Every now and then, more often when on call, I experience what I think it was like to be a physician when I was a boy.
I remember the era of the house call. I remember the physician as a part of the community. You saw him around town, school, and at church. You knew his wife and went to school with his kids. I remember that. And I remember the …
We’ve killed the way physicians should be
February 14th, 1990 was not any extraordinary Valentine’s Day here on Earth. Couples dined, candles flickered, hands were held. On a day characterized by love, companionship, and joy, an enormous marvel of human ingenuity named Voyager One was embarking on a solitary trip into the cosmos. Initially launched 13 years previous by NASA to explore the universe, this spacecraft stood alone in the silent void of deep space, six billion …
A reminder of life’s pale blue dots
In September 2010, a seasoned pediatric intensive care unit nurse administered an accidental overdose to a critically ill baby, giving ten times the amount of calcium that was prescribed. Five days later, this baby, with an already tenuous heart condition, died. The nurse recognized her mistake immediately, informed her superior, and also told the family and physicians. She was, however, escorted out of the hospital, put on administrative leave, and …
Doctors and nurses need better support when they make errors
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I was recently invited to visit an academic anesthesiology department to speak to the residents about becoming a leader. In addition to recognizing the honor and privilege of addressing this important topic with the next generation of physician anesthesiologists, I had two other initial thoughts: 1) I must be getting old; and, 2) This isn’t going to be easy.
I came up with the following list of lessons that I’ve learned …
6 tips to be a great physician leader
Part of a series.
We tend to think of the primary care physician (PCP) as the one who does the simple stuff, a doctor who is a mile wide and an inch deep in knowledge and experience. That is a false impression. By education and experience, the PCP is actually a chronic disease specialist.
That is, provided the PCP has the time to care for his or her patients with …
Let primary care physicians be chronic care specialists
Her nails were painted.
She probably had them done just a couple of days ago. The bright red polish glistened on her perfectly filed fingernails. She had her toes done too.
Was she preparing for the holiday season? Had she begun her Christmas shopping yet? Was she making a list of new year’s resolutions?
It didn’t matter anymore.
She was lying there. The cold metal table provided the platform for her lifeless, still body. …
A vow to live a little more and worry a little less
Imagine you are an ambitious new worker at a powerhouse institution. Your job performance is soaring, but you frankly work like a dog. Your weeks top out at 80 hours, you get maybe a single 24-hour block of time off every 7 days, you work weekends, and you often work up to 30 hours straight in one stint, sleep at work, and eat exclusively from food options in the building.
You …
Don’t poop where you eat: Mental health services for young physicians
The afternoon began like any other day in medical school. Students arrived at the lecture hall and took their seats. An individual with long blue-and-white hair and handlebar mustache entered the room wearing oversized fish-print pants, a loose-fitting clown shirt, and a single earing fashioned out of a bent fork. He casually strolled up to the front, introduced himself as Dr. Patch Adams, and told us …
When “healing” loses its meaning: A cynical medical resident meets Patch Adams
Recently, the World Health Organization (WHO) released its report condemning processed meat as a group 1 human carcinogen — a classification that includes such notorious companions as tobacco smoking, smokeless tobacco, and second-hand smoke. This is not surprising considering that processed meat contains many of the same known or probable carcinogens as cigarette smoke, like heterocyclic amines and N-nitrosamines.
Red meat was labeled in the runner-up category as …
How the meat industry is acting like big tobacco
An excerpt from Cure: A Journey into the Science of Mind Over Body.
Linda Buonanno hugs me as soon as we meet, and shows me upstairs to her small, first-floor apartment in a housing block just off the freeway in Methuen, Massachusetts. Her living space is tidy but densely packed with framed photos, scented candles and an overwhelming preference for the color green. The 67-year-old is plump with …
A trial that would revolutionize the world of placebo research
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 21-year-old woman is evaluated for a 3-week history of painful nodules and a rash in the lower extremities, along with pain and swelling of the wrists, knees, and ankles. She reports a low-grade fever and a 2.7-kg (6.0-lb) weight loss since the onset of symptoms. She has taken naproxen with some relief. History is …
MKSAP: 21-year-old woman with a rash in the lower extremities
A Kentucky appeals court ruled that a surgeon was not responsible for a burn caused by an instrument that had been removed from an autoclave and placed on an anesthetized patient’s abdomen.
According to an article in Outpatient Surgery, the surgeon was not in the room when the injury occurred and only discovered it when he was about to begin the procedure.
An insufflator valve had been sterilized and was apparently still …
If surgery is a team sport, should surgeons bear sole responsibility for errors?
Dr. Robert Centor has an important post about hubris. It’s not a long post, if you want to click through and quickly read it. It’s about the danger of overweening pride and overconfidence that can come from blindly believing the praise that is often heaped upon us by those in our care. Essentially Dr. Bob is saying that we must avoid believing all the wonderful things our patients …
How physicians can resist succumbing to hubris
I have never been the director of any professional group. I have, however, been directed. As such, I have a few tips for those who are directors and administrators. I give you my physician satisfaction system. It is arranged in no particular order.
In every physician break room or lounge, there should be a wall for photos of girlfriends, boyfriends, children, spouses, parents, dogs, cats, horses, boats, new shotguns or whatever …
A guideline for physician satisfaction that every administrator should read
I recently wrote about inter-professional hostility in health care. I thought I would share some of the inspiration for that post here. Is there really an escalation of scope of practice conflicts and a downward spiral of disrespect, or is it just more palpable in the modern era of anonymous comments and viral online posts? I don’t know for sure, but lately, the conversation seems louder to me.
In …
Nurses and doctors are in this together. Let’s start acting like it.
I donated blood today. I’m one of those people who doesn’t shudder at the thought of needles piercing my skin, or get queasy as I watch the blood drain from my vein into the collection bag. It’s no big deal. I eat the cookies and drink the juice afterward, and I kind of enjoy talking with the elderly volunteers.
I think I’m lucky. I know so many people who are sickened …
What a nurse learned from a patient who wasn’t afraid to die
“It was a dark and stormy night.”
My computer didn’t catch fire while typing the previous sentence. No alarms were triggered warning me about the quality of such opening. I wasn’t prompted to select subjects and predicates from drop-down lists. I typed the entire sentence, letter by letter, not at all dissimilar to its first rendering back in 1830. Computer software, in general, and Microsoft Word in particular, magically removed the …
How to put EHRs back on the right track
Last year, I visited my brother in Rhode Island at Johnson & Wales University. We took a culinary school class together learning about the fundamentals of Italian and German cuisine. What were two medical students doing in culinary school?
As a fourth-year medical student, I learn the science and art of caring for the body and mind. Unfortunately, the majority of patients are plagued by ailments secondary to chronic preventable diseases …
Cooking is just what the doctor ordered
The daughter of the patient walked out of the room livid. She was convinced that the nurse had no business taking care of patients. She seethed as she recounted all the supposed injuries and mistakes that had occurred. I took a deep breath and paused for a moment, trying to collect my thoughts.
The daughter didn’t know that I had watched this same nurse successfully perform CPR on a man the …
7 surprising things patients should know about their physicians
I walk into the exam room on a Friday afternoon to find a 16-year-old female who is coming in to see me for a sport physical. On paper, everything looks great: Her vital signs are on point, she’s a straight A student, vaccines are up to date, she eats healthy and exercises regularly, Mom and Dad are still happily married and she’s not dating an abusive senior who is pressuring her into …
A straightforward office visit with a teenager turns into something much more
