery. He was taken to the operating room and made it through the surgery but in critical condition. He ended up in the ICU after the surgery. He was given fluids, pressers and multiple blood transfusions. Ultimately his body gave out and he died the night before I was supposed to see him.
Modern medicine affords so much technology and intervention. But is it always the right thing to do?
This man could have spent his remaining time comfortable and surrounded by family. Instead he rounded out his 99 years in a freezing operating room and ICU probably in pain and surrounded by strangers. 
Sometimes less is more and allowing people dignity is the humane treatment.

Being A Physician Patient

I’ve completed four years of medical school, four years of residency and have over ten years of clinical experience. I’ve learned it’s far more difficult to be a patient than to be a physician. And how incredibly broken the American healthcare system truly is.
Today, I was scheduled for a follow-up post-accident because, although I’m much better, I’m still experiencing neck pain. Normally I would do this sort of thing on one of my precious half days. Unfortunately the doctor was only available on two days, neither of which was my half day. So I took a sick half day to attend to my own health.
I arrived forty minutes prior to my appointment time. The receptionist handed me a 12-page pamphlet to complete. Among all the other questions, I had to put a dot anywhere I had pain and had to rate each dot on a scale and describe if I was improving or worsening. Paperwork took me almost twenty minutes to complete.
I was roomed fifty minutes after my appointment time. I have been on the opposite en…

Accident: Part 1

I am a physician but I am a patient too. On February 1, 2019, I was driving to clinic, where I had a packed schedule of patients to see. I was driving straight in the extreme left lane. I was one exit away from work when I suddenly noted the smell of rubber burning followed by a horrendous screech. Immediately thereafter, my car was impacted on the right side and subsequently swerved into the middle divider before spinning 270 degrees back onto the freeway against oncoming traffic. 
Once my vehicle stopped, a pickup truck pulled up to me, the driver glared into my car and drove off. My immediate thought was that I had been in a hit and run, and he was running. Shards of glass glistened like dew across the interior of my car. I sifted through them to locate my cellphone. 
A woman approached my window and instructed me to roll my window down. My trembling fingers searched for the button. The window had barely opened a crack and she said “My goodness!! Are you okay? I saw everything. He ca…

On “Burnout”

They call it “burnout.” As if I didn’t attend enough yoga. As if the fault lay within me for not being able to tolerate the abuse of a toxic and misogynistic work environment.
I do believe there is an onus of responsibility on physicians to care for ourselves. We must take care of our minds, bodies and souls as these are the tools we use to care for our patients. 
However, I also do believe there is an onus of responsibility on health systems to create and foster sustainable work environments. This involves sufficient staffing of both physicians and nurses, creating a positive atmosphere, humane scheduling, valuing the blood, sweat and tears of those at the frontlines, allowing staff to voice concerns and adequate representation in leadership for women and minorities.
“Burnout” really is an incongruity between physician resilience and workplace ethos.
In my experience, if you are holding up your end of the bargain and your employer is not, that place is not a good fit for you. 
The most di…

What Lies Beneath

I had the most interesting patient today. He was intelligent. He was eloquent and well-spoken. Most of all, he was kind.
When he was 20 years old, he donated his kidney to his grandmother. 
What do you think of when you think of 20-year old men? Maybe immaturity. Maybe lacking focus. Maybe silly. Are these judgements? Probably, because there are plenty of 20-year old men who are determined, focused and serious. 
I asked him more about what inspired him to donate his kidney. He said he couldn’t imagine committing someone to dialysis if there was another way. He has two family members who were kidney donors and live normal lives. He has one family member who received a kidney transplant and lives a normal life. His grandmother lives a normal life. To him, it was a normal gesture of kindness. He’s much older now and does not regret his decision.
Why do I bring up this story?
I bring this up because this person’s external appearance fit what media would have you believe is a bad person. He is …

A Day in the Life

My first patient of the day has metastatic pancreatic cancer. She's had it, in fact, for two years. Getting chemo for two years. Her hair has fallen out, her pain is becoming uncontrollable and she's been in and out of the hospital.

Her daughters came to the clinic with her. She is tearful. Her daughters pull me aside. "Tell her to focus on the positive," they request. I wonder if there is ever a positive twist on having metastatic pancreatic cancer, but I keep my thoughts to myself. This is not about me. It's about this patient who is living with it.

Every question I ask her gets answered by one of her daughters. I point the daughters to the door. They leave, and my patient opens up. She is severely depressed and "wouldn't mind if she doesn't wake up tomorrow." She is depressed about her illness and she is depressed about the treatment. I ask her if she wants to continue. "I don't know." We make a plan and follow-up for her depres…

Rockstar

Medicare covers an annual "wellness visit." The focus of a "wellness visit" is to create a prevention plan. The topics addressed in a "wellness visit" include health status, injury risks, risky behaviors, urgent health needs, risk factors for depression, functional ability, level of safety and cognitive function.

With that background and understanding...

Elderly woman in her 80s shows up for a Medicare "wellness visit." Her gait is steady and she is mentally intact. She plops herself down on the exam table, and we talk.

I review her history and medications. We discuss the support network she has in her life. I ask her about her appetite and activities of daily living. She claims it takes her a long time to bathe, otherwise she feels comfortable with everything, including shopping and cooking.

I notice her hair tied up in neat buns. Her clothes are clean and color-coordinated. Her nails are painted orange with silver sparkle. I notice abrasions a…