A Doc's Life: A blog dedicated entirely to life in the hospital and your health

wow. wonderfully articulated. thank you.

2009-08-28T22:46:10.866-04:00

wow. wonderfully articulated. thank you.

Thanks for your thoughts, I really enjoyed this po...

2009-08-28T05:09:20.156-04:00

Thanks for your thoughts, I really enjoyed this post.

Thanks, Hospicephysician! I loved your site.

2009-08-13T22:36:01.058-04:00

Thanks, Hospicephysician! I loved your site.

No comments, figure that, Doc. A woman goes throu...

2009-08-06T21:21:50.216-04:00

No comments, figure that, Doc. A woman goes through nine months of hormonal zigzags, blows up like a balloon and then goes through labor and delivery.

Your mother did that for you, and would be very proud. Hopefully your medical training blog will be used to help other students and that it is now a mere memory, like the pain that your precious mother had at the birth of her doctor son.

As a prospective patient, I'd rather interns and residents didn't have such grueling schedules. I'd rather not be seen by someone who's been on for 36 hours and is ready to clock out.

Your work is appreciated.

I also appreciate your insight as I do not meet ma...

2009-08-01T00:41:28.040-04:00

I also appreciate your insight as I do not meet many gastroenterologists as yourself. I am a Hospice and Palliative Medicine physician and in regards to getting ethics involved, the patients would just be as well served with Palliative Care involvement. We discuss many of the same issues and I get consulted on many cases to do a "Goals of Care" discussion that address many of the same issues that most people think are only handled by bioethics. Of course, there could be a problem if you don't have a Palliative Care Service in your hospital. I'm sure Dr. Sinclair would agree since he also is a Palliative Medicine Specialist. I recently started a blog and would appreciate your insight. I will post a link to your blog. Thanks again. My blog is www.hospicephysician.wordpress.com

Hi Christian, thanks for your comments. I certai...

2009-07-06T14:48:25.754-04:00

Hi Christian, thanks for your comments. I certainly hope that my colleagues share my view that, prior to putting a hole in someone, a lot of careful thought and planning needs to be undertaken. I do not consider myself at first a proceduralist. In fact, the procedures (while fun and often lucrative for my division) are the last step in a discussion with myself and the patient. Even a routine screening, while mundane to us GI docs, is a big deal for the patient to undergo, and requires a good amount of educating the patient and trusting that they understand the risks and benefits prior to me feeling comfortable enough to pick up the scope.

Found your post via Medical Futility by Thaddeus p...

2009-07-03T21:26:18.954-04:00

Found your post via Medical Futility by Thaddeus pope. Great insight and writing. Would love to hear your opinion about PEG tubes by GI docs. Do most GI docs consider themselves service technicians/proceduralists called upon to just put it in OR professionals willing to assess the probability of benefit for a PEG before putting it in.

James Hallenbeck had a great article and blog post about this issue back in 2006.

I think it bears remembering that lawyers do not s...

2009-06-24T12:10:49.173-04:00

I think it bears remembering that lawyers do not sue doctors: patients sue doctors. It's also important to remember that for every prosecution there is a defense. Most lawyers are as embarassed by their malpractice brethren as doctors are of their boob-job brethren. And while some lawyers do make great money straight out of school, many go on to work with the DA or take non-traditional routes that start around 40 or 50k. Law has residency, it just doesn't label it as such. Those that do make 150k starting will stay there for quite some time. Only Family and Peds make less than 150. The average physician salary still far exceeds any other profession including their archnemesis lawyers. For persepctive, I'm a medical student, not a law student.

The blog is both scary and hopeful, and I am happy...

2009-06-15T10:54:11.458-04:00

The blog is both scary and hopeful, and I am happy to know that doctors like you are thinking about this stuff. I do not think that anyone can truly imagine the decision until they are face to face with it, but knowing that a doctor would take the time to honestly explain all options is wonderful. Please keep writing your blogs; I love reading them.

These are vivid, compelling cases that raise impo...

2009-06-14T21:21:48.697-04:00

These are vivid, compelling cases that raise important issues about both our physical and our psychic health. Your honesty in telling us what you see, what you feel, and what you question is admirable, courageous, and, most important, decent. The title of your latest post speaks volumes.

The well-chosen scene from 'Malice' instantly reminded me of a couple of surgeons who could easily be stand-ins for Alec Baldwin's character. It is, therefore, very comforting to know that you, and other doctors like you, will be bringing a more human(e) touch to the medical profession.

Indeed, who is to judge is just the question. I t...

2009-06-13T23:07:55.612-04:00

Indeed, who is to judge is just the question. I truly hope, in an era of living wills, that the answer is the patient him or herself- their body. As for the medical profession extending life, your comment has inspired my next entry on that very subject.

Thanks for your input, it made ME think.

To what extent, I wonder, does the medical profess...

2009-06-13T21:34:19.334-04:00

To what extent, I wonder, does the medical profession, itself, directly or indirectly stimulate the desire to extend life beyond the point of meaningful viability? Given the marvelous advances in medical science and treatment that have lengthened the span of our lives, we have perhaps come to expect too much. These expectations, in turn, fuel "an ignorant attempt to cheat the inevitable."

Whether ignorant or not, the attempt is understandable. Our bodies will give out, but our hope won't: it is unquenchable. The ever-expanding possibilities of medicine, including prospects for "miraculous" cures, have, indeed, led us to hope beyond hope--a hope that never dies. Thus, the scene you describe well: Patient X is subjected to CPR with multiple defibrillations, followed by additional resuscitation attempts. Who is it who doesn't want to let go--the patient, the loved one looking on, the doctor...life itself?

I think that the heart of the matter is captured in your reflection, which I paraphrase: Who is to judge? That is the question: to be or not to be?
And as long as no one can really know the answer, it takes courage or love or godlike reason to confront the question. Fortunately for Patient X, his wife of 58 years had all three.

Thank you for your blog. It makes me think.

Thanks for your insights, Jim. It's really an ama...

2009-03-17T21:37:00.000-04:00

Thanks for your insights, Jim. It's really an amazing piece of film.

Thanks, Pat. A much needed hug indeed :)

2009-03-17T21:35:00.000-04:00

Thanks, Pat. A much needed hug indeed :)

What's the difference? YOU'RE the difference (in l...

2009-01-03T08:14:00.000-05:00

What's the difference? YOU'RE the difference (in lots of lives). Can you feel this? I'm giving you the hug. Why? Because we all need hugs, even our strong doctors. You're sleepless in Boston because you care about your patients, give yourself a break. I will keep you in my prayers . Keep the faith

You're not losing your patience, you're just in di...

2008-12-30T09:12:00.000-05:00

You're not losing your patience, you're just in dire need of sleep.
Today is the day you get the hugs!
Hang in there, we all need you.
Now, can you feel it? I'm hugging you.

Thanks for reminding me that I need to see that mo...

2008-11-30T14:51:00.000-05:00

Thanks for reminding me that I need to see that movie --- it's been idling on my must watch list for too long.

I find it comforting that doctors are encouraged to allow a heavy silence to ensue after bad news is delivered, rather than, say, trying to defuse the tension somehow. Processing fear and pain is natural and healhty, but so easy to defend against.

Wow. Heavy stuff.

2008-11-20T14:42:00.000-05:00

Wow. Heavy stuff.

Agreed, Jim! Well put.

2008-10-15T20:36:00.000-04:00

Agreed, Jim! Well put.

There's also the popular theory (mostly among reco...

2008-10-15T17:26:00.000-04:00

There's also the popular theory (mostly among recovering addicts and alcoholics) that addiction is a mental illness (they would say "disease") which drives the chronic return to damaging substances, often in spite of a strong desire to stop --- according to this theory willpower is only a small factor in one's ability to recover. It also requires education about addiction, resources for coping and life management, and even spirtuality.

This is not to understate the value of a concerned doctor putting it bluntly to the patient: "If you don't stop you will die. You need to get help."

So many people think that doctors aren't just peop...

2008-10-10T15:58:00.000-04:00

So many people think that doctors aren't just people too and this blog helps to show that you are real!

Congratulations on the start of your new blog. Th...

2008-09-27T14:18:00.000-04:00

Congratulations on the start of your new blog. There are few things I enjoy more than a doctor who can color his/her experience and practice with words, so that mopes like me can appreciate what a wonder it is.

Keep it up!

A Doc's Life: A blog dedicated entirely to life in the hospital and your health

More posts please!

wow. wonderfully articulated. thank you.

Thanks for your thoughts, I really enjoyed this po...

Thanks, Hospicephysician! I loved your site.

No comments, figure that, Doc. A woman goes throu...

I also appreciate your insight as I do not meet ma...

Hi Christian, thanks for your comments. I certai...

Found your post via Medical Futility by Thaddeus p...

I think it bears remembering that lawyers do not s...

The blog is both scary and hopeful, and I am happy...

These are vivid, compelling cases that raise impo...

Indeed, who is to judge is just the question. I t...

To what extent, I wonder, does the medical profess...

Thanks for your insights, Jim. It's really an ama...

Thanks, Pat. A much needed hug indeed :)

What's the difference? YOU'RE the difference (in l...

You're not losing your patience, you're just in di...

Thanks for reminding me that I need to see that mo...

Wow. Heavy stuff.

Agreed, Jim! Well put.

There's also the popular theory (mostly among reco...

So many people think that doctors aren't just peop...

Congratulations on the start of your new blog. Th...