Dear A, In 2002, I was a resident in Emergency Medicine finishing up my training at XXXX. I’d arranged through one of our part-time faculty to rotate through the Nairobi Hospital for about 6 weeks. When my sister mentioned to a friend that I was heading to Nairobi, her friend noted that her older brother’s good friend was working there …
My Proudest Moment in Medicine
I was having a conversation with dear friends over game night last week, and one asked if I would advise my kids to pursue careers in medicine. I ended up coming up with a laundry list of all the reasons that practicing medicine is difficult right now, but I acknowledged that although it has diminished with the weirdly adversarial position …
What Your Allergy List Says About You
I am a fan of the physician finance blogger Side Hustle Scrubs, a fellow ER doc who was my spirit animal. He made me laugh like no one before or since. He abruptly deleted his blog in 2019, and left no trace. Using a little black magic, I’ve resurrected his most memorable post. I hope to prod my old friend …
Father’s Day
Despite having left clinical medicine a couple of years ago, I remain an ER doc at heart. What this means is that I seldom get sentimental on specific holidays. I’ve had to work a lot of them over the years, which generally shields me from nostalgia over missed greeting card brunches and the like. Why did this particular Father’s Day …
Low Cost Delivers High Value: Why My $1.50 Bead Necklace Is Priceless
As an emergency medicine resident in 2002, I arranged a 6 week rotation through the Nairobi Hospital, which is where the who’s who of Kenya receive their care – presidents, expats, business people, tribal chiefs. My mentor during my time there was an American-born cardiologist, the private physician to then president-for-life Daniel Arap Toirotitch arap Moi. It was a formative …
Virtuous Or Vicious: Understanding Incentives In Value-Based Care
I’ve been taking a tour through the world of value-based care, which is the most recent place where the Centers for Medicare and Medicaid (CMS) have changed the rules of the game for reimbursement at the organizational level. Value-based care is defined as as positive health outcomes divided by cost. It’s a new and interesting body of knowledge to learn …
“Doctors are sadists who like to play God and watch lesser people scream”
The title of this post is a quote from the film Juno, a cleverly dismissive bit of venom spoken by the protagonist’s stepmother in a rejection of medical authority. It came to mind today as I listened to a fascinating podcast recalling the history of laetrile in the U.S. during the 1970s. Laetrile was a drug made from the extract …
Mechanic For The Human Body
As a medical student at UCSF, I attended a two-physician panel intended to orient us to the future we were heading toward before we commenced our third year clinical rotations. One speaker was a gentle-voiced and charismatic academic internist who told us we were joining a tradition of healers who practiced the art of medicine. Mastering the science was necessary …
Remembering The First Patient Who Became A Close Friend
He was about my age, coming in to the ER with a fever. He had lymphoma, and was a week out from chemotherapy with the expected drop in white cells that rendered him immunocompromised as a result. I was a second year resident in emergency medicine at the university hospital where he received care. Despite difficult IV access and discussing …
Interventions In The Golden Hour
One of the early lessons in trauma care during my emergency medicine residency was the concept of the Golden Hour: early, appropriate intervention during the critical first hour following traumatic injury can avoid death. I ended up practicing in a community hospital where our critical care cases are more medical than traumatic (stroke, sepsis, heart attack). Yet the concept of …