Organizations that nurture physicians’ careers can attract and retain the best doctors

Physician
June 3, 2021

Over the years, I’ve had the privilege of assisting more than 2,000 distressed physicians – some with burnout, others with “rough edges,” still others with psychiatric conditions or misuse of drugs and alcohol.  Some of these doctors were still functioning well; others had lost their licenses and their livelihoods, hoping against hope that they would somehow be able to return to medicine.  Linking all these physicians is a shared passion …

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The Pandora’s box of Step 2 CS reporting

Education
June 2, 2021

Introduction

The USMLE Step 2 Clinical Skills (CS) exam was implemented to assess medical students/graduates based on 12 standardized clinical encounters. The exam was graded as pass/fail based on three components: integrative clinical encounter (ICE), communication and interpersonal skills (CIS), and spoken English proficiency (SEP). To receive an overall passing grade, an examinee was required to pass all three components.

Over the years, there have been increasing demands to …

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Confession from a female doctor: I am sexist

Physician
June 2, 2021

Maybe it’s a testament to a hardy relationship that there was no resulting argument. Without thinking, I blurted out, “You are so sexist!” I could immediately tell by my husband’s face, his upper eyelids and eyebrows lifted a bit, his mouth freeze-framed in a small “o” — my exclamation surprised and insulted him. Maybe it was a completely unfair assessment; after all, he was standing at the sink, his hands …

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8 things I learned in my first year as an attending

Physician
June 1, 2021

1. You will be underestimated. This can look like many things: Little jokes about how young you look, having to correct how others say your name, having your orders questioned or not completed.

What got me through this was reminding myself why I was there: I am Dr. Patel here to take care of Patient X, and this is what we need to do. Make sure your badge works where it …

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The mission of medicine: not just a job

Physician
May 31, 2021

The mission of medicine is to heal the sick.  When cure is elusive, it is to relieve distress, and always to comfort.  All of us who became physicians had our reasons, but we had to have a genuine interest and ability in science, and an appreciation of people as individuals living in families and societies. We had to be willing to work hard to learn and to keep up with …

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Breastfeeding is not the end all be all

Conditions
May 31, 2021

“Thank you. You’re the first to say it’s OK for me not to breastfeed.”

These words have been said to me before by tearful, exhausted mothers. It had been sporadic, but now, it feels like I hear this every day in the clinic. Each time, I feel a rush of mixed feelings as I explain that other options had not been explored because of the known benefits of breastfeeding. I tell …

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Caring for caregivers post-pandemic

Physician
May 27, 2021

Health care systems in the United States are beginning to emerge from the devastation of the pandemic. Since the existential threat of COVID-19 first hit in March of 2020 and the waves kept rolling across the country, doctors, nurses, and other clinicians put themselves and their families at risk to save others.

Clinicians were thrown into situations for which neither they nor their institutions were prepared. Like combat, the pandemic created …

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Doctors’ dirty little secrets

Physician
May 27, 2021

Doctors have a few dirty little secrets. We have the highest rates of suicide amongst all professions and are in desperate need of mental health reform.

For those who don’t know what it’s like to work in this area, it can be difficult to understand the pressures that doctors face daily.

Doctors live their lives balancing an intense workload with long hours, often without any time for themselves or their families. Many …

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Bridging the political divide [PODCAST]

Podcast
May 26, 2021
YouTube video

“Where do we go from here? Conventional wisdom suggests that we can only transform ourselves. This is why I propose that we attempt to recognize the Trump that lies within each of us and to heal him. We are plagued not just by the pandemic but by the human condition—and no …

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Raising the awareness of celiac disease in the medical community 

Conditions
May 26, 2021

May is Celiac Disease Awareness Month. Physicians and others in the medical community need to be more aware of celiac disease.  Celiac disease is an autoimmune disease triggered by the ingestion of gluten that affects approximately 1 percent of the U.S. population.   However, most physicians didn’t learn much about it in medical school or during training.  As a result, physicians don’t include celiac disease in their differential diagnoses and …

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I was a doctor. Could I also be a nurse?

Physician
May 26, 2021

One of my clinic patients recently asked me to administer his intramuscular medication injection. I appreciated the vote of confidence but had to tell him he was mistaken in thinking that my skill would surpass that of our nurses’.

“Trust me,” I told him. “You’re in better hands with them.”

It reminded me of the time, some years back, when I inadvertently found myself “impersonating” a nurse for a school field trip. …

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3 reasons why patients are unhappy

Physician
May 25, 2021

When I’m working in the hospital, I always find it interesting talking to patients about their medical history and experiences with outpatient physicians. I recently wrote about our broken primary care system. In fact, I’ll be stronger than that: Our primary care system is a tragedy, and it’s reflected in the comments I receive from patients. This is despite the best efforts of an amazingly dedicated number of doctors, …

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#PedsMatch22 and the social media imperative

Education
May 25, 2021

The 2020-2021 residency application cycle was profoundly altered as a result of coronavirus disease 2019 (COVID-19) in the United States which led to a completely virtual season for nearly all specialties. At the time of this publication, pediatrics, obstetrics and gynecology, and ophthalmology have announced virtual interviews for the upcoming 2021-2022 cycle. Using lessons from the inaugural “virtual” cycle, many residency …

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Here’s the secret to establishing a great physician reputation

Physician
May 24, 2021

Summer marks a flood of young new attendings hitting hospitals all over the country. There will also be many doctors whose first contract is coming to an end, and they are moving to a new position. Both of these scenarios create an opportunity to make a first impression at a new job. The effects of that first impression will linger for years to come.

What lingering effects do you want to …

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Lessons learned from a general surgery chief resident

Physician
May 24, 2021

I began this journey in 2010. It began as a fresh-smelling breeze after a year and a half of anxiety, depression, and uncertainty. I did not think I would be a surgeon. I thought maybe family medicine, psychiatry — at worst, I would like gynecology. I outgrew the fear of the stereotypes and chose surgery for myself, despite what my now-husband warned me. He thought it would change me, depress …

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When words mislead in the exam room

Physician
May 24, 2021

Words can be misleading. Medical terms work really well when shared between clinicians. But we can’t assume our patients speak the same language we do. If we “run with” whatever keywords we pick up from our patient’s chief complaint, we can easily get lost chasing the wrong target.

Where I work, along the Canadian border, “Valley French” expressions tripped me up when I first arrived. The flu, or in French, le …

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Go behind the scenes with a pathologist [PODCAST]

Podcast
May 23, 2021
YouTube video

“Clinicians want specific things from a pathology consultation. They want a short turnaround time and a clear and coherent report, which can be discussed with the patient and correlates with the clinical findings. Unfortunately, this does not always come to pass, particularly with some smaller or disrupted specimens, resulting from minimally invasive …

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Feel the musicality: A surgeon explores how he learns

Physician
May 23, 2021

My friends and I spent Thanksgiving 2018 attending surf school in Jacó, Costa Rica. We spent that week fully immersed in twice-daily surf sessions interspersed with conditioning, balance exercises, and of course, downtime to explore the town and rainforests of Jacó. Having been on a surfboard only a handful of times previously, this was a new experience for me. Our surf instructors quickly got us out on the water, and …

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My most dangerous COVID intubation

Conditions
May 23, 2021

As the pandemic grew in Southern California, intubating COVID patients became increasingly dangerous. Initially, any patient with signs of respiratory distress was intubated, then sent to the ICU immediately. My physician colleagues and I all thought we were doing the right thing — until we saw all the complications of mechanical ventilation.

Instead of immediate intubation, we tried placing patients on high-flow nasal cannula (HFNC), a special nasal oxygen device that …

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