When Angelina Jolie announced that she'd undergone a bilateral mastectomy to prevent the breast cancer for which a genetic mutation puts her at high risk, I found myself, as a doctor and as a woman, full of admiration and gratitude for her...and also, in retrospect, for Betty Ford.FULL ENTRY
I confess I'm besotted with "Call the Midwife," the British series on PBS, now in its second season. It's based on the memoirs of a woman named Jenny Lee, who served as a young nurse-midwife in the slums of London in the late 1950s. What's so great about it? The usual stuff that makes a British series so appealing--the writing, the period costumes...those accents! But what draws me to the show is the portrayal of Jenny and the other nurses, pedaling around London on their bicycles to deliver babies and tend to the sick and poor. The nurses are knowledgeable and technically expert in matters of health, but equally interested in every other aspect of their patients' lives. Mother not bonding with baby? Elderly shut-in seeming lonely? Back on their bikes go the nurses. The show is like a fantasy of what nursing is like.
Except it's no fantasy. Park the bikes, lose the accents and the funny hats, and the nurses with whom I work are not so very different from Jenny Lee and her comrades.FULL ENTRY
"Just tell me the first thing that comes to mind," the doctor instructs the patient as he shows him the ink blots.
Not long ago I noted a certain older patient's name on my schedule. I really dreaded seeing her. It's not that I dislike her--in fact she's one of my favorite patients. It was just that I hated the prospect of seeing her looking as poorly as I knew she would. She'd been through so much: an accident resulting in devastating injuries followed by painful surgeries, and, worst, in the middle of
all that, the death of one of her adult children. Surely she'd be in awful shape, psychologically, if not physically. I mean, how much can one person take?
A lot, apparently.FULL ENTRY
Shortly after we moved here 23 years ago with our baby daughter, my husband and I went to a party. I met a man who had moved here 20 years earlier and asked him how long it took before he felt at home. ďHasnít happened yet,Ē he answered.
But it did happen, eventually, for me.
A psychiatric colleague once told me that the incidence of anxiety disorders went down drastically during the Blitz, when London was under constant siege by German bombs in 1940-1941. I don't know whether this is true, or even how you could measure such a thing under those conditions--but it makes sense to me. The patients I saw at Massachusetts General Hospital the day after the terrorist attacks just two miles away, near the finish line of the Boston Marathon, were very calm. And more interested in talking about others than themselves.FULL ENTRY
There's this weird feeling I get when I hear bad news, or even not that bad news, or even the possibility of bad news: a tingling that spreads across my forehead, down my face, into my jaw, and then to my chest, where it settles like a...no, not a lump...a void. I get the feeling every time I go for my annual mammogram or any other medical test, I wonder how I would react to a bad outcome. Would I be brave and noble, as so many of my patients are? Or would I be like Woody Allen in this classic scene from Hannah and Her Sisters--yes, the actress is Julie Kavner, the voice of Marge Simpson--one of the "weaker ones," panicked, swallowed up in the void of my own fear?
Certain questions come up frequently--daily!-- in my medical practice. Often these concern issues that have been reported heavily in the media and/or about which there is controversy. Here is the first in what will be an occasional series on this blog--"FAQ"--addressing some of the questions my patients ask me frequently. Please contact me at firstname.lastname@example.org if there are medical topics which you think should be covered here in "FAQ."
One of the things about which I'm asked most commonly is calcium. Some of the confusion comes from the fact that our knowledge about calcium and health is evolving. A recent study showing that men who take calcium supplements have an increased risk of heart attacks is just the latest in an avalanche of sometimes conflicting information.FULL ENTRY
When I entered the exam room I found my patient, a woman in her 80s who'd come in for a routine visit, holding a photograph. "I need to show you something," she said. Some patients bring me photos at every visit--usually their kids' or grandkids' annual school pictures, or smartphone shots of a wedding or christening--but she never had before. I wondered what it might be.
She laid the photo on the corner of my desk. In it, she appeared, a few years younger than she is now, with a handsome, middle aged man who resembled her. He might have been her son, except she'd never mentioned him before.
"This is my son," she said.
Mention the term "surgeon general" to anyone over 35 or so and they won't think of the doctor who currently holds that position (that's Regina Benjamin, who some have felt has not spoken or acted forcefully enough about threats to our nation's health). Nor will they think of the surgeon general who released the famous 1964 report linking smoking with lung cancer and whose warning appears on every pack of cigarettes. (That was Luther L. Terry). Rather, they'll think of C. Everett Koop, who held the office from 1981 to 1989 and who died this week at 96.FULL ENTRY
In an excellent recent cover article in the Boston Globe Magazine, Darshak Sanghavi explored a fascinating phenomenon: patients are less likely to sue doctors who admit they've made a mistake, particularly if they apologize for their errors. Innovative programs, such as one at the University of Michigan, encourage physicians to reveal their mistakes to patients, express remorse, and offer compensation to patients who may have been harmed by those mistakes---even if those patients haven't sued them.
But less dramatic apologies are actually a frequent and important part of everyday medical practice. I say "I'm sorry" all day long--and so do my colleagues.FULL ENTRY
I know I blogged about it last week, and I don't intend for this to become the Downton Abbey forum (fun as that would be), but the hit Masterpiece series has again raised an issue that's as relevant to medical practice today as it was in 1920 when the drama is set. Since the last episode, people have been asking me whether I thought Dr. Clarkson told a lie, which got me thinking about whether it's ever okay for a doctor to lie to patient.
SPOILER ALERT! If you have not yet seen the fourth episode of the third season of Downton Abbey and wish to be surprised by it, read no further. And if you aren't watching PBS's addictive costume drama currently set in 1920--and, seriously, why aren't you?--read on anyway.
This is about medicine, then vs. now.FULL ENTRY
Welcome to Boston in January.
One of the most basic parts of my job is sorting out who's a little sick from who's very sick, or in danger of getting very sick. How do I do that when so many people have the same symptom? And, as a patient, how do you know when your own cough is worth a trip to the doctor (especially when it's cold, you feel rotten, and the waiting room is likely to be full of...coughing people)?
It's enough to make you tear out your hair--or run to the refrigerator. Just when you've made your New Year's resolution to lose weight, pulled the laundry off your treadmill, and replaced the egg nog with Crystal Light, an article comes out showing that being overweight may actually make you live longer.FULL ENTRY
My husband and I don't exchange holiday gifts. We don't not exchange them--we're not protesting the commercialization of the season or anything--it's just how we roll. There is one exception though: every year he buys me the annual edition of Best American Essays. Even though I could buy it myself, even though I routinely do buy books for myself, traditionally, he buys this one for me.
I love Best American. It always contains great writing from expected places like The New Yorker, Harper's, and The Atlantic. But it also features essays from lesser known journals with wonderful names like Normal School, The Hedgehog Review and Lapham's Quarterly.
This year's volume, edited by New York Times columnist David Brooks, includes no fewer than eight essays on medical themes. 8 out of 24! One-third!FULL ENTRY
No, not that kind of health/medicine books. If you were interested in learning more about how to go gluten-free, have clearer sinuses, or be less co-dependent, I have recommendations for reading--but not here.
Rather, I'd like to share with you my five favorite works of literature relating to health and medicine published in 2012. This genre is ever-growing, with new memoirs, literary nonfiction, and even novels and poetry collections added each year.
Enjoy--and do comment below or write to me with your own favorites:FULL ENTRY
Suppose 20 children and 6 adults died at a school in a very short time period. And suppose there were clusters of similar deaths, many of young, healthy people, around the country: at a movie theater, a shopping mall, a high school, a house of worship. Wouldn't you expect the Centers for Disease Control to get involved in trying to figure out why these people died and how to prevent similar deaths? Wouldn't you want your own doctor to do all he or she could do to prevent similar "outbreaks" from occurring in your community? Even if the cause of the deaths turned out to be complex, multi-factorial, and overlapped non-medical arenas, such as the law?
I would not have thought that such suppositions would be controversial, but they are.FULL ENTRY
Many years ago, I wrote this essay in which I wondered why I receive so few gifts from my patients in the holiday season. I was prompted to write the essay by the memory of my father, an orthopedic surgeon in solo practice, whose patients showered him every December with foil-wrapped bottles of booze, tins of cookies, and all manner of goodies, including a "World's Greatest Doctor Figurine." I speculated that perhaps dad's speciality, his age (I recalled only his 50s and 60s), his gender, his cozy office on the ground floor of an apartment building, and the era in which he practiced explained his patients' relative generosity. When I wrote the piece I was a young woman caring mostly for other young women in a large internal medicine group housed in a mega-sized, late 20th century hospital. These factors, and not my patients' lack of affection, surely explained why I went home every night with the physician's equivalent of a lump of coal, right?FULL ENTRY
A representative of Boston Mayor Thomas M. Menino said yesterday that the mayor hopes that his newly diagnosed diabetes provides a "teachable moment" for those who aren't aware or informed enough about this common and serious disease. Currently, about 25 million Americans have diabetes, with millions more at risk or undiagnosed. To assess your own knowledge of diabetes, take this brief quiz that covers some basic facts--and frequent misconceptions:FULL ENTRY
'Tis the season when we'll see countless articles about holiday weight gain. It's commonly believed that Americans gain, on average, 5-10 pounds between Thanksgiving and New Years. It turns out that the average gain is closer to one pound--but that, according to this study, it's a pound you never lose. After a few decades that annual pound becomes...obesity.
But say you're someone who does gain a few pounds this time of year. Is it really because you eat turkey, mashed potatoes, fruitcake, and eggnog non-stop from late November to January 1st? Okay, so maybe you do. But is something else going on, too?FULL ENTRY
In our practice, doctors have the option to administer influenza vaccines right in the exam room. The truth is, giving the flu shot only takes a couple of seconds. The syringes are pre-filled, so all you have to do is pop on a needle, swipe the patient's upper arm with an alcohol pad, and jab.
It's the conversation that precedes the flu shot that takes time.FULL ENTRY
On November 6th, Massachusetts voters will have some important choices--other than Brown vs. Warren and Obama vs. Romney. Two questions, one concerning a terminally ill person's ability to end his or her own life and the other regarding medical use of marijuana, will be on the ballot. In both cases complex issues that medical professionals, policy makers, and ethicists have struggled with for years will be put before voters in dense summaries that many, realistically, will skim while standing on line at the polls.
I won't tell you how to vote on these questions, but maybe I can help you make your own decision by providing some details about the choices and summarizing their opponents' and supporters' points of view.FULL ENTRY
Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients' understanding of their medical care. This article discusses the extent to which clinicians overestimate patients' "health literacy"--with potentially dangerous results.
But sometimes, medical lingo has a more subtle negative effect: it reinforces our false sense of being less human, less fallible than our patients.FULL ENTRY