“I had sent an email to some key people in my organization about managing patients’ expectations and how that needed to be addressed differently on an organizational level. The truth of the matter is that I am powerless to change the way the system handles a lot of things. The …
Managing expectations during COVID-19 [PODCAST]
Since the beginning of COVID-19, we have recognized the truth of philosopher George Santayana’s oft-quoted 1905 writing — “Those who cannot remember the past are condemned to repeat it” — and looked for lessons from the 1918 Spanish flu, the deadliest pandemic of the 20th century. Much was different, yet so much the same. There was no testing, treatments, or ability to prevent the virus then beyond shutdowns, masking, distancing, …
Looking back on 2 years of uncertainty, adversity and more than a few silver linings
Even before I turned 16, I knew I liked girls. I also knew I liked boys. I didn’t understand it. Why was I drawn to women? During that period of my life (between 11 and 16 years of age), I was also in a boarding school. An all-girl boarding school, for that matter. It was torture. It went against everything I knew to be “right.”
That was the first time that …
When the government comes for your trans kid
March is Colorectal Cancer Awareness Month. Share these gems with your family, friends, and patients. Take the time to reflect on your personal history and encourage yourself and others to get screened when appropriate.
1. The large intestine or the large bowel consists of the colon, rectum, and anus. The colon and rectum have a cumulative length of 150 cm or 4.9 feet.
2. Gastrointestinal contents are received from the small bowel …
10 colorectal pearls for Colorectal Cancer Awareness Month
Keeping someone alive? I could do that. After all, that’s what medical school taught, ways to save lives. Give me a disease, and I could find the algorithm. Death, however, was murky, messy, and confusing. An algorithm does not exist. There is no uniform response to provide grieving family members at bedside. Death was its own master, chose its own rules, and decided its own course. Death was something I …
“There is a small amount of literature about secondary trauma. This means that the people who respond to trauma (firefighters, police, doctors, EMTs, etc.) experience PTSD from experiences they were not the primary victims of. I haven’t read the literature, and I don’t know what qualifies. I do know …
How a code profoundly affected this physician [PODCAST]
Staffing shortages and turnover rates have recently become a pertinent topic for hospitals. However, these personnel challenges have haunted certified nursing facilities since the 1970s. Even before the COVID-19 pandemic, the turnover rate for total nursing staff in nursing homes was about 128 percent. While increasing transparency on these atrociously high turnover rates has been a commonly proposed solution, it has only recently been …
The nursing home staffing crisis will not be fixed through transparency
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.
The refrigerated trucks had not yet left our parking lot when I got an email from the IT department. It was late spring 2020, and deploying a new electronic health record system for the anesthesia department was not front of mind. We …
Prioritizing patient safety during a global pandemic
In health care circles these days, you hear about the social determinants of health (SDOH) almost as often as you hear: “You’re on mute!” SDOH are the conditions in the places where people are born, live, learn, work, play, worship, and age that affect health outcomes. These non-medical factors like income, socioeconomic status and access to health care, safe housing, and reliable transportation drive …
Coding for social determinants of health and unmet social needs
I describe work-life balance not as a see-saw with one side going up while the other goes down, but more like a wobble board with imbalance possibilities in infinite directions.
Now that I’m in my fifties with grown kids, I feel compelled to share what I think I did right — and on what I feel I wasted time/energy with the disclaimer that it all depends on your values and this …
Work-life balance is not an accident
“If you knew we are like the ‘Two Fridas,’
that our hearts are connected,
would you change your mind?
Would you stop
as you are about to cut
the artery feeding your heart and mine?
If you knew that when you cry because of your loneliness,
because of your longing for your family,
that I cry, too, …
Unrequited: love in the time of COVID-19 [PODCAST]
We are nurses. We are in highly dangerous and volatile units at hospitals. We are not working in a prison. We work in behavioral health. The intensive management unit, the adolescent unit, the dual-diagnosis unit, and the behavioral health emergency department.
We are specially trained to protect ourselves and others with CPI — a mandatory nonviolent crisis intervention training. We have patients who are schizophrenic, bipolar, drug addicts, with assault charges, …
We are behavioral health nurses and we want to thank our public safety officers (PSOs)
I almost quit my job in 2014. I didn’t like my life, and I didn’t like myself. I had a lot of problems personally and professionally, and I wondered if I was good enough to solve them. I often felt weak and powerless. People were coming to me for answers, but I sometimes felt like a fraud.
My usual strategies of working harder and reading more books weren’t helping me, and …
A burnout coach saved my medical career — and possibly my life
When you are trapped in a locker room in only your underwear at 3 a.m., you realize how many things must have gone wrong for you to land in that spot. Within the first week of my clinical rotations, I managed to be bested by the scrub machine. It was a strong start, to say the least.
My name is Ed, and I am writing to you as a fourth-year medical …
New medical students: Do not take yourself too seriously
Very few are talking about workplace bullying, yet many are benefitting from it. It acts contrary to the principles of care at the heart of medicine — and we need to do something about it.
How many physicians have wanted to leave medicine because they were subject to horizontal violence or bullying in the workplace? Who has felt undermined, belittled or humiliated when showing up to work on a daily or …
Let’s talk about bullying in medicine
Almost ten years ago, there was a knock at the door. My children and I were playing games as it was only a few days after Christmas. All of us answered the door, and there stood a sheriff with papers. He said those dreaded words, “you are served.” As I closed the door, I tried to hold back my tears and get my kids situated in front of the TV. …
Avoiding medical malpractice in the wake of the pandemic
“For the most highly educated and specialized professional on the health care totem pole, physicians put up with a ridiculous amount of nonsense in the workplace.
You are pressured to see high volumes of patients in a rapid-fire fashion (15 minutes per visit) even when it interferes with the quality of …
Why do physicians stay in toxic work environments? [PODCAST]
For most of my life, I was so busy cramming and training to focus on my nasal profile or my pesky protruding lower left canine. The drive to achieve academically consumed me from a very young age. I staved off self-doubt through study, intense repetition until the knowledge bled from my brain onto the pages of countless exams. For eleven years, I missed birthdays, family gatherings and sacrificed friendships and …
One surgeon’s decision during COVID to finally believe in her long-term survival
I have deep roots in the Benedictine tradition at St. John’s University, MN. I took my first steps in Guild Hall, graduated from St. John’s Prep School and University, and later married my wife Ashley at The Abbey church. My understanding of the biopsychosocial and spiritual aspects of the human condition grew from these formative years at St. John’s and inspired me to become a physician and leader. I’m grateful …
From the ground up: an invitation for self-care for physicians and health care professionals
As a hospice and palliative care physician, grief is a familiar concept to me. It is most often discussed in the context of loss of life. However, grief at the root is simply profound and agonizing distress caused by loss — any loss. In hospice and palliative care, we train to recognize risk factors for complicated grief and to refer for early intervention. The pandemic has been the ideal breeding …
Complicated grief: the hidden pandemic in health care workers
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