I recall during my freshman year in medical school, sitting in class and listening to what were supposed to be 50-minute lectures from people who’d been teaching the same course for years. These were highly educated and intelligent folks; they knew how much material they could cover in 50 minutes. Yet, they frequently went past their time; encroaching on what was for some a badly needed bathroom break, and for …
Every physician is a wounded healer
“How are you feeling?”
It’s a question we frequently ask patients — on rounds, in the clinic, post-operatively — and with all good intentions and gentility. But, do we ever stop to think: What is really the point of this question? What information are we trying to glean? I think for most of us, we’re asking the question with a cognitive bias towards the physical. How are they “physically” feeling: better, …
Ask patients how they feel, along with how they are feeling
Physicians have one of the highest rates of suicide of any profession: nearly twice the rate of the general population. 400 physicians commit suicide each year in the United States. The stress of being a doctor is constant and unrelenting. The majority of us are perfectionists with a strong work ethic: your classic Type A personality. Maybe we set ourselves up for failure and then cannot accept when it inevitably …
How a physician suicide 30 years ago affected this doctor today
He had loved her with all his being for more than six decades. In the last two years of their 61-year marriage, he had watched helplessly as dementia wrapped its noose around her, slowly tightening its grip on her mind and pulling her away from him.
When I met him, I knew the injury was irrecoverable. Her brain was consumed by hemorrhage that had filled the space (cerebral atrophy) left behind by progressive dementia …
A death that feels good to a surgeon’s soul
When I had my first baby, one of my friends coordinated a meal train where coworkers could sign up to bring our new family a dinner every other night. Those first few weeks of motherhood were such a chaotic blur that I do not even remember how many weeks this meal delivery went on for except to say that it was both long enough and over too quickly. There was …
Meals for new parents is food for the soul
There you are in your father’s arms. He is practically running to keep up with the triage nurse. The nurse is walking quickly toward the room that we leave open for true emergencies and the sickest patients. Your father’s eyes are full of fear, and the nurse’s tone is worrisome.
I look down at you all snuggled up to your father’s chest. You are beautiful. So small and bright-eyed. You don’t …
Medicine is the most emotional profession. This story proves it.
A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed …
You should want surgery residents for your operation. Here’s why.
I took a fantastic emergency medicine (EM) job when I finished residency. There was no question in my mind that it was the best job within a hundred mile radius, maybe more. When I first started, my expectations were met. My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed. The hospital was independent, …
How to destroy a great ER: A step by step guide
I am about to place my plate in the sink, until I see a single pea left on my plate. I recall a recent article in National Geographic that stated that one-third of all the food we produce is wasted.
I have a Zen moment, and think of the journey the pea made to reach my plate. A farmer in California sowed the seeds six months earlier. A farm worker harvested …
What is food waste and how can we fix it?
If you are a doctor, everywhere you hear or read about all that is wrong in medicine. Please do not get me wrong, the medical profession is under assault. Change is occurring all around us, and much of it has the potential to be disastrous to not only us and our families, but more importantly to our patients. For many of us in the profession, we feel helpless. We feel …
Doctors need to fall back in love with medicine. Here’s how to do it.
I learned that the 148-year-old community hospital that I did my residency at will be closing, and I am angry. Who am I angry at? Myself. Oh, and you. I’m angry at us because we as a country have turned our backs on one another. And in the end, your relationship with your own doctor is in jeopardy.
Pawtucket, Rhode Island, home of Memorial Hospital, used to be a prosperous mill …
Your anger towards doctors is misplaced
I dialed the number to return the call of the nursing home. The nurse who answered the phone was relieved to hear my voice on the other line: “Dr. Mass, thank God you called back! She has been pacing since she woke up, and she refuses to take her meds. We’ve kept her away from Catherine, so they don’t get into another fistfight. But we can’t handle her here anymore. …
6 medical breakdowns in my mother’s care. And 1 close call.
Like many boys born in the 60s, my heroes were often frontiersmen. I grew up watching the Daniel Boone television series, with Fess Parker. (I can hear the theme song in my head as I type.) I watched the Disney production of Davy Crockett, and had a comic book of the same. I never missed a chance to watch John Wayne die on the walls of the Alamo (also as Davy …
The joy of practicing medicine in the frontier
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Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to …
Doctors can’t see the forest from the trees. And it’s cost them.
Despite all the challenges that we, and every other nation, faces with their health care systems, it’s worth remembering that in the broader picture we really have progressed in leaps and bounds over the last several decades. How easy is it to forget that only 100 years ago the average life expectancy was in the 20s to 40s in most parts of the world (just as it was for nearly …
Communication is the core of many health care problems
“One of the most prominent definitions describes burnout ‘as a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment that can occur among individuals who work with people in some capacity.'”
– Maslach, Jackson & Leiter, 1996
In 1974, the year I started medical school back in Sweden, the German-born American psychologist Herbert Freudenberger published a journal article titled “Staff Burnout.” In it, he wrote about the physical and emotional symptoms of …
Burnout is a consequence of the deprofessionalization of medicine
I adored the physical exam in medical school. We were taught the exam by sections, and I devoured one after another. No matter how much I had learned about physiology, it was during our physical exam sessions that I finally started to feel like I was learning how to be a doctor. We were getting the tools we needed to really take care of patients. We would have the means …
Treat the physical exam with the respect it deserves
At the end of 2015, The Leapfrog Group announced its annual list of America’s top hospitals for quality and safety; 98 hospitals receiving the honor.
Unlike some other hospital rating schemes, Leapfrog’s does not factor in reputation. You won’t find any of the usual suspects on Leapfrog’s list. Instead, Leapfrog uses surveys of hospitals and publicly available quality and safety data.
Leapfrog’s top 98 included 62 urban, 24 rural, and …
Here’s why you can’t believe “top hospitals” lists
This presidential campaign has been alternately amusing and terrifying, courtesy of the antics of Donald Trump. The prospect of someone who feels the need to boast about the size of his penis during a presidential debate having his small, small hands on the button to launch our nuclear arsenal does not inspire feelings of security.
He is looking increasingly likely to be nominated by the Republican Party. Many, however, …
Should we be concerned about Hillary Clinton’s health?
As a primary care physician at one of the nation’s leading academic medical centers I’m still hanging on.
Over my 32 years, I’ve seen how my ability to interact with patients has been diminished by an ever-encroaching health care system. There’s a clock keeping track of how much time a patient’s chart is open. I have less than 15 minutes on average to assess my patient’s symptoms and discuss treatment options, …
This doctor has practiced for over 30 years. Here’s why he’s not burned out.
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