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 →

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 →

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 →

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 →

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 →