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Physician Visibility In Public: I See Patients, And They See Me

In the movie “The Sixth Sense,” there was that kid who saw dead people. I’m like that. But I see patients and their parents instead. They’re all around me.

They’re watching at the grocery store when my kids act up. We meet during anniversary dinners, at Christmas Eve service, and on the treadmill at the Y. I bump into parents when buying personal effects and even during the early morning coffee run in my oldest sweats. I see patients.

The follow-up dialog between the parents might go something like this:

Dad: “Marge, don’t you think Billy’s colitis might be better managed by a doctor capable of pulling himself together?”

Mom: “Don’t be ridiculous, Frank. DrV’s bedhead has nothing to do with his ability to care for Billy. And besides, I’ve heard that he can intubate the terminal ileum in under 10 minutes.”

It’s not that I necessarily mind being seen in the wild. I’m pretty comfortable in my own skin, even when it’s glistening after a workout. I’m bothered more by the fact that patients may be repulsed by my occasional bedraggled appearance. If I knew they were good with it, I might be less caught up with the whole matter. Read more »

*This blog post was originally published at 33 Charts*

Physician Lifestyle Is Criteria When Choosing A Medical Specialty

Medical students today consider lifestyle an essential criteria when choosing a specialty. It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness.

There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands. Claudia Golden, a Harvard economics professor, recently noted that,

high-paying careers that offer more help in balancing work and family are the ones that end up luring the largest numbers of women. Surprisingly, colon and rectal surgery is one of these, because of rapid growth in routine colonoscopies that can be scheduled in advance, giving doctors control over their time. Goldin says 31% of colon and rectal surgeons under 35 years of age were female in 2007, compared with only 3% of those ages 55 to 64, and 12% of those ages 45 to 54, reflecting the fact that younger women are flocking to the field.

Of course, what’s not said is the grueling training that it takes to become a colorectal surgeon — but the numbers cited above do not lie. The new generation of doctors — both men and women — want greater control of their time. That means more shift-work and a predictable call schedule. Read more »

*This blog post was originally published at*

Dr. Patient: Doctors And Self-Care

I did a little “self care” earlier this week. I did it by not caring for myself. I went to the doctor.

I was sitting in the waiting area for my appointment and saw the mother of one of my patients. “Why are you here?” she asked. “I have a doctor’s appointment,” I replied. She got a curious look on her face, asking: “Don’t you doctors just take care of yourselves? I thought that was what doctors did.”

We do take care of ourselves. In fact, we do it far more often than we should. Being your own doctor allows for a lot of denial. When you spend your day advocating healthy lifestyles after you had trouble finding pants that would fit in the morning, denial is necessary. “Do as I say, not as I do.”

I realize that this is hypocrisy — that is why I was at the doctor on Monday. My patients have noticed my expanding waistline, commenting on it more than I would wish. Certainly my pants get in the way of denial as well, not forgiving the fact that I have been under a whole lot of stress. Pants don’t accept excuses.

So I found myself in the unfamiliar experience of being the patient. Instead of closing my mind and emotions to my own body, I had to frankly assess what I was doing to it. Standing on the scale was as frank of an assessment as I would ever want. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Book Review: Just Like Someone Without Mental Illness Only More So

I’ll cut to the chase: I loved this book. Five stars. Two thumbs up.

When I read books, especially psychiatry books that I write about on Shrink Rap, I often read more carefully and sometimes more critically. I was so immersed in reading “Just Like Someone Without Mental Illness Only More So” that I didn’t stop to think, I just went on the journey.

Mark Vonnegut is a pediatrician and the son of my favorite author when I was in junior high school. His memoir is a poignant and candid account of his struggles with, well, life in general, and life with a psychotic illness in particular. Schizophrenia, bipolar disorder — who knows? (I’ll vote for bipolar disorder.) Some illness where he had three episodes in his twenties, then another episode 14 years later.

Thorazine and lithium and megavitamins and psych wards. Xanax and alcohol and how humiliating it is to be psychotic on a stretcher in the ER hallway of the hospital where he works. Divorce and remarriage. First and second families. Childhood as the son of a financially struggling, not-yet-famous eccentric writer, and adulthood as the son of an icon. Vonnegut is a hippy, a mainstream doctor, a middle-aged softball player, then finally a guy who accidentally poisons himself with wild mushrooms. Read more »

*This blog post was originally published at Shrink Rap*

The Practice Of Medicine: When A Funeral Provides Perspective

Here’s my column in this month’s Emergency Medicine News:

I have practiced with the same group, in the same hospital, for 17 years. Because we have been together so long, our group is a family. So it was with enormous grief that we buried our founder, Dr. Jack Warren, 11 years ago after a tragic car crash. That wound is still open, but we still tell stories about his humor, his compassion, and his grace.

As I write this I am tending another wound, or I should say our group is tending another. A second partner passed away last week. Unlike the sudden horror of the first death, the second was progressive, as our friend and partner, Dr. Howard Leslie, left us by degrees, the victim of metastatic melanoma. Jack and Howard founded our group before any of the rest of us arrived. Both of them are buried in the same wooded, hillside nature preserve. Pieces of our group, pieces of ourselves, interred in the red-clay earth. Just as they practiced before the rest of us, so they went to sleep before the rest of us. I think they’ve gone ahead to show the way. So they can one day help us adapt to peace the way they helped us adapt to practice.

But both deaths remind me of partnership. Medicine today is chaotic and difficult for many reasons. Part of the problem is that government and regulatory bodies overwhelm us and litigation threatens us. Part of the problem is that we, and our patients alike, have untenable hopes and impossible standards for the practice of medicine. Read more »

*This blog post was originally published at*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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