I’ve wanted to be a physician for as long as I can remember. As a teen, the choice to become a doctor seemed to perfectly meld my affinity for science, academics and helping others. Better yet, pediatrics offered the ability to work with families and children of all ages and developmental abilities.
For fifteen years, I lived, breathed, and worked toward my …
Confessions of a burnt-out physician
Radiologists discussing test results with patients, a subject that has been lurking under the radar for a while, recently came to light because of an article in the New York Times. The idea is that patient anxiety while waiting to find out a test result could be alleviated by an immediate discussion with a radiologist.
That would be very nice, but there are …
Should radiologists discuss results with patients?
A letter received by Pamela Wible, MD.
Dear Pamela:
I can’t tell if I’m burned out or just don’t like being a doctor. My own medical school experience was so abusive. I wonder how other students like me fare when they enter abusive residency programs. I supposedly work at a place that values patients above all else, but it feels like everyone is …
A doctor wants to leave medicine to sell Tupperware
Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER …
Don’t pay specialists for being on call. Here’s why.
Three days after finishing my residency, I became the medical director of the community health center where I had taken my first job. It forever changed, and probably saved, my career.
The risk of burnout hit me early. While I loved patient care, I also found the stress, the lack of control of my time, and the inefficiencies of my clinic’s system hard to accept and to manage. I knew I …
Public health work is my serenity prayer
It’s a strange thing to be driving about in your car in the middle of the day. For one who has spent the majority of his professional life sheltered in dark offices and aseptic hospitals, the summer sun and fresh breeze is quite lovely. One almost begins to approach humanness. Normal. This must have been what it felt like before immersion into the tribe of medicine.
Sometimes I have trouble remembering …
Escaping the curse of experience, for just one moment
I am a young hospitalist who is 16 months into my role at an urban academic medical center. Unlike many of my more senior colleagues who found their way to hospital medicine by circumstance, luck, or as a second career path, I have been planning my career in hospital medicine since the beginning of my residency training.
The things that drew me …
A day in the life of a hospitalist
Everyone wants to be sure their physician is competent and appropriately trained. The way this is done is through credentialing. A new applicant for privileges to practice at a hospital or other health care facility fills out an application and submits a curriculum vitae that details when and where a physician trained and the certifications obtained, such as specialty boards, and a work …
Hospital credentialing is one giant mess
I find myself in a unique position. I recently retired as an orthopedic surgeon and my wife and I moved out of my practice area. At the same time, my wife was diagnosed and started treatment for breast cancer. So I got opportunity to interact with the health care system both as a provider and as a family member of a patient receiving long-term care first from providers I knew …
When going “by the book” hurts patients
We all have prejudices. We have racial prejudices. Religious prejudices. Gender prejudices. Occupational prejudices. Age prejudices. Weight prejudices. Height prejudices. We prejudge based on hair style. Language. Accent. Clothing. Shoes. Attractiveness. Tattoos. Names. Jewelry. Family. Hobbies. Cars. Schools. Type of home. Music. Where a person lives. What type of work a person does. What a person reads. Talents. Disabilities. Physique. Medical history. Injuries. Opinions or assessments by others.
No one is …
Don’t let our desire to be respected get in the way of our oaths
There’s been a lot of talk recently about low morale and disgruntlement among doctors. A recent article on focused on a list of reasons when doctors know it’s time to quit. I found the article a bit sad and unfortunate, but I’m sure the feelings behind it were sincere.
Another excellent article in the Wall Street Journal last week extensively discussed the factors behind …
Don’t quit medicine. Here are 5 reasons why.
It is estimated that approximately 14 percent of U.S. physicians in training are depressed and another 10 percent experience suicidal ideation. Some 400 U.S. physicians take their own lives each year. Hampering efforts to deal with such problems is the stigma associated with them. I knew a top medical student who was reluctant to seek mental health care in part because …
I do not know about you, but I get confused about the Heisenberg uncertainty principle. Asked for a definition, I usually say something about how when you try to measure something, you change it, therefore one can never be complete or exact in measurement. However, that is wrong. The uncertainty principle has nothing to do with the effects of measurement, but rather its limits. If you measure one thing, such …
When the patient’s touch alters the doctor
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Today was (almost) the last straw.
If you’ve read this column before, you’ve listened to my diatribes about the insanity of the forms we are required to fill out, the wasted efforts, the missed opportunities, the duplicative care.
This one today takes the cake.
Going through my mail this morning, trying to clean up the work on my desk before I head off for a (hopefully) few days of jury duty, …
A form for a form’s sake: The difficulty of coordinating primary care
I appreciate the need for physicians and others to sleep. I’ve spent a great deal of my career awake in the wee hours. In some very real ways, emergency medicine as a specialty exists as a shield between patients and their sleeping (or otherwise engaged) physicians. But I fear we’re all wearing a little thin. Because the emergency room has become …
The American hospital as we know it is in peril
Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death.
Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. …
How to introduce palliative care to patients
Mr. B shook my hand as the paramedics got the stretcher ready to send him to a nursing home. His firm grip punctuated the end of a long hospitalization, which had been characterized by several decisions to leave the hospital against medical advice into extremely unsafe situations, leading into complex capacity evaluation decisions.
It was a pleasure to take care of you, I told him. He smirked back at me and …
The conflicting feelings a new intern has for a patient
She arrived by ambulance in the middle of the night, awake, alert, and bleeding like crazy. We’d gotten a call earlier in the evening that she was on her way from a small hospital about forty miles to the north. We were the big city hospital, and an attending physician had agreed to have her transferred for a life-saving procedure, in this case a shunt that might stop her bleeding.
People …
Witness to a patient, losing her life in front of us
Since starting a direct primary care (DPC) practice nearly three years ago, I’ve become accustomed to skepticism and even the occasional criticism. Given the status quo, I understand it’s difficult for some to envision a model that could be better for family physicians and our patients than traditional fee-for-service practice.
Two common concerns about DPC have emerged during my conversations with fellow …
Direct primary care: Setting the record straight
“My wife died uncomfortable and alone. She died thirsty!”
The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to …
She died thirsty! Ice chips matter when it comes to patient satisfaction.
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