“There will always be suffering. It flows through life like water …”
Those famous lyrics sung by Nick Cave in his Lime-Tree Arbour ring true for many of us. They take on an entirely different layer of meaning for physicians.
Even the very journey of becoming a physician is marked by suffering. While many of our classmates frequented football games, nightclubs, and social events, most of us were studying day and night …
The gift of suffering in medicine
Gender politics aside, let’s talk about why the way doctors get paid matters to you as a patient. Female physicians don’t just get paid less because they prioritize their families, they get paid less because they prioritize patients. In the fee-for-service model, doctors are paid per patient visit, so the more patients they see, the more they get paid. This means that the worst doctors are paid the most. Health …
Female physicians prioritize patients over profits
Yes, this is a piece on observation medicine as the expansion of our specialty. My oh my, have things changes since my days of training where I learned to care for all comers irrespective of their money, background, color or creed. I learned to stabilize, evaluate and treat then admit or discharge. Clearly, I’m simplifying though, historically, our disposition decision was binary, patient in or out.
Then overtime as I practiced emergency medicine (EM) …
Expanding the scope of emergency medicine
I have worked most of the last 20 Halloweens in the pediatric emergency department (ED), so I’ve seen how a split second can ruin your child’s holiday. Here are some things you can do to plan ahead and avoid the ED.
1. Avoid trip hazards
It’s a recipe for mishap. Your child is in a costume that may have long hems or unusual shoes or a mask limiting their normal vision. A …
How do I keep my kids out of the ER this Halloween?
On a Saturday morning, Michael, a physician, was making his way through the hospital atrium after his weekend rounds. On his way out, he noticed a family he knew well. They were talking quietly and appeared distraught. He asked them if they were okay. They said that the husband’s mother had been admitted overnight with a malignant pleural effusion, and since all beds on the oncology floor were full, she …
Should a HIPAA-questionable good deed go unpunished?
“Passion isn’t a path in the woods. It is the woods.”
-Tom Robbins, “Half Asleep in Frog Pajamas”
I’ve met plenty of accidental physicians. These have been photographers, travel writers, artists, outdoor guides and chefs who awoke one day to find themselves doctoring. Their passions didn’t die — they were just delayed by lifestyle choices. By the time they recognized a need to follow their passion, they were at least partially through …
It’s better to not go into medicine than try to get out of it
Late one Friday night while walking the long and lonely hallways of my hospital, my mind wandered back several years. I recalled my first weekend call as an eager, newly minted nephrology attending. I had met one of my colleagues earlier that morning in the doctors’ lounge, whereupon I had been handed a clunky, black weekend pager. “Welcome to being on call every fourth weekend for the rest of your …
Medicine is a calling and being on call is medicine
There are medical honors so rare you don’t even know they exist. When you’re trudging through the slog of PBK/AOA/other — ultimately meaningless — letters, these seem to be the definition of distinction. Just like every other lesson, a patient taught me what real prestige is.
Well, it wasn’t entirely that Oslerian, it was the patient’s nephew.*
Carl paged me on an ordinary day — a fellow physician, he once saved my …
Your greatest role as a doctor? Storyteller.
I’ve had this idea brewing for a while. It’s taken a while for it to form shape, to work its way from a random niggling thought in my head to something I can articulate with the passion and determination it inspires in me.
On labor and delivery: There is an “I” in team.
Yes, I know. I said something inflammatory. I can almost see heads shaking as you wonder how I could …
On labor and delivery, there is an “I” in team
Have you ever felt so cold? I mean bone-chilling cold. I don’t mean the same kind of cold that northern winters can leave you feeling. I am talking about working in a hospital that is climate-controlled, and you are undoubtedly shivering.
I still remember my first day on the job as a neonatology fellow. I was anxiously walking to the operating room to attend the delivery of a 25-week infant. As …
A physician loves the adrenaline surge
Sometimes things go just the way you want them to, and sometimes they don’t.
Compare and contrast the case of two different patients, and how things went trying to get them the care they needed.
The first patient, let’s call him Mr. Smith, called up one day last week with a brand-new symptom, which after a phone call was ultimately determined to be disturbing enough that he was offered a same-day appointment.
After …
When physicians order tests: a tale of 2 patients
People like to think the worst about doctors: We don’t listen, we don’t care, we only want your money. But, the truth is we do care, and that is why most of us answered the calling to become doctors. That is why the burnout rate for doctors is so high.
Patients hate to wait in the waiting room for too long. But, truth is, I sometimes need to take a break …
The doctor inside never truly rests
Today I had a followup appointment with a young adult male with severe intellectual disabilities. He is barely verbal. Several weeks ago his caregiver told me that this young man often pointed to his chest and would say “hurt” or “heart,” they weren’t sure which. He also seemed to have gotten pickier about his food, and would literally pick at the food on his plate as if examining it. His …
When patients can’t tell you their symptoms
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I don’t miss making the phone calls in the middle of the night.
“Hi, this is Dr. Yang calling from the psychiatric emergency service. May I speak to Mr. or Mrs. Doe?”
“Yeah, this is Mr. Doe,” he’d reply, his voice thick and slow with sleep.
“I’m sorry to call so late. Your son is here at the hospital.” Take a breath and slow down for the next part. “He’s alive and doing OK at …
The phone calls physicians make in the middle of the night
The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20 percent for Medicare patients (higher for certain patients, with up to a third of these occurring in the first 7 days), there is an …
We can do a better job with hospital discharge paperwork
Seven years ago, I officially became a doctor. After years of hard work, sacrifice and insecurity, I finished my residency and passed my board certification exam in internal medicine. I was a fourth generation internist in my family and was so eager to begin my career in a new city with my fiancé. My first job out of residency seemed perfect. I had a set outpatient schedule, administrative support, and …
A new physician experiences the opioid crisis
It’s 8:00 p.m., and it’s hour 14 in my 28-hour call shift at the large suburban hospital where I’m an intern.
You demand to speak with a doctor now, right now. You cannot wait. Your mother is sick, and you want to know exactly what is going on.
It doesn’t matter that we already spoke at length by phone earlier this afternoon. It doesn’t matter that it’s 8:00 p.m. It doesn’t matter …
I’m not your nurse. I’m your doctor.
Failure is a guarantee. “Success” assumes that certain metrics have been set and that the words used to describe those metrics are understood in the exact same way by all parties involved. One patient with parotid cancer and given facial paralysis after surgery was thrilled to be alive. Another is furious about a widened scar.
The brain, primed to act on behalf of the organism, works at times without our input …
Why physicians should embrace failure
As a radiologist, I interpret thousands of imaging studies every year. Of the millions of medical images that have crossed my screen, they all have one thing in common. They were all acquired by a technologist in the radiology department.
Imaging technologists perform a vital role in medicine. All have specialized training that is unique and critical to patient care. Truth be told, many of them have a greater knowledge base …
Technologists drive quality in medical imaging
I am recalling a workshop on unconscious bias from last year, the moderator hands outpatient prototype profiles to each table of participants. Ours is a glossy paper with a color photo of our patient, Jane, and a clear outline of her type of employment, hobbies, interests, family members, religious beliefs, and how she prefers to receive information. This strikes me as very clear and succinct, calling attention to many of …
Thorough documentation can be weak representation of patients
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