I just watched the movie 1917 at the theatre. Shot in a unique way giving an immersive experience, showing the frontline reality of war through an unforgettable human story, it has to be one of the greatest war movies ever made. I’d encourage everyone to go watch it. I learned a fair bit about the First World while I was in high school in the United Kingdom. Its stories are …
Health care is like lions for lambs
I sit in Dr. Victor’s small crowded waiting room, awaiting my turn. I am seated between two women, the one on my left probably 45, and the one on my right, somewhat older, both though younger than me.
The lady on my right doesn’t have much to say beyond telling me where she is from, and she is seeing Dr. Victor for the second time. The woman to my left is …
Everyone has their moments. Even doctors.
Being a physician is an important role. It’s easy to forget the impact that you have on a patient just by being at their bedside.
It’s huge.
Have you ever been a patient? It’s an incredibly vulnerable experience.
You’re not really sure what’s happening and what is going to happen next.
People are really putting their faith in you to understand their needs and to ease their suffering. It’s a powerful thing to ease …
How you can show patients you are listening
Every winter, flu season descends upon the hospital. The most consistent reaction among any of our physicians — trainee and attending alike — who succumb to this nasty virus is one of guilt. Even the thought of “calling out sick” leads to such extreme guilt that many colleagues choose to come to work sick instead.
Several trainees have admitted to suffering from flu-like symptoms but pushing themselves to come to the …
“I dreamed a dream my life would be … so different from this hell I’m living.”
Twenty years ago, I would pull out my Les Miserables piano book and pound out “I Dreamed a Dream” while my fellow medical student/roommate would sing along with me to the line above with gusto.
In the scheme of things, we didn’t have it so bad. We hadn’t been abandoned by our lover-baby daddies. We weren’t …
Why Les Miserables should resonate with every physician
In recent times, physician burnout has rightfully surfaced as a social concern for the medical fraternity. Physician burnout is a thing, and lately, I was thinking about it related to nephrology.
Many national physician organizations and local hospital systems are developing strategies to reduce work-life stress and improve the engagement of the workforce. In November 2018, I represented the Renal Physician Association at the interim meeting of the American Medical Association …
Today my clinic patient lost his wallet, including his cash, government ID, and his credit cards. He drove more than 130 miles to the clinic. Still, somehow, he sat in front of me in the exam chair as patient as ever through all my history questions. When I asked about his day as I was washing my hands just prior to the exam, he told me his wallet story. I …
How patients put my life into perspective
“Under duress, we do not rise to our expectations. We fall to our level of training.”
– Bruce Lee (supposedly)
When I was looking for My Patient, well before his neighbor grabbed my butt, I remember noticing that most of the slots in the doors of the isolation jail cells were open. These slots are tall enough to pass a softball and wide enough to pass a clipboard. They are about three …
When a patient in jail lacks impulse control
It is well known by now that a physician’s demeanor influences the clinical response patients have to any prescribed treatment. We also know that even when nothing is prescribed, a physician’s careful listening, examination, and reassurance about the normalcy of common symptoms and experiences can decrease patients’ suffering in the broadest sense of the word.
This has been the bread and butter of counselors for years. People will faithfully attend and …
How to build trust and therapeutic relationships in 15-minute office visits
Many doctors decide to pursue a career in medicine in their youth. They have experience that points them in this direction. Once the decision is followed by a firm commitment, we seldom change the course. Medicine, here I come! At that age and with such limited life experience, it’s impossible to truly grasp the depth of the commitment to this career.
Becoming a doctor is not a career decision; it’s a …
Why physicians should have courageous conversations
Tiramisu, chocolate mousse, red velvet cake, freshly baked cookies, and warm brownies topped with ice cream. These are some of my favorite desserts and the things I start thinking about when I am under intense stress. I often gaze at the bakery section at the grocery store just to take a look when I feel overwhelmed with stress at work or home. It is the classic description of what we …
Stressed is desserts spelled backward
It was mid-January, and I found myself catching some rays on a rooftop in Cancun with 15 other physicians — all women of varying ages and medical specialties. Besides enjoying the sand in my toes and a martini glass in my hand, I was there to attend the TransforMD retreat, looking for clarity on my life choices, values, and goals.
Daily Vedic meditation was to be integral to the agenda. That …
A doctor’s foray into meditation
Most of us are, to some degree, procrastinators. We avoid or postpone doing unpleasant things. In this sense, physicians who are avoiders are no different from anyone else. For a doctor, however, avoiding things often leads to poor, or at least less than frank, communication with parents.
One kind of avoidance behavior is when the doctor avoids answering your questions. These doctors do not behave this way because they are poor …
The doctor who avoids answering your questions
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About three years ago, I was chatting about pain with a friend at a social function, and she told me she was taking a prescribed opioid for her chronic pain. I quickly got the uncomfortable feeling in my stomach that comes from discussing and prescribing opioids in clinical practice. I responded with my concerns, based on solid scientific evidence: “Opioids aren’t really effective for the treatment of fibromyalgia, or chronic …
Talking about opioids can lead to strong emotions
Soon after match day, I became concerned. I knew I was going into emergency medicine. However, I felt unprepared to manage a clinical encounter with limited time and incomplete information. At the time I entered residency, the only published guides available on “how to be an intern” reviewed the medicine I already knew. The only books available on decision-making included statistics, which I knew wouldn’t be immediately useful in a …
Should we teach novice physicians how to manage emergencies before they face emergencies?
He came to the office in search of help as many patients do, but the circumstances that compelled him to seek medical attention were all too similar to me. I’ve seen it time and again. He said that he couldn’t sleep at one visit. At another, his blood pressure was high.
At a visit after that, he’d share more information, and his wife would attend with him. He wasn’t making enough …
Black Man Syndrome: in memory of Bryce Gowdy
We constantly argue about how to fix the U.S. health care system. But what we must understand is that the most important issue isn’t how to fix health care. The issue is how to get our Congress, the President, and the health care industry to allow anything of importance to change at all. The problem is that all three have a vested interest in the current system. The health care …
These leaders will not fix health care
A recent excellent piece by Dr. Karen Sibert, an experienced anesthesiologist at my institution, raised some critical issues regarding how physicians are thought of by non-physicians, and how misguided that thought process is. Indeed, our stress levels associated with the moves we make and the decisions we contemplate, some of which are made and done in milliseconds, do not come with a price tag, but do …
There is no such thing as medical swag
When I finished my training, I wish that I had known all of the options I could practice medicine. Most of us categorized our options as either “academic” practice or “private practice,” but in reality, these two options only cover the tip of the iceberg. Was my limited understanding a shortcoming of my medical training? Perhaps. I doubt that many medical schools back then actually had seminars on practicing medicine. …
Here are the common ways that doctors can practice medicine
They say you learn a lot from your clients. Not in anesthesia, where I frequently feel great empathy for my sick patients and their families. Our connection in the peri-operative environment is too short-lived for this, I believe.
But in therapy, where the relationship is both critical and deeper, and where I have more recently turned my attention, I have come to appreciate that observation personally. I specialize in “burnout,” that …
Self-care for physician burnout: What does that mean?
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