Tag Archives: medicine

A post-pandemic view on medicine

I wonder about the difference in perspectives on medicine having been a doc trained during the pandemic. I see a frame shift in my generation, a sense of humility. I inherit patients from older doctors and see a different practice style, and ideal of manipulating people’s physiology to control disease, to treat sensations.

I was trained during a time where we realized medicine is largely helpless. I began my residency during normal times, watched a global pandemic decimate the healthcare system, kill off a portion of the population while researchers desperately scrambled to find any viable treatments. Physicians made up medicine on the fly, nurses desperately proned and suctioned secretions from patient’s airways. None of it seemed to help. The patients would just die despite your best efforts. Then, even when we found amazing viable treatments, a large portion of the population, unfortunately listening to quacks like Alex Jones and Donald Trump, declined our best evidence based interventions.

Doctors of the prior generation often blanket checked labs on all patients, listened to every patient’s heart and lungs, palpated their abdomens. They did these intensely thorough physical exams to find hidden pathology, palpated every prostate that walked in the door, felt for every breast lump, did a hernia exam on every adolescent boy. What we have found based off that mentality, through extensive population level studies, is that sometimes patients who came and saw us, patients who were poked and prodded, actually died faster than the patients we left alone. Our interventions for prostate cancer often caused incontinence, erectile dysfunction, and even killed people who were never going to have any problems from their prostate cancer. We tested the thyroid of everyone who walked in the office, and we found that the younger population rarely if ever benefited from treatment when they didn’t have symptoms and the older population actually died faster because of our treatment.

I have watched a prescription opioid crisis create a whole population of patients whose pain is worse than had they never been started on the medications. I have watched patients come in emaciated, anxious and sleepless because they were prescribed amphetamines for their very normal, very not-pathologic difficulty concentrating in life. I have seen recovered alcoholics pride in their sobriety be decimated when they learn that the clonazepam their doctor put them on for anxiety is, in reality, just alcohol in pill form.

I believe we have created a population of patients who believe sensations need treatment, that existence alone is enough to need medications, that we can prevent every disease. The reality is that it is always an odds game, always weighing probabilities of risks and benefits. And after seeing a portion of the population die from a slight mutation in a common virus, I think I respect our limitations in medicine.

Avoid us. We will poke and prod you and test you and “treat” you until we have caused more harm than good. The most fundamental tenet to the hippocratic oath is “do no harm”. The reality is that there is no way to do no harm. I wish Hippocrates had gone with my high school economics teacher’s motto: “TANSTAAFL” an acronym for “They’re ain’t no such thing as a free lunch”. I tell my patients this all the time when I am trying to talk them out of unnecessary lab testing, unnecessary physical exam maneuvers. Anything I do comes with a cost. I listen to your heart and we lose a few seconds where I could be talking about tobacco cessation or healthy diet with you. Or worse, I hear a murmur that never would’ve caused you trouble and now I’m getting an ultrasound of your heart to evaluate that and I find a mildly dilated thoracic aorta and now I put you on beta blockers which slow your heart rate to a point where you lose your ability to hike up your favorite trail and I do annual monitoring of your aneurysm because that’s what the guidelines say to do and it costs you hundreds of dollars a year, money which you could be spending on a dietician, or a physical therapist, or going to a show with your family, or taking your partner out for a lovely date.

Don’t just avoid doctors. Avoid all of us. “Alternative medicine” practitioners are no better. Naturopaths, chiropractors, functional medicine, homeopaths, will poke and prod you, empty your pockets, convince you of pathology that has no basis in reality such as “being out of alignment” and bring you back in for repeat “treatments”. Avoid all of us unless you need us.

Nothing I do is benign. Nothing I do is without risk. Doctors are not gods. There is a 100% mortality rate to this existence. Don’t fix it if it’s not broken. TANSTAAFL.

How to help a stressed medical student


Most likely this is all a stressed medical student needs. If you pull this one off, you’re very likely one of our very best friends. A crucial part of this is allowing for silence. Don’t feel the need to interject at every pause. In fact, we’re probably not done talking yet. Silence makes us feel like you’re listening whereas a rapid response makes us feel like you really just couldn’t wait to get out what you wanted to say.

Chris Pratt I'm always tired Continue reading How to help a stressed medical student

My Granddad with vascular dementia

He remembered I was in med school, asked me how it was going. Usually I have to remind him. He reminded me of how he was a medic in the Navy during the Korean War, forgetting he had told me this story more times than I could count. I loved hearing about his life though and listened intently. 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. Continue reading My Granddad with vascular dementia

Weight loss isn’t simply a math problem

I used to cite the simple math of calories in<calories out=weight loss as an argument for the ease of weight loss. I’ll be the first one to admit that I’ve believed and said some extraordinarily stupid stuff. It sometimes takes me a while, and I may never learn, but I have to get over my insecurity of admitting I was wrong and admit that this claim about weight loss was fundamentally naive. Continue reading Weight loss isn’t simply a math problem

Stratton Mountain: Day 18, 36.7 miles

When light crept through the trees and lit the fog around the shelter I dreaded the idea of another day. My stomach was empty and growling after a night of vomiting. Others gathered their stuff, packed up, and set off to go hiking. I laid on the shelter floor, dust from dirty boots coating my quilt and sleeping pad. The misty rain had washed the strewn remains of last nights meal spilled outside the shelter, but I had not forgotten. After a couple disappointing days just two days ago, I desperately wanted to be okay. But it was too early after such a long night so I rolled over and went back to sleep.

Eventually my stomach settled and the thought of continuing became less unbearable than the thought of stopping. That’s really all it ever was, never inspiration to continue, just dread at the thought of quitting my Appalachian Trail unsupported record attempt so early. Continue reading Stratton Mountain: Day 18, 36.7 miles

Anatomy last day

Note: It’s taken me a while to post this because it was a very overwhelming experience but I do feel it is worth sharing.

The trademark medical school class will be over in less than a week. I’ve learned every piece of wiring, tubing, and structures of the human body, what else is there to learn? But really all I’ve learned is how the body is supposed to be, how it is supposed to look. In the elderly cadavers that predominated in our anatomy lab, we only learned of a handful of ailments: cancer, obesity, heart disease. Next semester we will continue to study the proper functioning of the human body with still some minor correlations to medicine. But second year we’ll learn the bulk of what goes wrong and a glimpse of how to treat it. Continue reading Anatomy last day

Anatomy lab first day

Note: This is a post I wrote at the beginning of medical school last fall describing the experience I had in anatomy lab for the first day of medical school. Having just finished my first year, I felt it was appropriate to share.

The tension was visible in all my classmates faces. This was big and we knew it. We had all lifted the stainless steel covers, unzipped the tarpaulin bags, and revealed our cadaver for the year.

Our donor, an elderly lady, lay on the table in front of us, a shell of the life that came before. She was scarred, from the sun and the chores of life and with each sun spot and freckle I could see age, wisdom, and love. Looking at her worn hands and feet I couldn’t help but imagine where those feet had been, who those hands had touched, what work they had accomplished and the infinite influence her life had on the world around her. What knowledge did she possess that no one else did? What stories did she tell that will never be heard again? Continue reading Anatomy lab first day

Alternative to what?

“You know what they call alternative medicine that’s been proved to work? -Medicine.” -Tim Minchin

I hate alternative medicine. Absolutely despise it.  I hate it not because of some belief that our current system of treating patients is flawless, nor because of a belief that medicine should be defined by pharmaceuticals, nor that all our current treatments are evidence-based and all-encompassing. No, the reason I hate ‘alternative’ medicine is that it implies a separation where there absolutely is none. It’s a meaningless, confused misconception that splits a common goal into two ambiguous non-categories. The goal of physicians is to care for patients and no concerned doctor is going to deliberately exclude any evidence based treatment at the risk of harming a patient. Continue reading Alternative to what?

The unseen effects of belief in alternative medicine

There’s always a cost. In the case of ginseng as an herbal remedy, the largest cost is very likely not its symptoms to the user. I read an article earlier on NPR about the effect of wild ginseng harvesting on our National Parks, highlighting the effect it has on ecology, the risk of American ginseng extinction, and the impact of its poaching on individuals and communities. Ginseng is selling for ridiculously high prices in Hong Kong, up to $20,000 per pound. For the poacher here in the eastern United States, that can mean selling their prize for over $200 per pound, a healthy income for some in rural Appalachia. But it can also mean 5.5 months in federal prison in the case of Billy Joe Hurley who was convicted multiple times for ginseng poaching. The reason for the high selling price for american ginseng is not that it is a culinary treasure over in southeast China, instead it is viewed as an herbal remedy for many ailments and diseases. And the reason that it isn’t simply cultivated is that the delicate forest ecosystem is difficult to mimic and mechanize. With ginseng selling for such a high price and having a tremendous impact on people’s lives and the ecosystem of the Appalachian Mountains, I wondered whether this is all worth it. Continue reading The unseen effects of belief in alternative medicine