“Breathe in slowly, deeply, giving fresh energy to your body.
Breathe out, releasing any tension from your day.
In … 1 … 2 … 3 … 4 …
Out … 4 … 3 … 2 … 1 …”
I try to follow the yoga instructor, but in my post-call fog, I struggle to let go of the last 24 hours. We begin by sitting poses to stretch our necks. But my neck is so …
To survive in medicine, compartmentalize your patients
Recently I had an interaction online with a physician regarding his thoughts on ADHD treatment. (Let’s call him Dr. Stigma). This post is not about doctor-bashing but more to point out the prevalence of stigma against those with a psychiatric diagnosis even from within the medical community. Stigma, unfortunately, is so indoctrinated into our culture that sometimes people don’t recognize the pure ugliness of their words.
Dr. Stigma’s comments:
Many patients use …
It’s time to stop prejudging your patients
“Does physician leadership matter?” asks cardiologist and author Dr. Sandeep Jauhar in his New York Times opinion piece “Shouldn’t Doctors Control Hospital Care?” He opens his piece with the termination of the elected leaders of the medical staff office at the Tulare Regional Medical Center due to poor performance. He answers his rhetorical question with the obvious and simple response that doctors should control hospital …
Physicians must embrace the business side of medicine
Harry understood at last that he was not supposed to survive. His job was to walk calmly into Death’s welcoming arms … All those times he had thought that it was about to happen and escaped, he had never really thought of the thing itself: His will to live had always been so much stronger than his fear of death … It was over, he knew it, and all that …
The lessons of Harry Potter and the Deathly Hallows
The last few passengers filter in and buckle themselves up before takeoff. The emergency exit row is occupied by an elderly couple, and I am seated behind them. The flight attendant asks whether they are comfortable in those seats, given that they’d have to respond in the case of an emergency.
“Not that I expect anything bad to happen,” the flight attendant adds with a smile.
I, too, am familiar with discussing …
The worst-case scenario question you must ask patients: even healthy ones
I’m passionate about patient safety. In no small part because I was raised to be. My mom has a lot of letters behind her name (RN, BSN, MSN), and she’s dedicated her career to the field.
Before I was accepted into medical school, I knew about “six sigma,” the “Swiss cheese model” and root-cause analysis. I’d been taught about creating a culture of safety and the example of the airline industry. …
4 problems with the Joint Commission
While doing my doctoral dissertation research at a clinic for kids with diabetes, I observed the attachment that some of them had to the physician faculty member who directed the clinic. I particularly remember one teenager who complained that this doctor “did not care” about her, as he sent “fake doctors” (residents) to take care of her, not coming himself. She was refusing to cooperate. When I suggested to the …
The doctor-patient relationship is everything
As a corrections physician I frequently heard the question, “How can you take care of those people?” I understood what they were asking, after all, I was caring for people convicted of such crimes as murder, rape and child abuse.
And yet I had very little difficulty providing the same care to inmates that I provided to everyone else. In fact, the corrections environment was generally easier to work in and …
What I learned as a corrections physician
Here it comes — another email about “physician wellness,” advertising mindfulness training, an ice cream social, or a volunteer day. As a psychiatrist, I can attest to the importance of tending to one’s own mental and physical health in order to strive for wellness. However, the trend of implementing physician wellness programs throughout the U.S. is nothing more than putting proverbial lipstick on a pig. Or, stated differently, this may …
Physician wellness programs are lipstick on a pig
A little ways back, I was at a gathering of friends and family and was in the kitchen setting out a dish of black bean and quinoa dip. Suddenly, I heard someone from behind me exclaim: “What is that? If that’s something healthy, I am not eating it.”
Although somewhat intended as a joke, there was no doubt a truthfulness to what was said, just as exists in similar comments which …
Here’s why we don’t care about our health
Giving birth and running a marathon. They are two seemingly different entities but have many similarities. The inevitable pain, the highs, the lows, the feeling that you may falter or can’t survive the pain and, in the midst of it all, that you will never do it again … but then you do.
Marathons take months to train for by growing your strength and endurance as you increase your training miles. …
Giving birth is like running a marathon
“How did you know what to say to her?” asked the resident, “We have been trying to figure her out all morning and have gotten nowhere.” An expression of mixed curiosity and frustration crossed her face.
“I try not to focus on how she is acting, as much as I try to talk to the part of her Jesus would love,” I found myself answering. This catchphrase would find its way …
Want to make meaningful connections with patients? Here’s how.
After about the first week of anesthesia residency, I was told, “Don’t get pregnant, you are going to ruin the call schedule.” Initially, I took it as a joke because I was getting married that year and I wasn’t thinking of having children yet, but I did think, “what if it happened accidentally?”
After it’s told to you over and over again by your male co-residents and even some of my …
Physicians: Be nice to your pregnant colleagues
Earlier this week, one of the residents and I saw a new patient who apparently had been sent in to see us for a pre-op visit, an evaluation to make sure that her medical conditions were well controlled and that the surgery was safe for the surgeons to proceed with. She reported that she forgot the paperwork they gave her. All she knew was that whatever we wrote had to …
Let’s get one thing clear: pre-op comments from primary care
In loving memory of my grandfather, my first physician mentor.
Earlier this year, my 90-year-old grandfather passed away unexpectedly after undergoing transcatheter aortic valve replacement (TAVR). Similar to many elderly patients who die each year in the United States, his death was preceded by a litany of costly and time-consuming tests and treatments. Despite this extensive workup, the end of his life was shadowed by suffering left unaddressed. But, unlike the …
We all treat the whole patient. We must avoid tunnel vision at all costs.
You’ve probably heard this story before: a young physician, who has spent all of his or her life succeeding and building goals, stumbles into a career without meaning or enthusiasm. Indeed, my story about burnout is much like the rest.
Like so many before me, I entered into a career in medicine motivated and eager to change the world through the care of my patients. I grew up in a family …
Burnout during residency? Yep, and here’s what it taught me.
The key to staying on time in a busy clinic and to finish the day unscathed is to be in battle mode from the get go. The ten rules outlined below will help you to achieve that goal.
1. Make sure your bladder is empty, and that you are well hydrated. This goes without saying. You don’t want to finish the day with …
10 rules to keep physicians on time
I wonder what the best thank you any physician has ever received? I think this one is mine. This recent thank you was for our efforts to not save a child but for simply allowing this family to have a few more days with their infant who ultimately passed away. This amazing thank you has deeply and positively affected me so much …
Thank you for performing CPR on my child
As a cardiac anesthesiologist, there are times I care for patients who are faced with a tough decision: to take their chance on a very high-risk surgery, or let nature take its course. It is in these times I feel most humble and most human, as I may be the last one to hear the last words they speak.
Recently I was at a social event and introducing myself to some …
For an anesthesiologist, this is the hardest part of medicine
7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel.
“He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, …
Here’s what death really sounds like
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