The day begins at 6 a.m. I am rounding on my nine patients, quickly examining them and providing a brief update about the plan. Like the other harried residents, I am speeding from one room to the next, trying to get everything done on time. And then, inevitably my beeper goes off — “Patient in emergency room being admitted, please call for signout.” I stop in my tracks. I can …
What can physicians do to combat confirmation bias?
In June, a story circulated online about how Brigham and Women’s Hospital in Boston, one of the most famous academic medical centers in the United States, and a major Harvard Medical School-affiliated institution, decided that it would take down physician portraits that were hanging in a popular and historic lecture theater.
The reason? Well, it was felt that the portraits were predominantly of white male physicians, who had been esteemed teachers …
A hospital removed historical portraits. Did it make the wrong call?
How do we choose what we wear when seeing patients? Is it by what tradition dictates? Do we need to meet our institution’s dress code? Or do we just like what makes us comfortable? (Those scrubs sure are comfy — almost like going to work in pajamas!) Well, how about choosing what our patients prefer that we wear?
A recent study published in the British Medical Journal found …
The white coat means something more to patients
There are gifts given and gifts taken away. And Jacob’s abilities could be described as nothing less than a gift. He was a violin virtuoso. Or at least, that was the word the university professor of violin pedagogy fumbled with over and over again as she ushered the eight-year-old Jacob out of her office and cornered his parents. He was immediately enrolled in an advanced curriculum, taken out of …
Gifts given and gifts taken away
The wizards have determined that an important monitor for the eventual success of your children is … drum roll please … whether or not the family eats dinner together. How prosaic. At first glance, this seems counterintuitive. What about private school, tutoring, soccer camp, circumnavigating the earth solo?
Those activities all pale against the family values that are shared, whether you know it or not, at the dinner table.
“How was your …
Do your children know what you do?
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
The path to becoming a physician is remarkably devoid of leadership training. Being an adept manager is an increasingly important aspect of medicine and is not explicitly taught as part of medical training. When we, as attending physicians, suddenly find ourselves in situations …
Women in medicine: Are we leading yet?
What is evidence? How do we gather evidence of patient harm? More importantly, what is the evidence that counts?
A research paper dating back to 2004 suggests that besides research evidence, clinical and patient experiences, as well as contextual information also constitute evidence. However, the only currency of science is data collected through systematic and rigorous research.
But when it comes to the business of medical error, Read more…
The currency of science and the value of stories
I have been working in pediatric primary care for nearly 5 years post-residency and truly love my work. I currently am dealing with very painful post-herpetic neuralgia and many people with this quit working. At some personal cost, I have continued my practice because I find my work day so rewarding I simply can’t imagine not being a practicing pediatrician.
On a given day I might see a newborn fresh from …
Primary care pediatrics is more than medicine : It is a calling
The landscape of health care has changed nearly beyond recognition in the past decade. If you’re a veteran of the profession, you’ve seen the other side of things — you once had the chance to live the dream, to swim in the pool of autonomy and self-employment, to call the shots and act on behalf of the patient without the constant supervision of bureaucracy. If you are new to the …
The effect of private equity in medicine
Nobody punched me in the face. Maybe I would have preferred being punched in the face, though. And yes, I was bullied. I’m not going to talk about my own experience in this post however, because I already have post-traumatic stress disorder from the experience. I’m not ready to revisit it in detail yet.
I don’t need to talk about myself to tell you about bullying in the medical arena. I …
These are the stories of how physicians are bullied
My baby was crying non-stop as soon as we got her home. She tried to latch and did well, but I had no way of knowing how much nutrition she was getting. I counted the diapers, and the numbers were just barely on track, and she was making small quantities. I was trying to Google more tips with one hand and nurse her with the other. She was suffering, and …
The story of a new physician mother
Jerry and his wife, Pam, were not “medical people” and wouldn’t be considered high achievers. They seemed to be taking life in stride with a “mom and pop” disposition. Jerry had Alzheimer’s disease and was returned to his care facility after having a pacemaker inserted. The staff noticed Jerry slumped in his chair and called 911. Jerry’s blood pressure was low, and EMS transported him to the nearest hospital. He …
The lost art of reassurance medicine
It was 5:27 p.m. on a Friday evening when the pager went off. “Ahh,” said the intern, “Three minutes before shift change, and the ER is paging for another admission!”
I could see the dismay on his face as he dreaded the thought of staying late on yet another Friday night. I decided to take care of this patient myself and relieved the intern of his duties. As I went downstairs …
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Establishing a medical career inevitably requires signing a number of contracts along the way that we are not trained to evaluate, leaving us at risk for malignant retention strategies. At the beginnings of our careers, we were obligated to sign all contracts offered to us without question. The medical school match did not leave much choice, and salary negotiations were nonexistent. This lack of choice later changed, as most of …
3 malignant retention strategies in health care contracts
We are human, we are not indestructible. We have feelings and emotions that can get hurt, probably more than the average person based on the careers we have chosen. Yes, we will pass up on our well-being (such as sleep, hygiene, exercise, relationships with family and friends) to be there for our patients. To receive our critical training to be able to care for others. This is our sacrifice, and …
We’re doctors, but we’re humans too
I’ve been river rafting just one time in my life. We paid for a guided trip down Idaho’s famous “River of No Return — the Salmon,” and spent the day traveling stretches of rapids and stretches of calm. It was exhilarating enough for a newbie but not enough to ever feel like my life or livelihood was seriously at risk.
But I’ve also seen that same river at flood stage, and …
Let’s reshape the river of burnout
Do you ever wonder
what compels someone to walk away from their current life
to leave all they worked for — jobs, spouses, kids — behind?
The community around them are caught off guard
of how unhappy or unfulfilled or
the silent suffering
that made their life so hard.
We say it is shocking and act so surprised.
But that seems a pretense.
It’s no secret that compassion fatigue and physician burnout
are both on a steady rise.
For us in …
Physician resilience: cause or symptom?
Recently, a patient came in around 11 p.m., just as the chaos of the day had settled, and I was thinking of rest after 16 hours of work. He was an older gentleman with vague and concerning complaints that would demand a thorough workup. I suspended my thoughts of self-preservation and stepped in to evaluate him.
After an hour and a half, I had found a source of infection that explained …
A day in the beautiful life of this doctor
The pay gap between men and women has been a subject of interest recently, particularly in 2018 reports by Doximity and Medscape.
Notably, the gap favors men, is not explained by obvious factors such as hours worked or choice of specialty, and does not seem to be improving. In-depth studies published in the medical literature have examined the relationship between gender …
The antiquated conversations on the gender pay gap
“I give up! I can’t help these people.” Emily was completing the final month of her emergency medicine residency and flopped into her chair with exasperation.
“What’s up?” I asked. We were on the final two hours of our shift together. And I, as her attending, was already feeling apprehensive about the patient encounter that awaited me.
“They want so much from me, and I can’t fix them!” She began to tell …
Sometimes what patients really need can be surprising
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