Call a consult: depression vs. burnout

Physician
September 8, 2020

CC: “I feel like crap.”

HPI: 29-year old female internal medicine resident. Hasn’t seen sunlight in over three months due to 100 hour work weeks.  Crying at work. Always exhausted and irritable.  Isolated from friends and family.  Feels guilty that she is not effective at work and home.  States recent labs were normal.

ROS:

Gen: hypersomnia
HEENT: teeth grinding
CV: chest pressure, palpitations
GI: decreased appetite with weight loss
Neuro: headaches
Psych: apathetic, not suicidal

Meds: none

Social: alcohol on …

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Are the life sciences the best premedical majors?

Education
September 8, 2020

The medical school admission process can be overwhelming. There is no definitive path that guarantees admission. Prospective students are meant to create their own way that could bring them an acceptance letter. That is why some individuals with a 3.6 GPA and a 508 MCAT score get accepted, and others with a better academic record get rejected. They might be considered an outlier, but some are not necessarily …

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After 4,380 days, a pair of Danskos — and a calling — fall apart

Finance
September 8, 2020

My Danskos literally disintegrated last month.

I was in the hospital team room, finishing up my patient notes at the end of a busy hospitalist shift. I happened to look down at the floor, and there they were: black chunks on the carpet.

I thought, “Who left such a huge mess under the desk?”

I looked at the bottom of my black Danskos. There was a sizable chunk of the sole missing.

Finally, the …

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Rural communities have unique vulnerabilities worsened by the pandemic [PODCAST]

Podcast
September 7, 2020
YouTube video

 

“While Imperial County faces a confluence of vulnerabilities that have led to its susceptibility during COVID-19, it is not alone. Like an insidious undercurrent, these deficiencies are lurking in every region of the United States. Structural issues require structural solutions—to effectively contain COVID-19, our local, state, and federal leaders must address these underlying faults in the foundation of the systems which …

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Intentions don’t sanitize impact

Physician
September 7, 2020

While there are certainly instances of malicious intent in thoughts, feelings, and actions, most people operate with the intent to do good, be good, offer good to the world – but what we do isn’t always received in the way we set out to offer it.

In the words of Oscar Wilde, “No good deed goes unpunished.”

It can be frustrating and even paralyzing to consider this consequence, resigning us to, “What …

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Why doctors should be trained to speak out and lead the movement for social justice

Policy
September 7, 2020

Dr. Anthony Fauci, National Institute of Health Director of Allergy and Infectious Disease and White House Coronavirus Task Force member, recently underwent surgery to remove a vocal cord polyp. This is not surprising given that a major risk factor for developing vocal cord polyps is overuse of the voice, something Fauci has likely experienced during the COVID19 pandemic as he has been called upon to speak …

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Medicine’s culture forces us to ignore our health [PODCAST]

Podcast
September 6, 2020

“Physicians are steeped in a noxious culture that seems to be averse to creating healthy physicians. We ignore mountains of evidence that show exercise, sleep, and healthy eating is beneficial for cognitive function, learning, and performance — all aspects that physicians should optimize. But the current medical training system pushes physicians, residents, and students to the brink of their physical, emotional, and mental …

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Recognizing childhood stress is so important. Here’s why. [PODCAST]

Podcast
September 5, 2020
YouTube video

“Advocate for the children in your community. Studies show that one of the most powerful buffering factors for kids experiencing toxic stress is having at least one supportive, caring adult in their lives. Who in your circles needs you to provide this role? Studies also show that a healthy foundation of sleep, nutrition, exercise, and coping strategies can also mitigate stress …

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Medical student suicide is the trend that must end

Conditions
September 5, 2020

Last November, our medical school’s community faced a devastating loss, as second-year student R took her own life. As she was rushed to our hospital’s emergency room, some of R’s classmates, as well as her physician mentor, were on rotation and bared witness to her getting rolled in. Understandably, the loss of R cut deeply. While not often discussed, medical student suicide has been no stranger to medical schools both …

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A journey from security guard to nurse, and why nurses don’t get the credit they deserve [PODCAST]

Podcast
September 4, 2020
YouTube video

“The pharmacy department plays a vital role in hospitals. They prepare and dispense medications. Sometimes the pharmacist will receive an order from the doctor on a med whose written dosage he is not sure of. In some cases, the pharmacist will call the nurse in order to get clarification on this. The problem here is that …

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Now is the time for postpartum home visits

Conditions
September 4, 2020

I ring the doorbell, waiting patiently outside.  I hear a weak “coming” and some shuffling.  Who greets me is a mother in her robe, hunched over at the waist, supporting her protruding postpartum belly.  Her hair is disheveled.  Her mask is revealing exhausted eyes with attempted mascara to look a “little freshened up,” she confesses a little later.

“My husband is just getting the baby; please come in.”

I …

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Blowing the whistle on health care fraud [PODCAST]

Podcast
September 3, 2020
YouTube video

“Fraud in the health care industry is a fact of life.  In 2016 alone, the federal government estimated that improper payments by Medicare and Medicaid totaled about $95 billion.  And that’s only a single year’s amount for just two of the government’s many health care programs.  With an aging population, increased health care spending, the passage of the CARES Act, and …

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Direct primary care: Great for some doctors, but challenging for patients

Policy
September 3, 2020

The COVID-19 pandemic and the consequent drop in patient visits have led some observers to conclude that primary care physicians would be better off financially if they were capitated than if they were paid fee for service. If they received a fixed amount of money per health plan member per month, they’d have a guaranteed income stream regardless of how many patients came to their offices.

However, a growing number …

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2 tales of physician assistant burnout

Conditions
September 3, 2020

For the first 12 years as a physician assistant, I thought provider burnout only happened to wusses, those better suited to working in health insurance or doctoring at a summer camp.  Sure, I felt overwhelmed at times, but I planned to soldier on in clinical practice, happily serving my patients until retirement.

That was before.   Before dreading Sunday nights, feeling heaviness in my gut, a tightness in my neck, and bouts …

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The transition from resident to attending: Setting the stage for your new life and career

Physician
September 3, 2020

You’re finally at the point in your career that you’ve been waiting for! Training has been strenuous, and you have spent many years of your life readying yourself professionally for this moment. It is now time for you to transition from a resident to an attending physician.

At this time, you may be tempted to jump right in and start working.  I recommend taking a little time off for yourself first. …

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An infectious disease physician says: Wear a F-ing mask [PODCAST]

Podcast
September 2, 2020
YouTube video

“In honor of one of the great classic novels, Go the F**k to Sleep, I would like to present to you my literary work: Stay the F@$k at Home.

To the healthy 20 year old who asks, “Why should I stay the F@$k at home, COVID-19 is not going to kill me?”

I ask: Do you want to kill your nana and grand-pops?

No?

Then …

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Virtual care needs to be designed for equitable usage and accessibility [PODCAST]

Podcast
September 1, 2020
YouTube video

“Although technology and disruptive innovation theoretically diminish systemic barriers and geographic isolation, in practice, they frequently widen chasms in access for vulnerable populations. The reality is telemedicine disproportionately caters to younger, wealthier, and more educated patients.

Hospital systems need to ensure every patient has access to remote health care services, whether through offering landline phone visits, examining pitfalls in digital skill requirements, …

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