What really makes a person complete?
What do we want in our lives, and what is it like to become our best, most fulfilled selves?
In the 1960s, psychologist Abraham Maslow tried to answer this question. This eventually led to his well-known hierarchy of needs. You might be familiar with the pyramid.
The premise of the theory is that once we fulfill our basic needs …
How physicians can become self-actualized
This time last year, I took the podium at conferences as far away as Dubai to deliver my keynote speech entitled, “On The Cusp Of Life And Death, Choose Life.” My talk highlighted the professional and personal development opportunities that show up as doctors, nurses, and parents navigate the challenges in the neonatal intensive care unit (NICU) caring for preterm and term newborns on the cusp of viability due to …
3 lessons physicians can learn from adversity
Harvard Medical School student Chloe Li typically dressed in scrubs or an efficient, professional outfit as she went about learning to care for patients in the intense, year-long clerkship program where I teach.
For her capstone presentation on graduation day, though, she wore a cream-colored wrap-around dress of luscious silk, tasteful jewelry, and an up-do hairstyle. She had clearly put a lot of care into these preparations. She …
The unintended consequences of #MeToo in medical education
Stock photos of “health care workers” who attend patients — physicians are no longer distinguishable — usually feature a stethoscope draped around the neck.
But some, such as cardiologist Eric Topol, consider the stethoscope obsolete, nothing more than a pair of “rubber tubes.”
The most important part of the stethoscope is the part between the ears. But some think that will be replaced by artificial intelligence and the rubber tubes by sophisticated …
The stethoscope is not just a prop
You were strong in college
You were strong enough to get through weed-out classes in undergrad. You were strong enough to balance the extra-curricular activities and clinical shadowing expected of you while crushing a 21-hour semester. You were strong enough to say, “no, I have to study” when friends wanted to go out because you had a dream of becoming a doctor someday.
You were strong enough to pay for the applications, …
Doctor: You were strong. You are still strong today.
I paced in the hallway outside of the patient’s room, going over my mental checklist of items to do during the history and physical examination. Bringing in a paper list was discouraged; we were meant to “flow” through the exam “naturally.”
I stuffed my hands into the pockets of the white coat I’d received three weeks earlier, during the White Coat Ceremony for first-year medical students. Feeling around the deep pockets …
The first lesson in medical school: Say you’re sorry
I recently returned from my second extended stay in New Zealand with my family. The entire experience was wonderful, but perhaps our most memorable day began with our three teenage sons waking up early to surf in the South Pacific Ocean. Once we had our fill of tropical paradise, we jumped in the car and drove a few hours to the local ski resort, where we found 10 feet of …
The secret to travel doctor success? Bring your family.
Why do so many of us (meaning me) need to be reminded to act with kindness? Why can’t we “just do it”?
Yesterday, a friend asked me why we don’t celebrate World Kindness Day every day. I believe that’s a wonderful idea. But in practice, it’s not so easy. So, I got to thinking about why that is.
If we want to spread the ripple effects of kindness — to our families, …
7 reasons why it’s hard to be kind
When I graduated from residency, I was too worried about killing my first few patients to examine the meaning of being an attending physician. An early patient, a 97-year-old retired doc, brought it to my attention.
“Being an attending physician means you attend. When you attend me, all I want you to do is show up. You do not have to do anything. Keep the people with needles, knives, and nonsense away from …
The key to being an attending physician
As a young medical student, in my early 20s, I was still too inexperienced to know how a physician was “supposed to” act.
But I took the model of stoicism that I learned from my East Indian father and applied it to the medical model. Lectures on “professional detachment” reinforced this. I remember being told that it was the doctor’s job to keep a professional distance from a patient. By getting …
It’s OK to cry when a patient dies
I enjoy a fairly small private practice and a manageable telepsychiatry side job with good support staff. But even the small scale of my outpatient clinical practice doesn’t fully insulate me from the pain of unnecessary practices that I wish would become obsolete.
1. Preauthorization. The dance of preauthorization starts with the naivety on my part that I decide what medication my patient should be on. I spend precious time crafting …
Stop telling doctors what to do
When I was accepted to medical school, I debated — hard — whether or not to attend.
Out of the physicians I shadowed and interviewed, 19 out of 20 advised me not to become a physician.
Their dissatisfaction was rampant.
Over and over, I was told, “Don’t be a doctor. Medicine’s not what it used to be.”
They spoke of concerns ranging from unreasonable work expectations to inhumane conditions. They described insurmountable pressure, decreasing …
Medicine’s not what it used to be
A recent article was published in the Atlantic about Americans being the worst patients.
Americans are part of a broken and dysfunctional health care system with exorbitant costs, a maelstrom of bureaucratic red tape, and insurance coverage that barely covers what most people need.
But are they contributing to this system by being such bad patients?
The article in the Atlantic seems to imply that this is the case. The …
Are Americans really the worst patients?
Like all doctors, I’m a lousy patient. My doctor is a lovely man, but going to see him? That’s right there with weighing myself, getting a flu shot and doing my taxes, and behind celebrating Thanksgiving with the in-laws and getting a root canal.
And I’m not the only one. If I had a dollar for every patient who told me they hate doctors (no offense), I’d be long retired.
If you’re …
When my obstetrician told me I was not going back to my clinic that afternoon due to severe preeclampsia, I was so indoctrinated that my first thought was of the inconvenience to my patients who would need to be rescheduled. Only a few minutes later did it register that I would be giving birth sooner than I had anticipated, and my new life as “working mother” would begin.
I was due …
Choosing family over medicine: Why I decided to leave clinical medicine
In the current health care system, patient outcomes, and patient satisfaction are increasingly important. With the hospital value-based purchasing program, Medicare adjusts payments to hospitals based on the quality of patient care they provide. Hospital consumer assessment of health care providers and systems scores are tied to Medicare reimbursements. Under the hospital-acquired condition reduction program, hospitals in the highest quartile of hospital-acquired conditions are subject to a 1 percent payment …
3 things every hospital should invest in
It’s difficult to imagine a world now without Google and the internet. It’s also strange to think that most people alive right now received the bulk of their education in the pre-internet era. I remember in the United Kingdom, where I went to medical school, Google only became a thing perhaps midway through university. Since then, of course, the internet has exploded and penetrated every facet of our lives. And …
Don’t judge patients for researching their health issues
Just before I induced anesthesia, he said, “Doc, I want to apologize beforehand. I am incontinent due to a previous surgery so I might wet the sheets.”
I told him not to worry and that we understood and that “these things do happen.” His response has stuck with me: “Doc, but there is still some shame.”
I nodded, told him not to worry since he was going to get a catheter anyway, …
Don’t forget to manage your patients’ dignity
I am a middle-aged, full-time emergency physician, and part-time law student. Usually, I practice medicine during the day and attend law classes in the evening. Sometimes I have law classes in the afternoon or early evening then work in the emergency department all night.
So, what’s harder: medical school or law school?
Absolutely the most common question I am asked by physicians, attorneys, and students at all levels of training.
The other most …
Doctor by day, law student by night
Dear lawyers:
You got it right. Your operations make sense. I know this is wrong for me to say — doctors and lawyers are often at odds with one another — but I have to tip my cap here. I have this unsettling feeling that — from a professional standpoint — your billing practices make sense. And the way you do your documentation also makes sense. Your delegation and hierarchy make …
Lawyers have figured out what doctors haven’t
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