My mother-in-law died last week.
She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now …
The inhumanity of medical residency programs
With the latest data calculating physician burnout at greater than 50 percent, American medicine is at a tipping point. How to fix this crisis? Why, make physicians more resilient, of course!
Except physician resiliency is exactly what got us into this problem.
Let me explain. Doctors are notorious people pleasers. We spend years of our life at study, sacrificing the fun and freedom of youth, deferring childbearing, and delaying …
To prevent burnout, physicians need less resilience, not more
The month of September has been Women In Medicine Month (according to the AMA) since 1989.
Statistics are always telling:
Medical eponyms: Where women are clearly underrepresented
Hospitals have always served as a lifeline to survival. Whether from pneumonia, heart attack, stroke, or trauma, they have been a community safeguard between life and death.
Today, a cost of care has been added to the patient treatment discussion forcing medical decision-making to look closely at expense. Financial considerations have come to the forefront as preservation of resources will be important to national health care. This can be a threat …
The ambiguity of diagnosing brain death
It is 80 degrees in the exam rooms. The air conditioner is broken and despite calling and alerting our clients, almost none of them want to reschedule. I finish writing up a chart in the treatment room where the air conditioner from the kennels still has some influence. Despite the temporary respite from the heat, my skin is still glistening with a thin layer of perspiration. I look sullenly at …
Do white coats make us better doctors?
The Affordable Care Act has been touted as the answer to our country’s huge uninsured epidemic. There is no denying the fact that millions of uninsured people signed up for insurance through an expanded Medicaid program, which is called Medi-Cal in California. The blessings of a decrease in uninsured patients makes for a great sound bite and has been repeated over and over in the media. The only problem is …
Medi-Cal for all: It’s coming soon
“We do not remember days, we remember moments.”
– Cesare Pavese
“A plane! A plane just crashed into the World Trade Center.”
The surgical case was moving along steadily. Another surgeon had removed a skin lesion from the patient’s neck, and the pathologist had not been certain if it was a cancer. I had recommended removing the scar and several of the nearby lymph nodes. The surgery had just started and was going …
As the audience of medical students decried the experiences that defined their academic lives, my cohort of middle-aged doctors started to squirm. We knew these stories: Doctors mistreating medical students, nurses, and other doctors; learning to cope with brutally long work hours; the struggle to grasp vague and ever-changing expectations while quickly bouncing from one clinical rotation to the next.
The four of us had eagerly agreed to participate on the …
The battle against medical student and new-doctor burnout
I write this while sitting in our sailing catamaran, swaying in the wind and current eight feet above sand and sea grass. I know this because I can see right through the water in the Bahamas. There is clarity here.
When I started this journey thirteen months ago, I was burning with anger. I was angry at insurance companies for developing complex, mutable formularies, coverage policies, and appeal procedures, maximizing my …
The story of a neurologist who quit medicine and lives on a boat
Exercise. Growing up I competed in multiple sports. The physical enhancement of the human body through movement sparked my interest in human physiology and kinesiology. Consequently, my interest in physiology ultimately led me to medical school. It only felt natural, when medicine became what felt like the bane of my existence, that I’d revert back to this pursuit’s humble beginning. Given the fact that time was a scarce resource during internship, …
6 steps to overcoming physician burnout
I saw a new residency graduate post about how balanced she will choose to be and how not taking work home would keep her idealism alive. Like a woman who has been pregnant and gone through delivery and postpartum, I wanted to tell her the truth about how emotions get changed in practice and how the emotions become physical ailments at times. I wanted to tell her birthing and raising …
Physician burnout may not happen. But “burn in” is guaranteed.
“The unintended consequences of these seemingly well-intentioned laws are doctors who can’t apologize for harming their patients even if they want to …”
A recent JAMA article about disclosing medical error described a hypothetical situation involving a dermatologist who, after completing skin biopsies on two patients, discovered that the instruments had not been sterilized. He wondered if he should tell the patients and what he should say.
The authors …
Why don’t more doctors apologize for their mistakes?
Around the U.S., millions of college age kids head back to start their fall semester in college. Their courses carefully selected months ago and their packing completed in a frenzy of activity. But, little thought is given to the most violent crime that happens on college campuses: rape and sexual abuse. Estimates show that approximately 25 percent of college women have been victims of rape. In fact, every 21 hours …
A culture of rape: What can we do as doctors?
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Pamela Wible MD’s book, Physician Suicide Letters Answered, is a devastating view of raw pain, the pain of young, energetic, highly committed young people motivated to help and heal. These healers themselves have been plunged into the spiritual, physical, emotional, and intellectual hell of suicidal thought and action. Iatrogenic illness in action (iatrogenic illness being that which is caused by medical practitioners). Unfortunately, and tragically, the iatrogenic illness that …
Exposing medicine’s secret underbelly: Physician suicide
“If physicians aren’t happy, they can’t heal others”
– Vivek Murthy
Last year, nearly 400 physicians committed suicide, a rate higher than other professions. Our nation is facing an epidemic of overwhelmed physicians subjected to increasing external stressors. Modern medical practice has evolved into a system driven by incentives to meet care quality measure benchmarks, implement incomplete electronic systems, provide care that is satisfying to patients and more. To keep up, physicians …
Fostering wellness: Tips and practical advice from front line physicians
We are witnessing a strange migration of restless tribes, moving between doctors and clinics, traveling great distances in search of what no one wants to give them any more.
This eerie movement is steadily gaining momentum in our community, in our state, and across the country. We can hear it in telephone calls, we can read it in records of patients looking to switch their care, and we can see it …
How the integration of behavioral and primary care treats pain
Smoking and drinking caused the cancer, which Ed ignored for a long time. By the time a doctor looked at the hole in his neck, the mass had congealed the base of the tongue to the right side of the jaw and burst through the skin. A steady drip of pink tinged, foul saliva ran down the side of Ed’s neck. Ed, not being able to chew for months, was …
I do not care what you say. I have to try.
I was treating John W., a psychiatric patient who was an insurance executive. He was angry about his work situation. He complained bitterly about his supervisor whom he felt singled him out for unfair criticism. Over the course of months, John’s complaints escalated to the point where he said, “I swear … if there was a chance I’d get away with it, I’d love to get rid of the guy.”
I …
The psychiatrist as a double agent
Think keeping your life organized is hard? Try keeping your doctors organized.
In this era of fragmented health care, patients find themselves in the impossible position of having to coordinate their care themselves — a task that many can’t meet. Having multiple chronic medical conditions often means being subjected to a dizzying assortment of specialists, medical terminology, and tests that can quickly overwhelm patients.
How many times have you found yourself in …
The cure for a poor historian? A good medical record
I recently was speaking to two doctors about newspapers. Neither of them subscribed anymore. “Who has time to read the paper?” they agreed. “And any news you need is free online anyway.”
No big news there, right? Plenty of people — in medicine and otherwise — have made similar decisions since the rise of the Internet in the mid-1990s. But what was striking to me is that these were not millennial …
A simple suggestion to doctors: Subscribe to a newspaper
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