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Do physicians feel guilt and embarrassment more often than they admit?

Physician

August 31, 2019

I was an intern, doing a rotation in the coronary care unit (CCU) of a large urban hospital. It was very challenging: The patients had complex medical issues, and my fellow residents and I were given lots of responsibility for their care. Still, I felt I was finally getting the hang of residency.

One of the first patients I saw was Mrs. Smith, a middle-aged woman who had come to the …

Is medicine really a model family-friendly profession?

Kristina Fiore

Policy

August 30, 2019

An article in the New York Times touting medicine as a family-friendly profession has stirred up critics who say it denies the reality of career sacrifice and gaps in leadership and pay that female physicians face.

Writer Claire Cain Miller profiled female doctors whose specialties afford them flexible work hours that make it easier to balance their professional and caregiving responsibilities. Britni …

Should hospital systems post physician salaries?

Smart Money, MD

Finance

August 30, 2019

One of my coworkers who grew up in India told me that their teachers in grade school would post everyone’s scores in the hallway after every exam. This comparison of grades and objective testing further extended to cities and even regions in the country. There are people going through the hierarchical ranks with “gold medals” in science or engineering. Throughout this process, it was relatively transparent who the smartest or …

Will separating obstetrics from gynecology help specialist burnout?

Robert Pearl, MD

Physician

August 30, 2019

At the end of a long table covered with hors d’oeuvres and a birthday cake, I struck up a conversation with three primary care physicians.

I was hungry for their opinions.

Inside the crowded apartment, we spoke for some 20 minutes about the systemic and cultural causes of burnout in primary care—a conversation that informed the first article in this series.

As I was about to leave, I …

The sensitive topic of physical contact during exams

Hans Duvefelt, MD

Physician

August 29, 2019

Touch is a sensitive thing. No pun is intended here, but whether and how we touch our patients deserves our careful thought and deliberation.

So much interpersonal contact these days is virtual, with emojis, abbreviations and whole words thrown around as substitutes for human contact. Think XOXO and, “hugs and kisses.” And when people do touch in our health care environment, it is often with gloves, even for simple fingerstick blood …

Just because EMRs can document everything doesn’t mean they should

Fred N. Pelzman, MD

Tech

August 29, 2019

It’s always kind of a surprise when you read a patient’s chart, and you see an examination of a body part they just don’t have.

Just the other day, I was reading a consult note on a patient of mine who had been seen by a subspecialist for evaluation of a serious issue, and I received back a long detailed office …

The story of a hospital collapse and how small towns were devastated

Barbara Feder Ostrov and Lauren Weber

Policy

August 28, 2019

The money was so good in the beginning, and it seemed it might gush forever, right through tiny country hospitals in Missouri, Oklahoma, Tennessee and into the coffers of companies controlled by Jorge A. Perez, his family, and business partners.

It was his “secret sauce,” the rotund Miami entrepreneur would smilingly tell people in their no-stoplight towns. The money-making ventures he proposed sounded complicated, sure, but he said they would bring …

A surprise pregnancy in medical school

Christine Loftis

Education

August 28, 2019

“You’re 27-and-a-half weeks pregnant.”

As I lay on the exam table, time froze.

How can this be? I wondered dazedly. I’m a second-year medical student. I’ve just completed a course in female reproduction and endocrinology. How could I have missed the signs?

I attribute my obliviousness to the surgery I’d gone through only months before: the removal of a 27-pound, mucus-filled ovarian cyst. My lack of menstrual periods was nothing new; they’d been …

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A surprise pregnancy in medical school

The decision to undergo robotic surgery is a more than just about the length of the scar

Anonymous

Conditions

August 27, 2019

Over the last three decades, surgery has slowly but steadily evolved towards a minimally invasive technique. The standard of care for appendicitis now involves creating three half-inch incisions and using a laparoscopic technique to remove the appendix. This technique uses a camera to see inside the body via a large screen. Instruments that are over a foot long are used. Sufficient research has shown that this minimally invasive technique leads …

What role does the science of complexity play in medicine?

Robert Trent

Conditions

August 27, 2019

The science of complexity lays a conceptual foundation for understanding “complex adaptive systems.” What all complex adaptive systems have in common is that they are all bound by the same set of physical laws. Their “behavior,” i.e., growth, maintenance, and death, can all be described using the same set of mathematical relationships. These systems (animals, plants, ecosystems, etc.) are the most productive and functionally effective systems known to man.

Unfortunately, our …

Considering CBD oil? This psychiatrist suggests these questions to ask first.

Greg Smith, MD

Meds

August 26, 2019

One question I get asked a lot lately is this: “Is it OK for me to use CBD oil?”

First of all, CBD oil and associated preparations are types of alternative medications, medicines that might not be mainstream or readily prescribed by doctors, but are nevertheless used by many people on their own. Alcohol and marijuana are two substances that are often used as “medicines” by those that think they function …

Should physicians yearn for the nostalgic ideals of their predecessors?

Ioana Baiu, MD

Physician

August 26, 2019

What has the medical community, once thought of as the “ultimate team,” finally come down to in 2019? The “back in my day” sigh I often hear from more senior physicians has inspired me to read several books about the history of medicine. As I devoured them from cover to cover, the excitement of medical discovery, the anticipation of the near-miracles that were about to be revealed, and most importantly, …

Haven’t thought about investing in group homes? You should.

Cliff Janke, MD

Finance

August 26, 2019

Back in 2006, I settled into my career as an emergency room physician. It was then when I started working in multiple hospital groups in several cities in Arizona and Texas to maximize my earning potential.

The strategy worked. I was able to make enough money to service my medical school debt as well as dabble in commercial real estate, buying some duplexes in Central Texas then single-family homes and larger …

I’m a residency program coordinator. My role has changed over the years.

Lori Berryman

Education

August 26, 2019

I was a 22-year-old intern, just about to finish my public health internship. I had an ambitious career ahead of me. I was trained as a public health educator. I was doing wellness fairs, writing newsletters, and excited to get to the next stage of my life. I wasn’t yet certified, however, so when all of a sudden a job opportunity presented itself to me and gave me a chance …

The power of music in the ICU

Nomi C. Levy-Carrick, MD

Physician

August 23, 2019

“I just don’t know what to do, how to help.” My patient’s wife was slumped in the plastic chair by her husband’s side, fatigued and beleaguered. She had been there for hours, days, as we waited for antibiotics to start fighting back against the infection that had overwhelmed his body.

“What sort of music does he like to listen to?”

“Depends on what he’s doing. Zeppelin to work on the car. Jazz …

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The power of music in the ICU

Physicians need to stop being so nice

Suneel Dhand, MD

Physician

August 22, 2019

The changes that have occurred in health care over the last few years represent a sea change from the autonomy and clout that physicians once had. It’s no great secret to anybody working in medicine that most of these changes to practice — including the push towards employment instead of private practice, and the need to now spend the majority of the day clicking boxes on a computer screen — have …

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Physicians need to stop being so nice

A physician’s first telemedicine video visit

Fred N. Pelzman, MD

Physician

August 22, 2019

I just did my first telemedicine video visit.

The concept seems so strange, the idea of carrying out an “office visit” without the patient actually being in the office.

Right now we have it structured so that when a patient calls up requesting to see me on a day when I am already fully booked (or, as is usually the case, overbooked), …

Don’t make me choose between motherhood and my career

Anonymous

Physician

August 22, 2019

A debate highlighting gender discrimination in medicine currently rages within the pediatric hospitalist medicine community.

The debate centers on the board certification process for “grandfathering” for the new pediatric hospitalist subspecialty which effectively excludes women on the basis of motherhood.

For those not familiar with “grandfathering in,” this is the process by which a new subspecialty may grant board certification to physicians who have been practicing in the specialty. The alternative option …

5 lessons from an emergency physician

Navpreet Sahsi, MD

Physician

August 21, 2019

The emergency room is an interesting place to work. It’s controlled chaos. Walk through the hallways, and you’ll hear people screaming, see others crying, and others wincing in pain.

Over time, you get a unique perspective on the human condition. In my years of training and practice, I’ve seen so much. People experiencing their worst days. Others receiving news that will change everything. Some lives ending. Others returning from the brink.

Certainly, …

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5 lessons from an emergency physician

Asking patients the right questions isn’t as easy as you think

Mary Braun, MD

Physician

August 19, 2019

I made my 10:20 a.m. patient wait while I told my support staff about my day off.

“I was getting an ice cream when I saw a car accident. By the time I got there, it was clear that there were no serious injuries and all I did was to distract the passenger so she wouldn’t panic while we waited for EMS. Her husband hit a tree with their van, and …

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