When I was in medical school in the 1990s, students were given a bleak picture of the life of a subspecialist. We were told that there would be few job opportunities and that the only way to ensure a job was to pursue a career in primary care. Many of my classmates did go into primary care but the majority of us accepted residency positions in surgery, neurosurgery and other …
Reform medical education to fix the primary care shortage
The health care scene is evolving. Rapidly. We all know that. Thanks to legislation, changing patient expectations and physician shortages, we are all in for a roller coaster of changes over the next few years.
But what does this mean for physicians? Plenty. Most importantly, it means physician’s roles in the health care system will change. Drastically. And that means the traits and skills you’ll need to be successful will change, too.
Some traits …
The successful physician of 2015: 5 essential traits
The patient – blue-eyed, red-haired, and healthy but worried looking – guided the doctor’s hand to just below the angle of her jaw, where a small lump was barely palpable. She had first noticed the swollen lymph node after a cold and thought nothing of it at the time. But five months later, it was still there. She knew it was nothing, …
To CT scan or not: What is the ultimate goal of patients?
For the past month I’ve been trying to formulate a blog that could capture my thoughts about mental illness and the prevention of violence. At this point my ideas are still not crystallized, but perhaps writing this will help. A few days before Christmas I received a phone call from a former patient’s mother. She called while I was at the mall with my family doing some last minute shopping—I …
Will improved mental healthcare be enough to curb gun violence?
As a pediatrician at a busy county clinic with close proximity to pediatric specialists, I care for a significant number of children with special health care needs. Instead of colds and ear infections (though there are those too), my days are often filled thinking about gastrostomy tubes, tracheostomies, and ventriculo-peritoneal shunts. I sign orders for specialty formulas and nebulizer machines. Many of my patients have thick charts and diagnoses like …
The myth of the difficult patient: Blame the system instead
A common rebuttal to any discussion about of gun control is motor vehicle accident deaths. We don’t blame the car, we blame the driver. Regardless of the object’s intent (the car is for transportation and the gun is shoot people, targets, game, and skeet), neither a car nor a gun can kill or maim without human touch.
And I agree. Comparing guns and cars is fair, after all they kill about …
We can learn a lot by comparing guns to cars
Recently both President Obama and the AMA have called for physicians to talk with their patients about gun ownership, especially if they sense mental health issues. This request sounds innocuous enough, but let’s explore the implications and the reality here.
First I need to issue a disclaimer. I am neither a member of the NRA nor do I necessarily feel that more gun laws and bans will reduce the recent tragedies …
Should doctors be required to ask patients about guns?
Don’t be surprised if patients start asking more questions than usual about awareness under anesthesia. We can all thank a recent article in The Atlantic magazine, with a large-print headline on the cover: “Awake Under the Knife”. Written by a UCSF medical student in preclinical training, the article not only assures everyone that awareness can happen, but takes pains to point out that anesthesiologists can’t always prevent …
Anesthesia awareness: Look beyond the headlines
My mom wrote me the following letter during my first semester in medical school. She has been a patient, and a mother/wife/sister/daughter of patients. She has been around countless doctors. Here is her take on what makes a great one.
Dear Son,
I am so very proud that you are becoming a physician and that you chose this profession, not for the prestige or the financial advantages, but because you want to …
From Mom: Here’s what it takes to be a great doctor
It’s showtime. No need to worry. This is just another routine performance. I can do this. All I need to do is get on stage, do my dance, and wait for the curtain to fall. Then move on to the next stage and do it all again.
The curtain opens.
My patient is wheeled into the operating room. With the help of the circulating nurse, we guide her from the hospital gurney …
Cancelling surgery: When the show can’t go on
An excerpt from Pet Goats and Pap Smears.
After two decades of formal education, today I’m finally set loose with real patients. It’the actual moment I’ve been waiting for my entire life.
We’re each assigned to a family doc for the month. I scroll down the list of third-year medical students, place my right index finger beside my name, slide …
Learning about human relationships and the art of medical practice
An article written by two physicians in Time questions whether we should blame doctors for the large number of chronic pain patients and the abuse of prescription pain medications.
There are two frames of reference to this article.
First, no one can argue that prescriptions for pain medications in this country are excessive. The article notes that in 2011, “enough …
The cost of blaming doctors for prescription drug abuse
Somewhere near where you live, a couple will discover this week that they are infertile and that if they want biological children of their own, they are going to need in vitro fertilization (or IVF). According to treatment protocol, the woman will need to take powerful medicines to ramp up her production of fertilizable eggs. One monthly cycle of this treatment will run …
Do doctors take advantage of desperate couples with infertility loans?
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Protected naptime is a luxury usually reserved for the under-five-year-old set. Might it also be a tool to combat our country’s astoundingly high rates of medical errors?
Trainee fatigue has been a major focus of patient safety efforts since the mid 1980’s, after 18-year-old Libby Zion died tragically from a drug interaction that may have been precipitated by residents working long hours. In 2003, the Accreditation Council for Graduate …
Can protected naptimes reduce medical errors?
Today I’ve been feeling stupid. My job absolutely requires critical, creative thinking and the ability to focus well, which was really hard today. But I don’t think I’m actually stupid. I think it has something to do with the task at hand.
So this is how today went. I think it kind of explains the stupid feeling.
My morning shift started at 7:30am in …
A doctor’s job is objectively impossible to do well
How we spend our days is, of course, how we spend our lives.
-Annie Dillard
I wish I could add up all of the moments I spend waiting for things to happen.
I wait for computers to boot up. I wait for computer screens to load. I wait for programs to ask for and accept my user name and password for the umpteenth time so I can view a CT scan and then re-enter a different …
Quiet moments are a precious and rarely appreciated gift
I’m proud to announce my new book, co-written with Susan Gay: Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
The Foreword is written by Robert Wachter, MD, with endorsements from Eric Topol, MD, Abraham Verghese, MD, Jerome Groopman, …
Online reputation for doctors: A comprehensive social media guide
You’ve probably watched the Super Bowl as I have many times, faithfully, elevating the occasion to some kind of macabre family tradition. It is a spectacle of athletic agility, drama, and struggle; the pinnacle of American sporting contests. Despite the heavy onslaught of commercialism, faux halftime culture, and evident violence on the field, we suspend our awareness that this event may not …
7 reasons to boycott the Super Bowl from a medical standpoint
It happened again today. A youngish man, age 59 (youth being relative these days) comes in for a consultation. His history began eighteen months ago when he started to notice hoarseness. Thinking he had laryngitis, he saw his primary care doctor. He was indeed diagnosed with laryngitis despite the fact that he had not been shouting for his grandson at the local soccer playoffs, nor had he had upper respiratory …
In oncology, hoofbeats are nearly always from zebras
“Sometimes, how you feel at the end of an interview can be clinically revealing,” my preceptor says. “How does this patient make you feel?”
***
“Mr. M?” I ask gently, knocking on the hospital room door. “May I come in?”
“Hello? Hello?”
I enter at what I think is an invitation to me, but see that 79-year-old Mr. M is speaking into the phone instead.
“I’m sorry, I can come back…” I start to say. …
Countertransference is a reality that must be grappled with
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