Too Much Medical Care

Not long ago, one of my elderly patients (who gave me permission to tell this story) began requiring blood transfusions for a condition known as ischemic colitis.

The Problem with Obstacles

I recently wanted to prescribe a medication called Prevacid for a patient. It's a proton pump inhibitor that shuts off acid production in the stomach.

The Caregiver's Manifesto

How many patients have I known over the years who've found themselves caught in the quicksand that is caring for a chronically ill loved one? Too many to count, so I'll recount

Finding Balance

Every once in a while (or perhaps more frequently than I’d like to admit) I find myself overwhelmed by my own life. Taking care of patients, blogging, writing,

Saving Primary Care

The healthcare landscape in the U.S. seems to have changed more rapidly in the last two years than it has in the last two decades. The Affordable Care Act (ACA) has mandated health insurance for all Americans and made it possible for approximately 30 million more of them to obtain it. While this is a welcome development, it poses a significant problem.

Genetically Modified Organisms (GMOs) and You

Despite the public controversy over the safety of genetically modified organisms (GMOs), in the scientific community the controversy is considered misplaced. The National Academy of Sciences has reviewed the safety of GMOs twice, once in 2000 and again in 2004. Both reviews concluded that genetically modified crops pose no threat to human health

At the End of Life

When I was a third-year medical student rotating for the first time on a general medicine service inpatient ward, my team admitted a thirty-year-old woman in acute congestive heart failure. That a thirty-year-old was in congestive heart failure was unusual enough. Even more shocking was the cause: an echocardiogram revealed a tumor sitting on top of her mitral valve

The Power of Influence

While I was growing up, my brothers (I'm the eldest of four boys) often chided me for being so much like my father. I suppose it was inevitable that I would be; firstborn children tend to be rule followers (if you believe in the significance of birth order) and I fit the stereotype.

How to Help People Grieve

After a prolonged, debilitating illness, two weeks ago my father--at long last--died. As a physician, I've observed many people experience loss, but this is the first time I've lost someone close to me. This has, not surprisingly, put me on the receiving end of many condolences. Yet unable to rid myself of my analytical mind even in the midst of grief, I've found myself

Can You Learn to Make Microcompromises?

I've observed, both among my patients and my friends, that the issues which ultimately threaten to dismantle romantic relationships are almost always present from their beginning. These are typically issues that were overlooked or consciously ignored in the adrenaline rush of hope and desire that brooks no interference with the establishment of the relationship,

My Father Is Dying

Somewhere around 2004 or so—I no longer remember the exact year—my father was diagnosed with Parkinson's disease.

How To Tear Up The Good Guy Contract

In a previous post, The Good Guy Contract, I wrote about the particular challenges faced by people dominated by their need to be liked by others. In that post I recounted my own inability to say "no" and then went on to describe my discovery of the reason for it: I'd signed a Good Guy Contract:

The Right Way to Think About Your Ebola Risk

Ebola has riveted our attention: It's a deadly disease with no known cure, and as is true of most infectious diseases, it's easy to imagine how it could become a global pandemic and threaten us directly.

How to Give Feedback

My student's voice trembled as she answered my question. "How do you think you've done so far?" I'd asked her. We'd been together on the general medicine inpatient ward for two weeks—the midpoint of the rotation—and as was my usual custom I was giving her feedback on her performance by first asking her to rate her performance herself.

The Middle Age Spread And How To Combat It

The reason so many people gain weight as they enter middle age is no mystery: if, as an example, you only eat 50 extra calories per day over a period of twenty years that you don't burn off by exercising, it will result in a weight gain of 104 pounds.

Why We're Nicer to Strangers Than the People We Love Most

Why is it we so often find ourselves treating the ones we most love the most shabbily? I don't think, contrary to popular wisdom, that the answer is that familiarity breeds contempt. After all, it's not that all the wonderful things we loved about our loved ones when they first entered our lives gradually become repulsive to us ("I hate that you're so kind to everyone!").

The Obstacle Is the Way

What’s the worst problem you have right now? Have you lost your home? Your job? Are you worried you might? Or are you facing a terrible illness? Long-time readers of this blog know much of my philosophy has been shaped by my study and practice of Buddhism. One of the most useful concepts I've adapted is the concept of changing poison into medicine.

Do Liberal Policies Make People Happier?

Though I'm loathe to wade into any discussion of politics in a public forum—and at the risk of earning the ire of conservatives—I want to explore in this post an argument put forth by Professor Benjamin Radcliff in his new book The Political Economy of Human Happiness that policies typically associated with the political left lead to greater happiness for citizens

How To Be Patient

In the book Siddhartha by Herman Hesse, the main character, Siddhartha, tells Kamala, a beautiful courtesan: "From the moment I made [the resolution to learn about love from the most beautiful woman] I also knew that I would execute it...when you throw a stone into the water, it finds the quickest way to the bottom of the water.

Why Be Honest?

We all lie. Admittedly, most of do so only occasionally. But we still all do. Yet most of us also consider ourselves honest. In his book, The (Honest) Truth about Dishonesty, Dan Ariely offers evidence that we're able to believe we're honest even though we lie or cheat by only doing so in little ways.

The Greatest Invention Of All Time

The greatest invention of all time isn't, as is sometimes argued, penicillin. Nor is it the computer. Nor is it running water, electricity, the automobile, or the airplane. Rather, it's the thing that has made all of these things—and so many more—possible:

The True Meaning Of Friendship

The Japanese have a term, kenzoku, which translated literally means "family." The connotation suggests a bond between people who've made a similar commitment and who possibly therefore share a similar destiny. It implies the presence of the deepest connection of friendship, of lives lived as comrades from the distant past.

Insomnia

Whatever its cause, few things interfere with our waking lives like the inability to sleep at night. Insomnia has multiple causes: anxiety, depression, and medications, just to name a few. I find myself unable to sleep when I'm excited about something (if I'm anxious, I drop off right away—unlike most of my patients).

Forgiveness

A few years ago I found myself thinking about what would happen if as an adult I encountered some of the children who terrorized me when I was in 7th grade (an experience I wrote about in an earlier post, Breaking Free Of The Past), wondering if I'd be able to forgive them for what they did to me. I'd like to think I would, but the truth is I'm not sure.

When Patients Refuse Their Doctors' Advice

In the North American hemisphere flu season is fast approaching. Influenza, as most people know, is a serious respiratory infection that can be life-threatening in the very young and the very old. Some strains, as we've all heard about in the press in the past, are more deadly than others and may threaten even the strong. Luckily, however, we've developed a vaccine.

Understanding With Your Life

When my wife and I were first learning to ballroom dance (much fun!) I was amazed at how effortlessly our teacher was able to lead her when demonstrating a technique to me. She always seemed to know where he wanted her to go and how he wanted her to move, despite being as inexperienced as I. When I danced with her, she mostly found herself confused about what I wanted.

Dealing With Anger

Years ago, a hulk of a man came to see me with a lump in his neck. He was as big as the lump was small, standing at least six and half feet tall with shoulders that seemed almost as broad. His lump, in contrast, was only 2 cm wide. Wide enough, however, to warrant concern.

Being Considerate Of Your Future Self

In a previous post, The Problem With Reincarnation, I wrote: "The sense of self I feel and have always felt has seemed constant throughout my life, which is why I feel as if I even have a core self. But a moment’s reflection reveals that what’s really remained constant is the feeling of the sense of self itself, not the content of that sense. Am I even remotely the same

How To Break Free Of The Past

As I wrote in an earlier post, The True Cause Of Cruelty, for me seventh grade was a disaster. I was persecuted by anti-Semites and so traumatized that my parents endured owning two houses at once for six months in order to get me into a new school. I left seventh grade mistrustful, fearful, and socially isolated, feeling as if I'd hidden my true self for so long

Where Does Wisdom Come From?

What, exactly, is wisdom, and where does it come from? As to the first question, I would argue this: wisdom is a belief that's not only true but that in the fact of our believing it leads us to feel and act in such a way that makes us suffer less or feel joy more. A common misconception is that wisdom is contained in words. But an exchange I witnessed years ago

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