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When Public Health Legislation Is More Effective Than Physician’s Advice

Last month, my family was involved in a scary traffic accident en route to the Family Medicine Education Consortium‘s North East Region meeting. I was in the left-hand eastbound lane of the Massachusetts Turnpike when a westbound tractor trailer collided with a truck, causing the truck to cross over the grass median a few cars ahead of us. I hit the brakes and swerved to avoid the truck, but its momentum carried it forward into the left side of our car. Strapped into child safety seats in the back, both of my children were struck by shards of window glass. My five year-old son, who had been sitting behind me, eventually required twelve stitches to close a scalp laceration. Miraculously, none of the occupants of the other six damaged vehicles, including the truck driver, sustained any injuries.

Family physicians like me, and physicians in general, like to believe that the interventions we provide patients make a big difference in their eventual health outcomes. In a few cases, they do. But for most people, events largely outside of the scope of medical practice determine one’s quality and length of life, and Read more »

*This blog post was originally published at Common Sense Family Doctor*

Surgeons Should Understand What Type Of Patient They Have

Over the years, I have found that patients can be loosely grouped into 4 different types. Nothing particularly wrong with any type, but it does help me to approach patients appropriately if I can get a sense of what type they are.

The four types are:

Type A: If a surgery can “fix” or “cure” me such that I won’t have to take medications every day of my life, than let’s do it.

Type B: I will never consider surgery unless it is a life-threatening situation. If a medicine can help, why do it???

Type C: I will consider surgery only as a last resort when all else fails.

Type D: Read more »

*This blog post was originally published at Fauquier ENT Blog*

Solo Practice Vs. Integrated Health Systems: What’s Best For Primary Care Reform?

The buzzwords of cutting-edge primary care reform – the medical home, coordination of care, electronic health records – have usually been associated with large integrated health systems such as Intermountain Healthcare, Group Health, and Kaiser Permanente. If you believe the arguments that economies of scale and financial resources give such organizations built-in advantages over the traditional small group practice, you may be inclined to believe that solo practice is going the way of the dodo. Indeed, immediate past AAFP President Roland Goertz, MD, MBA penned an editorial a few months ago, “Helping Small Practices Survive Health System Change,” that, while touting some services that the Academy offers family physicians in these practices, betrayed a decidedly pessimistic outlook on their long-term future.

Not everyone agrees, however. In the September issue of the Journal of Family Practice, Jeff Susman, MD cast solo practices as vital engines of primary care innovation: Read more »

*This blog post was originally published at Common Sense Family Doctor*

ER Physician Amazed By The Technological Advancements In Medicine

My father in law, now deceased, was a nephrologist. I met him while I was in medical school. He was a reserved guy, not prone to butt into what he saw as others’ business. So I still remember that while I was considering what sort of residency to pursue, he took a surprisingly strong stance that I should go into interventional radiology. His reasoning was simple: they have a great lifestyle, they make bags and bags and bags of money, and they get to play with all the coolest gadgets.

It was tempting, I admit. As anyone who knows me can attest, I am ALL about the gadgets. I’m not averse to bags of money either. But I never gave it much consideration, mostly because I am just not real good at radiology, though for an ER doc I do OK. (A low bar, it is true.)

I sometimes regret that decision. For example, I wrote the other day about a gentleman who presented with a ruptured abdominal aortic aneurysm. We had some heroic fun in the ER resuscitating him and getting him to the OR. After the fact, I had to wonder whether it was all in vain — Read more »

*This blog post was originally published at Movin' Meat*

The Reality Of Being A Doctor

Lest the students out there get disillusioned, it is probably a good idea to be upfront about the reality of being a doctor:


Maybe it’s not always this bad, but in the ER there is a real ring of truth to this.

From the marvelous Saturday Morning Breakfast Cereal

*This blog post was originally published at Movin' Meat*

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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