I want you to do me a favor. Pretend we’re meeting each other for the first time. You have to describe who you are in 10 words or less without mentioning any relationship to another human being. You can’t cop out and say: I’m Anne’s husband, Paul’s mom or Mike’s oldest child. Who are you? Who and how do you identify yourself?
For most doctors, a few of those ten words …
Why you’ll never escape being a doctor
Doctors know high-pressure exams. The day before one is the worst. There is cramming followed by anxiety and insomnia. When sleep finally beats anxiety, the dreaded nightmare falls upon anxious test takers. Every doctor knows. Walking into the testing center, opening the exam, realizing you studied for the wrong exam. The questions might as well be a foreign language. This nightmare was a reality according to this year’s group of …
A test taker’s worst nightmare became reality
Medicine has created a culture where public embarrassment, bullying, and passive-aggression have become pedagogy. How can we seek to care for others, when we treat our own so cruelly?
I recently met Angie (name changed), a young university student who had entered the clinical years of medical school. Like many, she was introduced to medicine as a naive, excited teen immediately out of high school — a high achiever with the …
Why do doctors treat their own so cruelly?
In the era of #MeToo, Missy Elliot, Whitney Houston, Tyler Perry, Oprah, Ashley Judd, Gabrielle Union, Teri Hatcher and, now, Padma Lakshmi — keeping kids safe and helping adults heal is our job as physicians. I am a pediatrician — and I am an incest survivor. My perpetrator was also a physician. I bore a dirty secret before I knew what a secret was. The person who hurt me was …
Don’t ignore incest: advice from an incest survivor
The medicine I practiced between 1974 to 1992 is gone. Evidence is the coin of the realm in the courts of modern medicine. The rule “first, do no harm” demands a corollary — be paranoid.
We receive extensive training and licensure to “touch” patients. Any person who is not a physician who cuts into another person commits a very serious crime. The same is true for merely talking with a person, …
Care but don’t touch: Being wise in the modern era
Some days, work frustrates me. Yes, we all have our frustrations. Maybe the traffic is slow, and you get to work late. Maybe you spill your coffee on your work clothes as you walk into your office. Maybe someone calls in sick, and you are short of help at work. But my frustration has to do with not being able to properly care for my patients. This frustration lies in …
Going to the gynecologist isn’t just about Pap smears
Not knowing what else to do after finishing my pediatric residency 15 years ago, I became a general pediatrician. Not knowing how to find a job halfway across the country and closer to home, I relied on a recruiter from a smallish town in South Dakota to woo me into private practice. Not knowing how to choose my future partners, I let them choose me.
Despite my unbelievably naive approach to …
This physician is a better hospitalist because of the time she spent in the clinic
A vivid memory stands out from my career.
Driving home from the hospital at 3 a.m., I reflected upon my most recent patient’s middle of the night delivery. It wasn’t an easy delivery, as they often aren’t. However, in the end, we had a healthy mom and baby and the family couldn’t have been happier — nor could I.
I felt a sense of gratitude as I was driving in the darkness …
How physicians’ grit is being taken advantage of
I had the fascinating experience of interviewing for residency at 20+ weeks’ pregnant. Although a number of people told me that I was doomed, I found the experience to be quite enlightening. Since I couldn’t hide the fact that life outside medicine was going to be important to me during residency, I felt empowered to ask the “don’t ask” questions during my interviews. What did I have to lose? The …
If you are ready to become a parent, don’t let residency stop you
Non-clinicians skip over some of the most necessary underpinnings of doctoring and speak too much about housekeeping issues: blood pressure targets, aspirin use, mass screenings, immunization rates and so on.
People without medical degrees could do those things. But there are steps that must be taken before we worry about the measurables. These are the essence of being a physician, what people ask for when they come to see us. Most …
Primary care does what Google can’t
I don’t want to be unclear here. I don’t want to mince my words. But I’m mad about an interaction I had on Facebook. I was commenting on the Physician Side Gigs group page when someone riffed on one of my statements. They mentioned that my opinions could be a slippery slope towards a future where doctors no longer see patients. The insinuation was that we as physicians owe it …
When doctors leave clinical medicine, don’t blame the victim
Some days in medicine seem like an epic saga in which the world seems to be playing whack-the-doctor. It is easy to vilify doctors and cast much blame at them. And true, we bring some of this onto ourselves.
Today was one of those days, and by the end, I was just all too ready to run out of the office and go home. And then the last patient came and …
Simple words can sometimes make a big impact on physicians
A physician recently recalled to me a situation he found himself in on the last National Doctors’ Day. Those of you reading who work in health care, will already be aware that this is on March 30th every year. I have seen this day celebrated in every hospital I’ve worked in since I first came to the United States over a decade ago. I actually think it’s a nice gesture, and …
The empty celebration room on National Doctors’ Day
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I love the idea of turning a negative approach to improvement in health care — looking for problems — on its head. Appreciative inquiry, a process of focusing on a group’s inherent strengths and fostering positive interactions among group members, is one way of fostering change with a positive approach. Positive deviance (PD) is another.
Basically, PD involves identifying what’s working and usual local solutions owned by the people involved to make …
How positive deviance can address clinician burnout
“Those who suffer illness learn by hearing themselves tell their stories, absorbing others’ reactions, and experiencing their stories being shared.”
– Arthur Frank
We stand together at the clinic room door, preparing to enter.
“Tongue cancer. This is a 78-year-old man with an oral cavity mass and some memory loss. He had an ulcer on the side of his tongue for a few weeks which was biopsied by an outside doctor. No imaging …
The key to this patient? Horseshoes.
There has been a recent surge in discussion about men’s fear to work alone with female colleagues in medicine. This reluctance puts both men and women at a disadvantage. Women are being excluded from career opportunities and men are missing out on the benefits of collaboration. As a victim of sexual misconduct during my own medical training, I find the recent increase of acceptance of reporting to be a step …
How to ease men’s fear of mentoring in medicine
My mom was recently diagnosed with cancer. I can’t even begin to describe the shock I felt or how my heart just sank. In an otherwise healthy person with no family history, this is not something you ever expect to happen. My mind immediately jumped to so many different conclusions, and I immediately wanted answers. Is she going to beat this? How did this happen? Why did this happen? What …
What my mother needs is a daughter, not a doctor
The absence of burnout does not equal wellness. While the focus on physician burnout as an epidemic is finally gaining more attention, we may be missing a larger issue. Most physicians are not burned out. We are able to function. We get through our days, make it to some of our kids’ activities and even manage to go out to dinner on the weekends. We survive the work week as …
Physician well-being: lessons from positive psychology
Everybody is a stakeholder these days in what we broadly call medicine, or health care. But there is little agreement on what medicine is and what the priorities of the health care “industry” should be.
I propose this breakdown of medicine into three separate phenomena.
1. Micromedicine
2. Macromedicine
3. Metamedicine
Let me explain:
Micromedicine: one on one, real doctoring
Doctors from antiquity have served their patients one on one, as individuals. Osler, the father of modern …
Medicine is a word with 3 meanings
Recently, my inbox has been overfilled with offers for programs, yoga, meditation, and a whole host of mindfulness training opportunities to combat physician burnout. I think by now everyone knows that doctors are fighting high burnout rates. But, those sending these “special offers” don’t get the root of the problem. We’re not burned out because we work long hours in a stressful job with limited time off. Rather, we are …
Meditation, yoga, and mindfulness aren’t going to solve physician burnout
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