“Direct Admit: bounceback 72M recurrent pleural effusion, new diplopia,” my pager beeped with our new admission. As a “bounceback” admission, this 72-year-old male would be returning to our service after recently discharging from the hospital. This type of admission often indicates that a problem recurred or an issue was not fully addressed during the most recent hospitalization.
I remember ranting to a friend one night about the terminology, lingo and semantics that run through medicine. When I started studying medicine, I found the language fascinating. Most physicians seem to appreciate the language of medicine because truly understanding it is proof that after years of studying, working, and putting nose to grindstone, you made it in to the exclusive club that utilizes this jargon.
Double-booking. Concurrent surgery. Procedural overlap. However it is named, the once clandestine practice is now under public scrutiny.
In April, I had the pleasure of attending the 4th Annual Lown Institute Conference in Chicago. The Lown Institute was named after and inspired by Dr. Bernard Lown, a renowned cardiologist who also championed social change by co-founding the International Physicians for the Prevention of Nuclear War, an organization to prevent nuclear war during the Cold War. The theme of the conference was promoting “right care” by addressing overuse, underuse and misuse of medical services through a coalition of patient advocates, community organizers and medical professionals.
Albert Einstein said, “Compound interest is the eighth wonder of the world. He who understands it, earns it … he who doesn’t … pays it.” The whole idea of investing is to take advantage of compound interest. Here are a few general principles to live by.
His eyes were as wide open as his mouth as he slowly placed his beer on the bar without looking away from me. Making no effort to wipe the thick foam from his upper lip, the man continued to stare in disbelief, “That’s the coolest thing I’ve ever heard.”
As the anesthetic wore off, the doctor looked at me and said, “We found a tumor and we think it’s cancer.” I struggled to make sense of that nightmarish phrase and even yearned to be put back under. I was terrified and uncertain about what the coming months would bring as a 36-year-old with a new diagnosis of colon cancer.
In the past two months, a group of Harvard medical students have launched the “End Step 2 CS” campaign, an effort to do away with the portion of the U.S. Medical Licensing Exam that tests clinical and communications skills in a hands-on, day-long clinic simulation using standardized patients. Not only is the Step 2 CS exam a necessary public safeguard, it has greatly strengthened the curriculum of medical schools nationwide.
A surgical resident writes: “Several recent studies suggest current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?”
It’s 2 a.m., and the patient’s blood pressure is beginning to rapidly decrease. Every IV line is occupied by an antibiotic or IV fluids, and we are in need of a vasoactive medication. The nurse comes to my computer and sternly states, “We can no longer avoid it. I think the patient needs a central line.” I quickly say “okay,” but I don’t move. I am momentarily frozen by my unease with the bedside procedure ahead.
I recently recreated a now-famous business school study on a subset of residents in my internal medicine residency program. In the original study, researchers asked students to read a case of the real-life venture capitalist Heidi Roizen, who expertly leveraged an extensive professional network to forward her career. Half of the students read the original case; half were given a case in which Heidi’s name was switched to Howard — a fictional male persona.
In an ideal world we would all die at home with our loved ones caring for us, slowly slipping away in our sleep into the placid beyond. But why doesn’t it happen this way? There’s a dignity to that way because of its organic simplicity. It’s how people used to die prior to modern medicine and before we started needing to always “fix the problem.”