September 21, 2016


On why medical scribes are money well spent, especially in the age of electronic medical records, which unlike my iPhone, makes things take infinitely longer. 

September 8, 2016

quackery, nonsense and utter bullshit

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

He hands me a stack of papers and says, "I was told to give these records to you."

Hey, a patient that brings their previous medical records! Awesome! I am about to thank them but my eyes quickly glance over the first page. It is a genetic test. Talking about theoretical drug-drug interactions. Ordered by his chiropractor. A confused look frumples my brow quickly replacing the smile.

"Could you please give me a bit information on these tests and why they were ordered?"

"My chiropractor ordered them for me. And he told me to ask you about the results."

"So he ordered them and charged you, but did NOT go over any of the results with you? Is that correct? I want to make sure I understand this properly."

"Yup. He said that you would know what to do with them."

I certainly did. I wanted to put them through the shredder but now they are a legal document and I am bound ethically to them. I glance over them for 5 seconds which is 5 seconds longer than the "data" deserves. I spent nearly 15 years in research and know firsthand the utility of this stuff.

I reassure the patient, "none of this is surprising or concerning. And it is not going to change how I manage your heart disease and diabetes."

And instead of shredding them, I dutifully scan them into our system to be added to growing pile of medical records that no one will ever be able to make sense of.

August 23, 2016

that which lacks words

If we make it through the night
If we make it out alive
Lord have mercy and pray for the dead
And you say that you can save me
Don't hope to ever find me
And I fear I'm too far gone
Pray for the dead

There is a hell
Believe me, I've seen it. 

I've never written of him. At least publicly. The words remain beyond my grasp. Or, is it that words represent a poor description. A mere charicature. But he left me songs to which to listen. After all, music begins where words fail. A thinly veiled attempt to bridge that chasm of pain. To communicate that which lacks words. 

August 19, 2016


"Hey, doctor. Have you eaten lunch yet?" a nurse whispered to me.

I stop typing orders and look at the time on the computer clock. It's 11:37. "Hell, I haven't even had breakfast yet."

"We have a bunch of leftovers in the break room. We had a breakfast pot luck. Want some?"

This is what happens when you treat nurses as human beings.

July 21, 2016


The twisted and rusted iron well represent the Muscle, Sinew and Will. A Will which struggles against the load which threatens to crush him.  Down on the right knee.  The left leg unbalanced and straining but with the foot dug in to regain a position of strength.  Metal rust bleeds down onto the concrete base.  And what gives blood it's red hue if not rusted iron?  How many times have I passed this sculpture?  First, as a candidate for medical school.  Now, as a physician......the metaphor of Atlas has deepened with experience in ways I suspect I will never truly comprehend. 

July 19, 2016

listening for nothing

I place my stethoscope onto the chest and reflexively bend my head down.  It could be mistaken for supplication.  Maybe it is.  It also pulls the ear buds on the stethoscope snuggly into the ear canal.  Sometimes there are electronic noises from beeping IV pumps to vital sign alarms.  Sometimes there are crying family members.  But what I am listening for is silence.  No heart beat.  So I mentally block out all the noise, as much to give a moment of silence to the recently departed as anything.  A heaviness is present in that silence.  Soon it will be broken by speaking with the grieving family members or speaking with the nurses to fill out the paperwork.  But in that moment, there is nothing but heavy silence.

July 13, 2016

end of the rope

The following is not FACTUALLY accurate. Details have been changed, things deleted, stuff made up, all to protect identity. But it is 100% absolutely true.

     Every month I am a different doctor.  One month I am a family doctor managing patients in the hospital.  One month I am an ER doctor.  Next month I am a surgeon.  And you have to embrace that because they each approach problems very differently, and deservedly so.  But underneath it all, I am still me.  On this particular day, I was a surgeon, more specifically, a colorectal surgeon.  That may sound like a big stretch but not as much as it could be. I am one of those rare family docs who is also learning colonoscopies.  And if one is going to learn colonoscopies, learning about colon cancer comes with that.  It is my way of saving someone from having to experience bone metastases as without colonoscopies, we usually find colon cancer once it hits the bones.  And if you have read my blog from a few years back, you can imagine what bone mets feel like.  It ain't pretty.  And so on a day where the clinic day is colorectal patients, one can imagine a fair share of them are there for colorectal cancer appointments either as follow ups after surgery or to be assessed as surgical candidates.
     This particular patient had been referred by their medical oncologist to assess whether they were a candidate for surgery after they had completed chemotherapy.  A common scenario.  In fact, I had dealt with it two times already that morning, neither of which had any hope of surgery improving those patients' quantity or quality of life.  But the third one of the day.....they had completely mistaken notions of the results of the most recent CT surveillance scan.  Their cancer was not in remission.  In fact, it was back with a vengeance.  And I simply could not do it.  I could not bring myself to tell a third patient that day that their results meant that surgery held no hope for them.  Maybe it was it was because I was exhausted.  Maybe I was tired of playing the surgeon.  Maybe consoling two before lunchtime had left me devoid of any further ability to empathize.  Maybe I had reached the end of my emotional rope because of my own baggage with cancer.  Regardless, I let the attending tell them. 
     I felt horrible afterwards.  I apologized to the attending.  I felt as if I had let the patient down.  That if a family doctor can't console someone then what the hell is that doc worth?  The attending looked at me and reminded me it wasn't my job.  It certainly wasn't expected that an off-service resident should be able to interpret a CT scan and interpret whether surgery was off the table or not.  But for me, it was not about being able to make the medical decision.  It was about being able to be there emotionally for the patient.  I left that day feeling worse than if I had made an actual medical error.