If you are a physician reading this, please pat yourself on the back. You made it through medical school and residency so, de facto, you have both resiliency and grit (serious buzzwords, y’all). But as anyone who has gone through these professional challenges, it often doesn’t seem so.
I am 44 years old and am faculty at a major public university and cis-gendered, heterosexual, married, two kids and have a full-time …
7 ways to not feel like an imposter
Afterword from a story entitled “Litigation Lane,” excerpted from Beyond Bedlam’s Door: True Tales from the Couch and Courtroom (Thunder Lake Press).
Forensic psychiatry involves the interface of psychiatry and the law. Over the years, I was asked to psychiatrically evaluate people in the context of civil …
Where money and the law intersect, truth can sometimes be the victim
Recently, the Harvard Chan School of Public Health reported on the effect of surgical checklists in South Carolina. The press release was titled, “South Carolina hospitals see major drop in post-surgical deaths with nation’s first proven statewide Surgical Safety Checklist Program.”
The Health News Review, for which I review, grades coverage of research in the media. Based on their objective criteria, the Harvard press release would not score highly.
The title exudes …
When science ceases to be value-neutral, science ceases to be science
December 2012, three days before Christmas. It started as an ordinary day, but soon it would become the turning point of my career. As I entered my office, I noticed a different energy in the room. The receptionist looked at me and said, “Doc, one of your patients died last night.” As a psychiatrist, I am not used to the feelings generated when someone you cared for, passes in the …
How are we supposed to deal with death?
When my children were growing up, I advised them, “Don’t choose any profession in which your worth is determined by knowing a body of information or using algorithmic thinking. If you do that, you’re toast.”
”Toast” because monopolies on information have been supplanted by the internet, and algorithmic thinking replaced by computers and artificial intelligence. Incredibly, this seismic shift in what society values has occurred in just a single generation.
And that’s …
Physicians are low-hanging fruit. Here’s why.
I pause in front of the door. On the other side, you all wait. A spouse, sons and daughters, sometimes with their own small children in tow. Today, it’s your husband and father you have come for. Yesterday it was someone else’s mother. You have come from near and far, across the street and the country. Your weary eyes are unable to mask your sadness. Over the past week, you …
I want to help him, but I need to know more about him
Mindfulness has gained a lot of awareness and attention over the last few years as the medical community has set out to find strategies for prevention of physicians burnout. What has been coined “mindfulness-based stress reduction” or “mindfulness” is a principle proven long before medical researchers decided to reduce it to treatment strategy to promote acceptance among the physician community. This very useful tool today is becoming widely used in …
Mindfulness is the key to physician burnout
“This is the end, beautiful friend
This is the end, my only friend, the end
Of our elaborate plans, the end
Of everything that stands, the end.”
– The Doors
I am an obstetrician. My job, distilled to its essence is to be present and assist during the birthing of a new life. Labor has its inherent risks, but with credit to those who came before me, delivering a child has never been safer for …
Not once during my eight years of medical school and residency training was I ever asked the converse of the titular question, what was my wife’s opinion of my career choice. Not while scrubbed into a case on my surgery rotations, not in the middle of an overnight call in the neonatal intensive care unit and never once by an attending, fellow or co-resident. Even those who knew me best and …
What does your husband think about you being a surgeon?
I received these emails recently. The writer gave me permission to publish them. They have been edited for length, and some details have been changed to protect his anonymity.
I’m a third-year medical student at an allopathic state medical school. I’ve always wanted to do surgery. My problem is I failed USMLE Step 1 the first time and got a 207 on my second attempt. I hadn’t failed anything else throughout first …
A medical student fails USMLE Step 1. Can he ever be a surgeon?
The cadaver lab is a rite of passage in medical school — those few months early on when we dissect a human body to better understand our anatomy. It’s grotesque: peeling back skin, separating muscle sinews, and sawing through bone.
It’s so emotionally jarring that young doctors in training often compartmentalize the experience, and this person before us …
Losing that patient was one of my most traumatic experiences
Two sisters (religious order, not biological relation, as far as I know) live in one of the condos across from us. They are very nice, older ladies, warm and pleasant, always ready with a kind word and a smile as they see others in the complex come and go. They seem, at least on casual observation, to lead very busy lives. They rise early, heading out to do whatever it …
What do physical gait, movement, and apparent drive tell us about each other?
When I am facing an alcoholic in the office, I do not advise him to stop drinking.
Other physicians may advocate a different approach. We live in a free society and individuals are free to make their own choices. I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that …
This physician won’t tell his alcoholic patients to stop drinking. Here’s why.
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When it comes to the review of systems, I’ve been a natural, a savant — a prodigy you might say.
During my first few weeks of medical school, I remember doing mock interviews with fake patients. This was long before I learned anything about “HPI,” “ROS,” physical exams, billing or anything medically relevant for that matter. As other students stuttered, trying to figure out what to ask a lady pretending to …
Let’s get rid of the review of systems
During medical school, my head was buried in the books while I was studying pharmacology and pathophysiology. In residency, my body remained in the hospital for most of my waking hours while I was caring for patients. And, during fellowship, my hands were busy learning how to perform endoscopic procedures.
All the while, my friends working in other industries were tapping into a different kind of skill set. They learned how …
7 lessons I’ve learned from my friends not working in medicine
“OK, it is time to move on,” my professor claps his hands together and yells above the chatter. We all look up from our Netter’s anatomy books and our cadavers. The smell of formaldehyde burns my nose as the fluorescent lights flicker above.
“We have explored the chest cavity and the abdominal cavity. It is now time to move onto the extremities, starting with the arms. I want you to unwrap …
The hands tell us the most about a cadaver
“I like good strong words that mean something.”
– Louisa May Alcott
My resident and I are removing a large, recurrent cancer from the neck. Dense scar tissue is everywhere from prior surgery and radiation therapy. The going is slow. Each move is arduous, and bleeding obscures the view of the anatomy.
“Watch out,” I tell her. “The jugular vein is nearby, probably buried in that scar.”
“Yeah,” she responds. “Look at this nerve! …
What surgeons do is a violent act
Hardly a week goes by without hearing about another case of police brutality. Many times, seemingly unnecessarily lethal force has been used, and these incidents have sparked protests across America. Each case is unique with differentiating circumstances, but the result is all too often — death. Many people have grouped these incidents together concluding that white officers have unnecessarily killed black men. This has initiated and reinforced mistrust of the …
Cops and doctors have the same problem: People don’t trust them
I drive a fast car. Which if you know me, is quite uncharacteristic. I would say that it is one the few possessions that generally doesn’t reflect upon who I am. How I chose this car, the make, and model, are a long story not to be discussed here. But let’s just say that it has quite a kick.
These thoughts jostled through my mind this morning as I pulled into …
Physicians have to stay in their lanes
With the ruination of American teaching using “value-based” purchasing and payment concepts virtually complete, the U.S. government is now training its sights on medicine with similar intentions. With the new MACRA pay-for-performance program, CMS bureaucrats believe they can force health care providers to practice better “quality” care by collecting clinical performance, practice-related, and cost data, and basing payment increases and penalties on the results.
There is one big problem associated with …
Instead of value-based care, how about giving clinicians the resources they need?
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