6 pieces of advice for graduating medical students and residents

Physician
July 13, 2018

My (sometimes solicited, but often unsolicited) advice for graduating medical students, residents, and fellows:

June is one of my favorite times of the year.  One, because it’s summer, but also because it’s graduation season.  I love seeing and hearing about everyone’s accomplishments, and seeing years of hard work come to fruition – although if I’m being honest, it’s bittersweet, because it’s also a reminder of how I’m getting older.

This year, I’ve …

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8 steps to have those difficult conversations

Physician
July 12, 2018


An excerpt from 7 Ways to Stop Drama in Your Healthcare Practice.

Although the ability to initiate difficult conversations is part of good leadership, I’ve never met a leader who enjoys it. Whether your conversation is about body odor, rude behavior, dress code, personal conduct or performance issues, difficult conversations are …

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A conversation with a doctor who was tired of feeling burned out

Physician
July 11, 2018

An excerpt from the Docs Outside the Box podcast, episode 1:  When the going gets tough… MOVE! 

Dr. Nii: All right, well thank you very much for joining us on the Doc’s Outside-the-Box podcast. You are our first guest — first victim, I guess. It’s the inaugural episode, so I just wanted to thank you for joining us. I know you are in New Zealand, which is roughly 18 hours away.

Dr. Brown: It’s …

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What’s better: mentorship or sponsorship?

Education
July 11, 2018

Literature coming from business and human resource management suggests that women are over-mentored and under-sponsored. However, if you have been reading reports about women in medicine, then you likely have heard that women are both over-mentored and under-mentored. Where does the truth lie? That depends on various factors including the definitions of these terms.

What exactly do these words mean? In the business sector, mentorship is …

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Prescription drugs are killing students and the educational system

Meds
July 11, 2018

The Centers for Disease Control and Prevention reports that 63,632 individuals died in 2016 as a result of drug overdose. Among these, 66 percent died from opioid overdose. The statistics are derived from in-depth research that was carried out by the research institute in 2016. The Centers for Disease Control and Prevention warns that cases of drug abuse are swiftly spreading geographically and increasing demographically. The …

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A physician’s warning on the keto diet

Conditions
July 11, 2018

The keto diet has recently garnered much fame for its apparent ability to improve diabetes and obesity – results so impressive the Journal of the American Medical Association recently highlighted the diet and thereby christened it as something more than a low-carb craze. However, not all the evidence supports such a positive outlook, leading the diet to straddle the increasingly blurred lines between faddist snake …

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3 steps for doctors to move into the next level of career growth

Physician
July 10, 2018

In medicine, this is the time when one season ends and another begins. New doctors graduate from medical school. They are excited and, at the same time, scared as they enter into residency training. Interns become residents. Senior residents celebrate moving into attending positions or look forward to subspecialty training in fellowship programs. It’s the excitement of completion combined with the uncertainty of charting a new course in medicine. Each …

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Sleeping with your baby: Mainstream media gets it wrong

Conditions
July 9, 2018

Recently, a journalist with NPR asked her audience if sleeping with your baby is as dangerous as doctors say.  In short, yes, it is very dangerous.

In the article, Michaeleen Doucleff repeatedly trivializes the danger of parents co-sleeping with their baby.  She uses anthropological evidence to reassure parents that sleeping with their infant is safe if parents don’t drink, smoke, or use illicit drugs.   She makes light …

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What I wish my family had known about medical residency

Physician
July 9, 2018
YouTube video

I sometimes get messages from people who have lost physician colleagues and loved ones to suicide. It’s the specifics of these stories that wound me: a note left for an unexpected person; an insignificant fight at sign-out that in retrospect is full of meaning; the white coat that a woman wore when she jumped to her death. Each of these lives is complex, and each of these deaths …

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Political polarization is harming America’s health

Policy
July 8, 2018

On May 15, President Trump attempted to kill not just two, but three birds with one tweet, simultaneously denouncing the Media and the Mueller investigation, and crowing about his approval ratings. “Can you believe that with all of the made up, unsourced stories I get from the Fake News Media, together with the $10,000,000 Russian Witch Hunt (there is no Collusion), I now have my best …

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Which of these patients should get a liver transplant?

Conditions
July 7, 2018

People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a …

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3 things patients really want from their doctors

Physician
July 5, 2018

The doctor-patient interaction is the absolute core of clinical medicine. Maybe I’ll go much further: it’s the core of health care in general. I always try to remember, whenever I’m ever feeling frustrated with the system, the crazy bureaucracy — and of course, the debacle of our clunky electronic medical records and their data entry requirements — to separate myself from all of that when I’m face-to-face with my patient …

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Job security in medicine is a myth

Finance
July 5, 2018

Imagine, if you will, that you’re an anesthesiologist. You’ve been part of a successful practice for over 10 years. You can walk down your neighborhood street and run into mothers whose epidurals you’ve helped place. You’ve established a home, a community, and your children are in a great school system.

One uneventful day, say Wednesday, you get an email from the hospital administrators announcing that there’s going to be a meeting …

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Don’t tell patients they look great, except in these cases

Physician
July 4, 2018

One of my colleagues sat on a wheeled clinic stool at the end of the examination table and told the patient, which was in this case an actor, “Everything looks great.” After, he swiveled around to face the instructor and the small group of onlooking medical students behind him. Our instructor also turned to us and said, “Very good job. But can anyone tell me what he did wrong?” He …

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A doctor’s apology can go a long way

Physician
July 3, 2018

I came across a letter I wrote to a patient while rummaging through some old files on my computer. I flashbacked to what triggered this: a response to a letter she had sent me, one that was, shall we say, extremely unflattering and quite scathing in the way she described me and our last encounter. From the letter’s tone, I sensed she held back on using more profane language to …

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5 ways to show empathy in medicine

Physician
July 2, 2018

As medical professionals we often see people at their worst: battered and broken, bothered and in pain, no make-up, bad hair day, naked and too ill to even care about modesty. At those critical moments, in our patients’ hour of desperation, they hand over their lives to us … and the lives of their family. All that they are — they willingly place at our mercy. At times, burnout, and …

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The difference between care and service is significant

Physician
July 2, 2018

My father, recently retired, spent over 40 years in private practice. After dinner, he would sift through piles of paper charts and call patients with their lab results. As a grade schooler, what impressed me the most was that he knew many of his patient’s phone numbers by heart. Of course, this was in the days before HIPAA and caller ID, so scattered charts on the dining table and calling …

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Attending time: That’s just a myth

Finance
July 1, 2018

One of the great myths amongst residents is that once they become attendings, they’ll have so much more free time. I’ll never work this much again, they think. This is the most time-intensive phase of life, and everything after residency is easy in comparison.

Unfortunately, they are usually wrong.

Statistically, working about the same number of hours in residency and as an attending is the norm. In one study, attendings work 59.2 …

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