By the numbers – my 2016

The end of 2016 – and every year – brings out the numbers – 10 best events, top news stories, greatest moments in sports, etc.  People have a natural need to quantify and rank things.  It gives us a sense of control over our lives – very important in a year that so much seemed beyond our control.  I am no different – living my life by the numbers.  I track my activity and sleep with a Fitbit, my runs with Runkeeper, occasionally track my calorie intake with Lose It! I track the number of patients I see every day, the articles I post on TheDiagnosisMD, number of hits it gets.  While the numbers are not the sum of all that is important in my life, it is an interesting lens with which to view it through!


  • 11 posts – missed my goal of 2 per month
  • Wrote 4/11 in January – meaning I went months without updating TheDiagnosisMD, other than via observations on Twitter and Facebook.
  • 824 people visited this blog in 2016 – less than in 2015 – perhaps an indicator of the lack of consistency last year!
  • In 2017, not only do I want to write more – I want to write consistently.


  • Tracked 4,463,882 steps – over 700,000 more than 2015 – NYC is a walking town for sure!
  • Ran 375 miles – 25 more than last year
  • Average distance per run 5.4 miles
  • Average pace of 8:56 per mile –  32 seconds per mile faster
  • I sleep an average of 6.5 hours per night – 12 minutes more per night than 2015


  • Not going to attempt to count hours!
  • Became more involved in a leadership role in our practice and the Department of Medicine
  • Was co-investigator on a grant submission (decision pending) to develop a clinical research project and education program
  • Taught medical students and residents
  • 2940 face to face visits with patients

This last number strikes me as incredible – not for its absolute value, but the opportunity it represents.  2940 chances to make a difference in someone’s life.  2940 shared moments of success, failure, hope and fear as people cross my path.  My goal in 2017 is to make the most of these moments – for myself and my patients!

What are your goals for 2017?

The path to wellness begins with a proper diagnosis

Tell Me What You Want

I am asking readers to tell me what you want.  Not in general, but at a health or wellness talk.  A few weeks ago I was asked to speak at a wellness seminar given at a company for its employees about heart health.  The talk was well received, and we had a good discussion after my presentation.

What struck me was how willing people were, in a room full of co-workers, to ask questions about their personal health.  In the office, we have safeguards to protect privacy at check-in, in the waiting room and at check out.  Yet in this conference room, with people they know listening, I was told about cholesterol results and other tests, treatments they were given, etc.  Granted, we were talking about heart disease, which may not seem as socially or professionally awkward as some other topics, but it still surprised me.

It also made me wonder – what did they want?  My professional interpretation and opinion of their situation, or validation that the choices they had made in their own care were “good choices”?

I did my best based on the information people gave me to address their concerns, while encouraging them to speak to their doctors.  Some had questions understanding what they were treating or how to interpret their results.  Others had decided to try a different therapy (often homeopathic) than what their doctor recommended and wanted my approval – so the answer to my initial question is “both”.

I found it to be a little uncomfortable being asked to approve someone’s decisions with limited information, especially if I didn’t “approve.”  However, the talk and Q&A are for the attendees, not me, so I did my best to give a recommendation and encourage discussion between the person and their doctor.

This is a copy of the talk I gave – I want to thank TheVisualMD for the image support in the talk.

My question to you – if you went to a talk like this what would you prefer?  A general Q&A or time at the end to make a mini-appointment to discuss your questions one on one with the speaker?  Tell me what you want!

The path to wellness begins with a proper diagnosis

Everything Old is New Again

Last week, I had a third year medical student shadow me in the office; something I hadn’t done since leaving my old practice in New York City.  Having a medical student changes your day significantly – I find I may be more formal, I spend time filling the student in on a patient’s history, and explaining my thinking and the science behind each case.  My first thought at having a student again was – there is no way I’m going to be able to stay on time!  

One of the things I love about Internal Medicine is the variety of illnesses I see.  While some days feel like I saw the same person 10 times, explaining each person to a student reminded me of the story behind the “same diagnosis” – what makes each person unique.  She asked me why I made a choice to treat one person in a particular way and another differently – because all people are different and have unique features that need individualized treatment.

Our second patient was an older man with swelling in one of his legs.  We discussed the usual suspects – too much fluid, heart failure, trauma were all reviewed.  We also discussed a blood clot (known as a DVT).  As we went through his story and medical history, we decided that it was important to rule out a DVT – the risk of missing it made the decision to get a sonogram on his leg easy.  Later that afternoon we got a call from the radiologist and indeed there was a blood clot in his leg.  Now, when I was training, that call would have triggered a 3-5 day hospital stay while his blood was thinned.  But on this day, it triggered a call to the pharmacy to start a pill and schedule a follow-up appointment a few days later.

The rest of the day was similar – hypertension, diabetes, cold symptoms, until our last patient.  A woman had a bat in her house and had read that people may need to be treated for rabies even without direct contact with the bat.  It turned out, as it usually does in these situations, my student had reviewed this topic recently and was able to teach me – in the situation we faced – we could reassure the patient that no treatment was recommended.  I got to teach my student, and she taught me.

Later that week I traveled to New York City to attend a conference on Cardiovascular Risk Management.  It was my first trip to my old hospital since moving to Arizona.  Reconnecting with friends and colleagues was great and seeing how NYU Langone Medical Center has finally begun to recover from the devastation of Hurricane Sandy was heartening.

So by returning to my roots over the past week – teaching and learning – I feel refreshed.  What seemed old is new again and the stresses of uncertainty in health care gives way to the art and science of helping people lead healthier lives.