Placebo or practices that are poorly or not based in evidence is an ethically questionable practice in medicine. Is it okay to prescribe medications for patients knowing that they will have limited or no benefit? Because of this I’ve established three rules for myself with regard to placebo. To some extent they are unattainable but I’ll keep trying. Continue reading My three rules for placebo
Category Archives: Medicine and Health
My style in primary care
I’ve been suffering an identity crisis as a new primary care physician. I’ve had guidance with nearly every decision up until this point but now I’m on my own. I reflect back a distinct interaction with one of my attendings in residency. He is an osteopath, manipulates people’s muscles, and fascia for the bulk of his work. I was precepting a patient with him one afternoon. The patient had terrible sleep habits, drank caffeine in the evening, took naps at 5pm, watched tv in his bed, had untreated anxiety and would contemplate the next day’s plans all night. He didn’t work, didn’t exercise, had nothing to exhaust him during the day. He wanted a medication to make him sleep and instead I counseled him on sleep hygiene, a strategy to fix the problem rather than masking it with meds. My attending, disagreed with me and said I should just give him the med. Continue reading My style in primary care
Intrinsic joy
When I was in high school and college, most of the activities I was doing were to obtain validation of others. I had quite an overpowering fear of death, or rather of being forgotten. I remember having this fear around my junior year of high school that one day I was going to die and no one would care. I quickly realized that theism was an easy way out of facing this angst and that was not going to be the solution for me. I needed something more tangible. For years that solution was to be greater, to have influence on the world, to be remembered. I pursued that through racing triathlons for a while. A few people noticed me and a couple people knew who I was. I was the first to cross the line at some little local races and I thought I was somebody. That was really hard. I tried so hard. Continue reading Intrinsic joy
Just a tuesday
In medical school we were taught hope. We were taught the infinite ways we could help a patient. We learned hundreds of medications, participated in surgeries, learned modalities, and were educated on counseling and rehabilitation. A notable piece missing from this education was how frequently medicine is a helpless pursuit and even more importantly, how sometimes it has no role. Continue reading Just a tuesday
What it’s like to die from covid
I had an odd interaction with a patient a few weeks ago. I was encouraging him to get the vaccine, telling him it was safe and effective. I dispelled all his fallacies claiming lack of research, rushed to the market, lack of long term data, and that as a late 40s guy he was at low risk for adverse effects or death from covid. I pointed out that he deferred to experts in his everyday life, trusted driving on a brand new bridge the day it was built (did not need any long term data there), and told him of several 40 year olds I had seen who had died or maybe wish they had died from covid. His response was that he was not scared to be dead. He said, if I am dead, I will be dead, so I won’t care. He has a young daughter. I told him his daughter would care. He said she would be alright without him. I told him it is not the being dead that is so scary, it is the dying part. He said he thought he would be sedated and unaware for that whole process. That is what baffled me the most. He had literally no idea how people die from covid. I want to dispel that. Continue reading What it’s like to die from covid
The strange ethics of vaccination, male contraception in comparison to cancer screening
We are facing a global crisis with an absurd amount of people refusing vaccination. I have nearly hourly conversations with patients about the importance of vaccination and largely my professional advice falls on deaf ears. To be honest, I’ve probably overly entertained the ethics and decision challenges regarding vaccination and find some similarities between that and male contraception in comparison to cancer screening.
Discussing specifically the medical ethics of immunization for rare diseases, it is kind of a strange practice. In the context of covid-19 vaccination this is moot given the absurd prevalence and declining the vaccine is really just an inability to make adult decisions. Nothing else. However, in the case of rare diseases, when we choose vaccination we choose to take a therapy that may potentially in even more rare circumstances cause us harm in order to protect those around us. It is an individually and medically absurd decision, but socially is absolutely vital. Continue reading The strange ethics of vaccination, male contraception in comparison to cancer screening
Why your hands swell while hiking: the real reason
The myths of why hands swell while hiking
You’re five miles into a hike with a group of friends. You’ve never been hiking before and it sounded adventurous and fun and a great way to to get out and have fun with friends, enjoy being outside, and relax for a bit. And you’re having a great time with the exception of a weird feeling in your hands. Your wedding ring and watch are getting tight and your skin feels taut. Your arms feel bloated and you look down and sure enough you’ve got big old sausage fingers. Are you dying? Do you need to turn around and race to the hospital? Maybe you have cell service and after you post a quick pic to insta you do a quick WebMD search. It says you have heart failure or this weird thing called thrombosis. Now you’re worried and want to go back so you can do more internet searching before you head to the ER. When you get home you dig deeper in your internet searching and get more specific. Instead of just searching hand swelling, you search had hands swell while hiking and find an Outside Magazine article, where you may learn that you’re suffering from hyponatremia. You find a facebook thread of loads of confident expert internet commenters recommending the cure-all tip of hydration or electrolytes.
But nearly all this information you’ll find is absolutely, jarringly, painfully wrong, so I hope this article becomes the one to top out on the google searches so maybe some people will learn the real answer, and learn a real solution. You don’t have heart failure, you’re not alone, and you don’t need to hydrate. Continue reading Why your hands swell while hiking: the real reason
Questions of a disoriented third year medical student
“We talked about how we were the only two people in our family with any background in healthcare. I said to him, ‘In a little less than three years, I’ll be Dr. Cobb, how crazy is that?’ He looked up from his lost gaze and said ‘I hope I’m here to be able to call you that,’ and for the first time in my life I understood that he may not actually make it that long, that he was dying.”
I wrote that sentiment two years ago today and while my granddad never had the chance to call me Dr. Cobb, reading through these words today made me feel immensely better about his passing. A little over two months ago he died of respiratory failure after contracting pneumonia. I was studying for my board exam when my mom called me to let me know I should come into town. I packed up my things and was there with him and my family when he breathed some of his last breaths. Continue reading Questions of a disoriented third year medical student
My granddad, Donald Cobb
A few days ago, as I sat watching my granddad take some of his last breaths, I couldn’t help but want to fight and resist the reality that was quickly transpiring. He had developed pneumonia over the last few days and it was progressing quickly. As he reached for each breath with every muscle in his body, I thought of all the medical measures they could do to save him. But he wouldn’t want to be saved at all costs and despite my desire to have him around for eternity, I respected that. But it was so hard for me, as someone who has been learning about all the ways to interfere in the process to just sit back and accept what was happening. Continue reading My granddad, Donald Cobb
3/8 MD
Last year at this time I was out in Colorado living out of my car climbing 14,000ft peaks. I was single, voluntarily homeless, and smelly. I had left school for a 10 month leave of absence just a couple months earlier and was taking advantage of that time to spend some introspective time out in the backcountry. But this year things have been going a lot differently and I couldn’t be more thrilled about it. Continue reading 3/8 MD