Friday, August 21, 2015

I had an article published on a well known blog:

What I Still Love About Medicine?

From every direction, the practice of medicine in the U.S. is under attack. If one were to believe the headlines, the American healthcare system is populated by insensitive, selfie shooting, medicare-medicaid cheating, inefficient, and ineffective physicians grappling with an over regulating government, predatory insurance companies more concerned about profits than the health of their customers, and a legal system that more often confuses a bad medical outcome with actual malpractice.  Morale in medicine may never have been lower among physicians than it is currently. Studies have demonstrated that few physicians are positive about the future of their profession, and the majority do not recommend medicine as a career choice for young people or their children. 

I have always wanted to be a physician. It has always seemed that it was the “family business”.  With a Grandparent, uncles, cousins and a father in healthcare, did I exercise “free will” when I accepted admission to a 6-yr medical program at the age of 18?  One could argue, maybe not!  However, on the eve of starting medical school I affirmed for myself that it was what I wanted to pursue.  I have never looked back on that choice with regret despite the ups and downs of this noble profession.  To answer my self-imposed question, what I love about medicine are the unique opportunities it has given me. Caring for others, educating trainees, a collegial bond, and the intellectual challenges have sustained me through difficult times.

As a physician we have a unique responsibility and a privilege. It is called the “doctor-patient relationship.”   I have always viewed this privilege as earned through years of hard work. Inherent in our profession is the acknowledgment that those we care for are suffering. The Latin root “patiens,” from “patior,” is to suffer or bear. I can’t stand it when some try to use the term client in its place.  My automobile mechanic has clients. I have patients. We share an intimacy of information and emotion with patients that few other professions allow. Other than maybe members of the clergy, no one else is privy to the closely held secrets, pains and distress of our patients.  We often have the ability and need to heal not just the body but also the spirit of our patients.  At the end of the day, it is just one doctor-one patient linked together in a sacred relationship. I don’t think any other field would provide the same opportunity. The more we give, the more we get.

Sadly, the pressures on physicians are increasing while economic reimbursement is decreasing.  The amount of debt accrued by medical students is astounding. In as study by the AAMC, it was noted that the median educational debt of all students was $180,000. Including interest payments, the total repayment could approach half a million dollars. Considering the length of time in post graduate training as a resident or fellow varying from 3 to 7 yrs. earning a modest income while working long hours, the “opportunity cost” of not being able to earn a higher income and start saving for retirement is a real economic hardship.  Medicine has attracted the “best and the brightest” historically. Given falling reimbursements, increased debt and outside pressures, people contemplating a career in medicine may not make the equation that the personal rewards that a medical career can give balance against the decreased economic benefits.  That will be a regrettable day that is probably already here.  To “save” medicine, society will have to absorb the cost of medical education in some manner as it did the cost of postgraduate training with Medicare.  Those that choose the profession in the future may actually be more dedicated and value the non-monetary reimbursements more than the financial.  Hopefully they will be just as capable.

Gary B. Nackman, M.D.
Owner, NJ VeinCare, LLC
Clifton, NJ

Clinical Associate Professor
Dept. of Surgery
Rutgers-Robert Wood Johnson Medical School

New Brunswick, NJ

Tuesday, August 18, 2015

     Here is an interesting article discussing the interaction between the venous and the lymphatic system. Chronic venous insufficiency can lead to not only the pain, aching, heaviness and restless legs but also swelling.  The tissue fluid can overload the lymphatic system causing edema.

Friday, August 7, 2015

     This is a touching story about how doctors and patients can touch each other's lives in unanticipated ways. It is about the magic of the doctor-patient relationship.

Tuesday, August 4, 2015

Individuality in Medicine?

    This is an interesting article by a physician early in their career. I have been out of residency and fellowship for close to 20 yrs and have a bit of a different take than the author. Sadly, the author's view reflects an element of being trapped in a field that the author would not recommend to others. I have always viewed being a physician as a privilege that was earned through years of hard work. I have spent most of my career as a full time academic surgeon/educator at a major university hospital until 6 yrs ago when I started a private practice. The author seems to feel that the subjective evaluation of his faculty is somehow unfairly inhibiting individuality and that the societal forces of medicine are pushing against the individuality of the physician practice. It is true that medical students and residents are evaluated by both subjective and objective methods, but education research has demonstrated the validity of the subjective observations of trained observers. The issue of when individual expression becomes a question of "professionalism" is a good one. The societal forces impacting medicine with increased regulation, governmental and corporate interference with the doctor patient relationship is a real issue. However, at the end of the day, the physician is granted a unique experience and responsibility in the doctor patient relationship, which is why medicine still offers exceptional opportunities to intervene in the suffering of others.

Monday, August 3, 2015


     Many people have questions about a medical condition called phlebitis. Phlebitis means inflammation of a vein. Most of the time this is a "sterile" inflammation, which occurs in the absence of an actual infection (an exception might be after having an intravenous catheter that becomes infected).  The inflammation of the vein may be associated with a blood clot, a condition known as thrombophlebitis. The superficial veins, such as varicose veins of the leg or arm may be involved or even the deeper veins found near the muscles.   A blood clot of a deep vein, a DVT, can have life threatening consequences.

     Most episodes of superficial phlebitis respond to elevation of the extremity, warm soaks, anti-inflammatory medication such as non-steroidal anti-inflammatory dugs such as ibuprofen or aspirin.  Sometimes, a superficial clot can spread to a deep vein so it is very important to see a physician if you have a painful vein.

    For an excellent review, see this article on WebMD: