had never seen someone so yellow.
It was as if someone had taken a highlighter to the whites of her eyes and coated her skin with a layer of mustard. In actuality, the cancer in her colon had crept to her liver, where it blocked bile from taking its natural path out of the body, causing the ominous yellow chemical to spill into her blood and tissues. She had left the hospital two weeks ago, hoping to die at home, but came back with worsening pain and bloating in her belly — and because she couldn't stand to look at herself in the mirror.
"Doctor," she said softly — it was a title that still didn't feel quite comfortable to me, a newly minted doctor, especially coming from a patient several decades older than me. "You remind me of my nephew."
She asked me to sit for a few minutes and, shamefully, I hesitated. I had eight more patients to see before rounds and was already running behind. But I sat — listening to a dying woman's fondest family memories, my mind racing through a seemingly endless list of boxes I had to check that morning. When my pager went off five minutes later, I excused myself, promising to return in the afternoon to finish our conversation.
But I didn't.
There were new patient admissions. Emergencies on other floors. Notes to be written, consultants to be called, outside hospital medical records to be procured.
When I got home that night, I kicked myself for forgetting to stop back to see her. I briefly considered going back to the hospital but, exhausted, told myself she'd be asleep by now and vowed to arrive early the next morning to spend extra time with her.
She died that night.
The most draining aspect of medical training, it turns out, is not long hours, brash colleagues or steep learning curves — it's the feeling that you're often unable to be there with and for your patients in the way you want, in the way you'd always imagined you would be.
For hospitals to run efficiently, it is widely thought that they must operate like companies. There's a certain number of patients to be seen, doctors to see them, diseases to be managed, procedures to be performed, and hours in which all this must occur. For patients to feel cared for, we must treat them like family — with all the time, energy and compassion that entails
More ...
http://well.blogs.nytimes.com/2015/03/19/the-importance-of-sitting-with-patients/?
Thursday, March 19, 2015
NYTimes: How to Get Your Spouse to Exercise
Spouses influence each other's exercise habits, for better and worse, more than is often recognized, according to an interesting new study of the workout habits of middle-aged couples. The study found that changes in one spouse's routine tend to be echoed in the other's, highlighting the extent to which our exercise behavior is shaped not just by our personal intentions but by the people around us as well.
In studying why people opt to exercise or not, scientists often and understandably focus on individual psychology and situations. But increasingly, exercise scientists are also looking into broader factors that can have a bearing, including our social relationships and whether being single, married, childless or employed is likely to affect exercise behavior.
The results of past studies on this subject have been alternately predictable and startling. Single men and women, for instance, generally exercise far more than do married people, although divorce can change that. Men typically exercise more after a marriage ends; women in that situation frequently exercise less. Meanwhile, employed men, even those with desk jobs, usually exercise more than men who are unemployed.
More ...
http://well.blogs.nytimes.com/2015/03/18/how-to-get-your-spouse-to-exercise/?
In studying why people opt to exercise or not, scientists often and understandably focus on individual psychology and situations. But increasingly, exercise scientists are also looking into broader factors that can have a bearing, including our social relationships and whether being single, married, childless or employed is likely to affect exercise behavior.
The results of past studies on this subject have been alternately predictable and startling. Single men and women, for instance, generally exercise far more than do married people, although divorce can change that. Men typically exercise more after a marriage ends; women in that situation frequently exercise less. Meanwhile, employed men, even those with desk jobs, usually exercise more than men who are unemployed.
More ...
http://well.blogs.nytimes.com/2015/03/18/how-to-get-your-spouse-to-exercise/?
NYTimes: Cleveland Clinic Grapples With Changes in Health Care
In downtrodden East Cleveland, a three-story family health center has replaced the city's full-service hospital. Seven thousand miles away in Abu Dhabi, a gleaming 24-story hospital is preparing to admit patients this year.
Back in Ohio, shoppers at Marc's, a local discount grocer and pharmacy in Garfield Heights, can enter a kiosk equipped with a stethoscope, a blood pressure cuff and a two-way video screen that lets a patient talk directly to a doctor.
These disparate ventures bear the imprimatur of the renowned Cleveland Clinic, one of the most respected nonprofit health systems in the nation, as it tries to manage the extraordinary changes now transforming health care.
While it has traditionally relied on its ability to provide high-priced specialty care, the system, along with every stand-alone community hospital and large academic medical center, is being forced to remake itself. Patients are increasingly seeking care outside the hospital — in a family health center, a doctor's office, a drugstore or at home. Medicare and other insurers are moving away from volume-based payments to new models, to pay less for better care.
Dr. Delos M. Cosgrove, a 74-year-old former heart surgeon who took over as chief executive about a decade ago, likens what is happening in health care to the upheaval decades ago in the steel industry, where companies disappeared when they were unable to respond to change and new competition. "The disruption is going to happen," he said. As an inevitable shakeout takes place among health care institutions, a look at how the clinic is responding underscores the industry's challenges and the flurry of activity taking place as institutions try to adapt.
More ...
http://www.nytimes.com/2015/03/18/business/cleveland-clinic-grapples-with-changes-in-health-care.html?
Back in Ohio, shoppers at Marc's, a local discount grocer and pharmacy in Garfield Heights, can enter a kiosk equipped with a stethoscope, a blood pressure cuff and a two-way video screen that lets a patient talk directly to a doctor.
These disparate ventures bear the imprimatur of the renowned Cleveland Clinic, one of the most respected nonprofit health systems in the nation, as it tries to manage the extraordinary changes now transforming health care.
While it has traditionally relied on its ability to provide high-priced specialty care, the system, along with every stand-alone community hospital and large academic medical center, is being forced to remake itself. Patients are increasingly seeking care outside the hospital — in a family health center, a doctor's office, a drugstore or at home. Medicare and other insurers are moving away from volume-based payments to new models, to pay less for better care.
Dr. Delos M. Cosgrove, a 74-year-old former heart surgeon who took over as chief executive about a decade ago, likens what is happening in health care to the upheaval decades ago in the steel industry, where companies disappeared when they were unable to respond to change and new competition. "The disruption is going to happen," he said. As an inevitable shakeout takes place among health care institutions, a look at how the clinic is responding underscores the industry's challenges and the flurry of activity taking place as institutions try to adapt.
More ...
http://www.nytimes.com/2015/03/18/business/cleveland-clinic-grapples-with-changes-in-health-care.html?
Wednesday, March 18, 2015
What Your Tweets Say About You - The New Yorker
How much can your tweets reveal about you? Judging by the last nine hundred and seventy-two words that I used on Twitter, I'm about average when it comes to feeling upbeat and being personable, and I'm less likely than most people to be depressed or angry. That, at least, is the snapshot provided by AnalyzeWords, one of the latest creations from James Pennebaker, a psychologist at the University of Texas who studies how language relates to well-being and personality. One of Pennebaker's most famous projects is a computer program called Linguistic Inquiry and Word Count (L.I.W.C.), which looks at the words we use, and in what frequency and context, and uses this information to gauge our psychological states and various aspects of our personality.
Tuesday, March 17, 2015
Medical Mysteries that solved other baffling cases - The Washington Post
"I hope this helps someone else."
I hear that every time I write about a patient's often tortuous and usually prolonged journey through the medical system, featured each month in The Post's "Medical Mysteries" column.
I began writing the column in 2007 with twin goals: to explain the surprising complexity of medical diagnosis and to document the impact on patients and families when the process goes awry. Most stories are told from the perspective of a patient or close relative, while others reflect the viewpoint of the doctor or health-care worker who figured out what was wrong after others — sometimes many others — failed.
So how often does this desire to help others actually pan out? While there is obviously no way to measure the ripple effect, sometimes I learn about successes as dramatic as the original cases that served as the catalyst.
http://www.washingtonpost.com/national/health-science/medical-mysteries-that-solved-other-baffling-cases/2015/03/16/bb73f6dc-b930-11e4-aa05-1ce812b3fdd2_story.html?
I hear that every time I write about a patient's often tortuous and usually prolonged journey through the medical system, featured each month in The Post's "Medical Mysteries" column.
I began writing the column in 2007 with twin goals: to explain the surprising complexity of medical diagnosis and to document the impact on patients and families when the process goes awry. Most stories are told from the perspective of a patient or close relative, while others reflect the viewpoint of the doctor or health-care worker who figured out what was wrong after others — sometimes many others — failed.
So how often does this desire to help others actually pan out? While there is obviously no way to measure the ripple effect, sometimes I learn about successes as dramatic as the original cases that served as the catalyst.
http://www.washingtonpost.com/national/health-science/medical-mysteries-that-solved-other-baffling-cases/2015/03/16/bb73f6dc-b930-11e4-aa05-1ce812b3fdd2_story.html?
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