ON THE WAY to work the other day I heard a radio commercial advertising a local hospital network’s cardiac care services. In it, a patient’s daughter related her overwhelmingly positive experience with the hospital team that treated her 90-year-old father with a transcatheter aortic valve replacement (TAVR), a minimally-invasive alternative to open heart surgery.


It was a good commercial. It had all the elements: “I was worried at first, the doctors earned my trust, the surgery went well, everyone was so nice, now Dad is back at home and doing all the things he used to do, thanks to Hospital X.”


The problem with commercials like these is that they’re misleading, and they don’t really tell you anything at all about the hospi...

THINK KEEPING your life organized is hard? Try keeping your doctors organized.


In this era of fragmented health care, patients find themselves in the impossible position of having to coordinate their care themselves—a task that many can’t meet. Having multiple chronic medical conditions often means being subjected to a dizzying assortment of specialists, medical terminology, and tests that can quickly overwhelm patients.


How many times have you found yourself in this situation: You have a patient in front of you who is a “blank slate,” so to speak—no notes in your EMR, no labs, no imaging. The only information you have to go on is what comes out of her mouth (or, in some cases, history that the family offers). If the patien...

EVERY FEW MONTHS I see this video pop up on the social media feeds of doctor friends, mainly emergency physicians, with some approving caption along the lines of, “This is my life.” The video depicts, in overly dramatized and satiric fashion, patients presenting to the ED with various non-life-threatening conditions, among them an ingrown toenail and nasal congestion. The message: Don’t come to the emergency room if it’s not absolutely necessary.


The video is a product of the government of Queensland, Australia, and is one of several that it has released in an attempt to stem the flow of patients into its emergency departments. Each video implores patients to exercise restraint and consider alternatives to emergency care, such as...

NOW THAT the dust has settled in the wake of America’s most recent mass shooting, the odds seem high that history will repeat itself and our legislature will again fail to enact any meaningful reform.


Like it or not, we as a country, through our elected representatives, have decided that we value unfettered access to deadly weapons over an individual’s right to feel safe in public spaces. Why this is, and what can be done about it, are topics for another day.


The more morbid—but, I believe, essential—question to ask is, When a citizen is struck by a bullet from one of those sacred guns that the NRA and its allies in Congress have worked so hard to protect, what rights do we extend to that person?


An ambulance in under...



This week, you—the white-rapping, thrift-shopping, LGBT-activist-ing, Grammy-winning 2013 phenom—teamed up with President Obama to deliver a message to the country about the current opioid epidemic. Now let me preface this by saying, I like you, Macklemore. I like the mixture of equal parts political, earnest and downright goofy that you bring to your music. I like that you seem genuinely self-reflective and even a little uncomfortable with the chart-topping success your appropriation of black music has enjoyed. And I believe that the rampant opioid abuse and overdoses happening now in our country is an issue near and dear to your heart.

You mention in this address—as well as on the track “Kevin” on your wholly un...

ON MY RECENT bi-coastal tour of residency programs, I had the pleasure of meeting many foreign medical graduates (a.k.a. FMGs—not to be confused with international medical graduates, who are U.S. citizens who go abroad for medical school). Almost uniformly, they struck me as confident, mature and articulate. Many were older than me, some by as much as 10 or 15 years. Most had extensive research experience, and a few had even completed residency already in another country and were here to take a shot at becoming a U.S.-licensed physician, which would require them to do it all over again. To an outsider, they would appear as competitive candidates for programs that aspire to produce first-class doctors. But I did not envy their plight. I...

I CAN ALREADY feel it beginning to happen.


I first noticed it while working in the emergency room. I’m sitting at a computer at the nursing station, which is surrounded on all sides by beds with patients in them, chairs with patients in them, patients ambling around aimlessly in gowns, bored, frustrated, tired. The bank of computers at the nursing station is like a fortress, separating providers from the throngs of sick by means of a chest-high wall. A patient walks over. Standing directly in front of me but addressing nobody in particular, she asks for one of the many things patients ask for: something for pain, something for sleep, a sandwich, their doctor. I forget what it was because in that moment, although I hear her, I pre...

MEDICINE HAS a fraught relationship with money. Dealing as they do with matters of life and death, doctors are loath to assign a dollar value to human life, preferring to avoid the subject altogether and instead provide the care that they deem appropriate no matter the cost. Insurance companies, on the other hand, make their business in rationing health dollars and have no such qualms: the general consensus among them is that a human life in this country is worth about $50,000 per year (though new data suggests that number may be closer to $130,000). Controversial though this may be, it has real implications for which treatments are made available to which patients. There is no getting around the fact that illness is expensive, and the...

WHAT'S HAPPENED to medicine?


It’s a question that plagues physicians, residents, nurses, students—pretty much anyone who has had to close a complicated 15-minute office visit without really resolving anything, or fought tooth and nail for approval for an essential medication, or been named in a lawsuit. Anyone who has begun chipping away at a quarter million dollars of educational debt while simultaneously starting a family. Anyone who has had to navigate the hulking, monolithic bureaucracy that is the American health care system.


The time for existential ruminating is behind us. It’s time to stop asking, “Have we lost our way?” and acknowledge that, yes, we have definitely lost our way. An MD is no longer the ticket to pre...

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