This is the patient’s eight admission over the course of two weeks. The patient is a heroin abuser and has bacteremia and endocarditis. Their heart valve is failing and they are in and out of congestive heart failure. Every day, dozens of medical professionals converge on the patient to give treatment and advice. And every day after hearing that advice, the patient leaves the hospital against medical advice and goes …
7 ways to combat compassion fatigue
Hate your job? You may be in the right profession, but the wrong position for your personality. Want to love your life and career? Step one: discover whether you are an employee, a business owner or an entrepreneur.
Here’s how to figure it out:
Employees are risk averse and like to know the rules. They thrive on structure and predictability. They need clear instructions …
Doctors: Are you employees, business owners or entrepreneurs?
While in training, we were told that we were not efficient if we couldn’t see 20 or more patients and complete our notes for billing. We were told that primary care offices were asking our residency program for our efficacy data before consideration of hire. This was the line drawn in the sand by our new health care system. We would either rise to the occasion or be harassed by …
What do primary care doctors need? More time.
A commencement address delivered on August 5, 2017, to the 2017 class of anesthesiologist assistants (AAs), Emory University.
Distinguished faculty, graduates, honored guests:
It is a great pleasure and an honor to be here, and to congratulate all the graduates of the Emory University Class of 2017 on your tremendous accomplishment. Just think about all you have learned in the past two years. You’ve transformed yourselves into real anesthesia professionals, able to …
A commencement address to anesthesiologist assistants
I read something recently that shocked me. Despite working in health care for 15 years, I had no idea that nearly 80 percent of the U.S. health care workforce is comprised of women (according to the Bureau of Statistics.)
I did know, however, that women make up less than 20 percent of executive boards and less than 40 percent of middle management in health care. Those that do exist in the …
How can we ensure medical leadership includes more women?
We in the medical community believe wholeheartedly in the prevention of all illness, especially by vaccination. Science and history continue to show that vaccination dramatically decreases both the mortality (death rate) and morbidity (severity of illness) of infectious diseases. And, more than 98 to 99 percent of the general population (non-medical) agrees with those statements as well.
Yes, it is absolutely frustrating when parents refuse to follow our advice and protect …
Why pediatricians should not kick out unvaccinated children
It’s 7 a.m. We sit down around a table in the physician’s lounge to discuss and our patients. I am a general and critical care surgeon. Every fourth week I’m “on service” for the ICU. This is my week. I was off over the weekend. I’m refreshed and ready to go. I’m excited. I enjoy the challenge of taking care of critically ill patients.
I get sign out from my partner. …
Physicians should not tolerate racism from patients
I struggle with customer service. I truly never anticipated that it would be such a big part of my career. I never fathomed that it would be something that I struggle with on a daily basis. Well, honestly it does not happen every day and does not occur at every facility that I work at. Yet, it happens often enough that it has affected where I work, how I interact …
A physician struggles with customer service. Can she still be a good doctor?
I spent the week in meetings discussing logistics and hospital preparations for the alt-right’s “Unite the Right” rally to be held this weekend in my hometown of Charlottesville, VA. We discussed the likely injuries that would occur, how we were going to decrease the hospital census to deal with potential overflow, methods of securing the campus, and the latest police updates.
On Friday afternoon I summed up our discussions with my …
White nationalists are marching through my town
Today, I hugged a stranger.
And I didn’t know his name.
We had just operated on a young man, probably in his late teens. He sustained multiple gunshot wounds to the chest and abdomen, and was in critical condition. When he lost pulses in the trauma bay, we cut his chest open and spread his ribs. His lifeless body laid there as we held his heart in the palm of our …
On a normal Tuesday, one of my fellow residents did the same things we all do. She woke up before sunrise, put her best face forward, came to work, saw patients quickly, wrote notes, said “good morning” to everyone at morning conference, saw more patients, wrote more notes, then went home. She said “good night” to her loved ones — her parents and siblings at home — and went to …
Doctors don’t have the luxury of grief
Do you ever have that “aha!” moment? That moment when a revelation hits you with such a level of intensity that your physical being is jolted. Attention is obtained as if a Louisville slugger or defibrillator pad made contact at an opportune moment. That moment of revelation when a crimson string interwoven through the fabric of your life makes a connection, transcending childhood, college, young adulthood, professional and personal relationships. …
How this physician lives his life in the margins
To me, five years ago:
Right now you are 28, seated at the top of everything: chief resident of the entire pediatric department. You are in charge of 19 other interns and residents. You are resilient, kind, funny and determined. You seem to have the solution for everything, yet you don’t actually have the answer to anything. At least that’s how you’ll feel on most days in your new leadership role. …
As a physician, you will fail at your job in these different ways. Learn from them.
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If you had told me I would be writing someday on women’s issues, I would have grabbed a pulse oximeter and placed it on your finger to check your oxygen levels. As a physician scientist, I have spent the majority of my career reading, studying and writing on clinical medicine. Then, something changed.
For years, I have had the pleasure of working with and for some pretty phenomenal men in medicine. …
For medicine to grow, we need to look at our own biases
Medicine is a lot like grade school mathematics. The days are long gone when instantly knowing or quickly arriving at the right answer was enough. Now it’s all about showing your calculations. Process is everything. It’s almost like having the right answer doesn’t matter anymore.
If you ask a patient with a given symptom, like tremor, lameness or a skin eruption, only a few questions and then conclude that they have …
The health care quality debate has a myopic view
I’d known her for almost 3 years. She had advanced ovarian cancer — clear cell — and was diagnosed with disease already in her chest, stage IV. She had a terrific response to neoadjuvant chemotherapy, which had resolved her extra-abdominal disease sites after three cycles. She had an aggressive interval surgery which achieved complete resection …
A cancer patient’s incredible response to treatment
A patient of mine recently came to see me in a follow-up appointment after an emergency department visit. He had been working out at the gym, on a hot day, after he had skipped breakfast, and after his usual routine he felt extremely lightheaded. Everyone told him he looked “white as a sheet”, and a physician who was at the gym told him he must go to the emergency department.
In …
How to game medical coding isn’t why I became a doctor
On the afternoon of July 26, I opened an email from Dr. Peter Slavin, president of Massachusetts General Hospital, where I work as a primary care doctor. Dr. Slavin frequently sends messages to all MGH employees, uncontroversial broadsides announcing new hospital initiatives, grant awards, promotions and retirements that often end with: “Go Sox!” (or, depending on the season, “Patriots!” “Celtics!” “Bruins!”).
So I was not expecting that …
A hospital leader speaks out against the transgender military ban
My 74-year old obese, poorly controlled diabetic patient with high blood pressure, high cholesterol, coronary artery disease, asthma, obstructive sleep apnea has been difficult to motivate to improve his lifestyle and his health. He is bright, sweet and caring but just not very disciplined.
At each office visit, we review his medications, review his dietary habits and go through the check list of check-ups for diabetic complications including regular ophthalmology exams …
The sad direction of hospital care
Several years ago, when I was working as a hospital physician in Florida, a patient’s wife said something that has always stuck with me. The service was very busy on that day, and I was doing my best to get through everybody in a timely manner. I was with a patient whose wife was at the bedside, beside herself with worry. I was focused on the main presenting complaint, but …
Make the patient feel like the absolute center of your world
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