We get what we incentivize.
This is a basic rule. I’d love to say it’s a basic rule of humanity, but unfortunately, I have a background in psychology, so I know it goes a lot deeper than that—it’s a basic rule of every living creature. Humans are, in many ways, just very big pigeons. We reliably prioritize certain rewards. We prefer smaller sooner rewards to larger later rewards; we push the …
After a great game of doubles tennis, a good friend brought up a recent visit with his primary care physician while sitting with friends, trying to cool down. He expressed appreciation for his position but complained about the need to see his doctor every three or six months, all the while acknowledging various medical problems being addressed.
This led to general comments by several non-physician friends about how they feel that …
Why even doctors need regular doctor visits
Last evening I crumbled in the arms of my patient and wept. This was unknown territory to me, an unexpected role reversal. For three weeks after my Mom’s death, I maintained a stoic distance as patients offered their condolences, as they asked about my mother, and empathized. We doctors have been trained to do this, to face death, to keep our emotions at arm’s length. But this patient, who has …
Dear Dr. El-Dalati,
I am sorry that we will not be able to publish your recent letter to the editor regarding the Chowdhury article of 16-Sep-2021. The space available for correspondence is very limited, and we must use our judgment to present a representative selection of the material received. Many worthwhile communications must be declined for lack of space.
The response from The New England Journal of Medicine (NEJM) seemed simple and …
When your letter to the editor is rejected or ignored
From the halls of ancient Greece to the heights of television screens, the myth that the physician is more god than mortal has stood the test of time. As such, we are held to moral and superhuman standards no matter how tough things get. And thanks to our friend Hippocrates, we are oath-bound in our virtues to help anyone in need; while putting OUR personal needs aside, of course. Many …
Doctors treat people in all types of situations. Life or death. Sometimes both. Babies die, children die, and teenagers die. Women die. Men die. Sometimes you even have the misfortune of delivering a stillborn. Everyone experiences death, but for doctors, it’s part of our daily norm. Day after day, for decades throughout their career, we have to experience death and the pain of others. Beyond being knowledgeable and competent in …
It’s called crying and it’s normal
On the day before the last day at my last job, I reviewed my patient roster. Five of my seven most worrisome teenagers were currently admitted to a psychiatric hospital for a suicide attempt. This was not completely surprising. It is the fall. Teenagers notoriously struggle two to three months after starting school, getting into academic work, falling prey to bullying and stress, or not meeting their goals. But I …
A goodbye note to my suicidal teenagers
I read an article recently suggesting that physicians were burned out from hearing about burnout. The proposed solution was to create systemic changes to help alleviate the burden of complexities of care that have polluted health care delivery. The solutions involved adding a team of individuals, including nurse practitioners, physician’s assistants, pharmacy assistants, and other physician extenders.
Once again, rather than focus on the physician-patient relationship on which medicine is based, …
The physician’s real problem isn’t burnout
Dear Art:
On Friday, June 11, 1982, members of the faculty convened to discuss the performance of the psychiatric residents during the last six (6) months. The following is a summation of their comments as they apply to your performance.
The faculty’s reaction to your performance was uniformly excellent. There was some comment on your earlier fear of the psychotherapeutic role, but the consensus was that this has improved markedly and that …
I’ve spent years deeply uncomfortable in my skin.
Wanting to disappear.
Last night, a wave of anxiety hit me as it often does when the world gets quiet.
In tune with my body for a brief moment, my heart ached.
Why?
I envisioned that moment when we ponder what we would regret on our deathbeds.
And I saw the years many of us spend hating our bodies.
Our glorious bodies that make being present in this world …
What does self-compassion look like in your life?
Medical support staff is leaving in droves and leaving patients’ health at greater risk. Calls and messages to doctors’ offices have surged as patients try to access care. Wait times skyrocket to book visits.
News stories about the current state of the health care system typically focus on the plight of doctors and nurses. Studies detail the “Great Resignation” impairing the health care industry–a new report published …
Medical support staff is neglected, disrespected, and mistreated
An excerpt from Doctor and Goliath.
We’ve all heard about David and Goliath, correct? In one of the most epic underdog stories ever written, a young boy defeats a giant Philistine warrior. But how did that happen? What tools did David employ to win his battle? Was it the five round …
How can doctors slay their Goliaths?
Loss of autonomy, gaslighting, abuse, exploitation, and hypocrisy are all strong words. Just writing them brings to my mind the harsh reality of my experience and the collective experience of others who have dared to speak up. These words come to mind when I think about primary care in Canada. I recognize similar sentiments are heralded by my U.S. colleagues and those in the United Kingdom.
The system is failing. …
The slow death of primary care: a Canadian perspective
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Patient volume has recovered across the country, and most medical offices are back to a steady state of care delivery—but ambulatory care has changed irrevocably. We’ve entered a phase shaped by crisis and marked by even more intense cost pressure and consolidation. What steps can independent medical practices take now to help ensure stability and prosperity moving forward?
Offer employees a more rewarding work experience.
The great resignation—unprecedented turnover in the labor …
Ambulatory medicine today: Focus on what you can control
An essay posted by Fareeha Kahn, MD (“A hospitalist’s struggle to find teamwork in academic medicine“), raises an important issue. The problem of lack of collaboration is not unique to academic medicine. The problem is the result of misaligned incentives.
Having read the work of Harvard Business School professor Michael E. Porter, I better understand the goals and challenges of value-based care. If we look at the premise …
Why is collaboration missing in health care?
The precipitous decline in the mental health of U.S. children and adolescents has been meticulously cataloged in newspaper articles, books, and documentaries. In our own pediatrics clinic, the numbers have skyrocketed — a baseball player unable to get out of his car for practice, a teenager with aggressive behavior masking underlying depression and anxiety, and another 9-year-old unable to attend school due to daily panic attacks. Every day now, we …
Digital philosophy: a critical tool for the mental health of children
The question of addressing physicians by name has been addressed again. Yet the question about names has not been addressed.
Before addressing the name question, I will talk about how I have evolved with time.
In India, I have been used to formally addressing everyone as either “Sir” or “Madam” during in-person meetings and in virtual communications when I have known them — “Sir/Madam” or rarely …
Why we should end gendered titles
I saved a baby’s life today.
I say that not to impress anyone or to make myself out to be some kind of deity but because it is simply true.
A three-week-old baby arrived at my office, gray and limp, with agonal respirations and oxygen saturation of 67 percent. My team of dedicated office staff worked with me rapidly and seamlessly, providing oxygen, bag-mask ventilation, and emergency medical services (EMS) activation. Together, …
To paraphrase Fat Man’s Law Number Three, “At a code, the first pulse you take is your own.”
Enduring advice, as true today as it was in the early ’70s when Roy G. Basch, MD, and his gang of hapless interns roamed the airless wards of The House of God, the mythical hospital in the infamous novel by Samuel Shem, although almost everything else about practicing medicine seems …
My first COVID vacation last year was spectacular, except that I barely remember three days because I was drinking to the point of amnesia.
I am a physician from a multigenerational family of alcoholics, and I never wanted to struggle with alcohol use disorder. Instead, I discovered that I could avoid feelings of discomfort by overworking, achieving, and staying perpetually busy. Workaholism became my drug of choice. As an adult, I …
The story of a physician, after a year sober
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