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Not all residency programs are bad. Here’s what to do if yours is.

Physician

January 4, 2017

A response to “This resident works 100+ hours per week, but is still a poorly trained surgeon.”

I am truly sorry your experience in a urology residency thus far has been far below your expectations. I am finishing residency in June, and I know how hard it is. There are sleepless nights, thankless tasks, and residency feels like a learning process that crawls forward in inches rather than feet. …

An ode to a beloved ICU nurse manager

Debbie Moore-Black, RN

Conditions

January 3, 2017

Once upon a time, I worked for a large hospital in the surgical-trauma ICU. It was just a six-month gig, and I had to travel from home further than I wanted. But my son would be starting college soon, and the $10,000 bonus was too irresistible.

Diane was the manager. The most kind, skilled, and helpful person I have ever met as an ICU manager.

She had every possible attribute as a …

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An ode to a beloved ICU nurse manager

Should doctors’ personal judgments affect their patients?

James C. Salwitz, MD

Physician

January 2, 2017

Medicine is a paradox. To save, we cut with sharp knives. We ignore pain so that it will light the path to diagnosis. We give toxins to destroy toxic disease. We scold our neighbors when they neglect their health, even as we work ourselves to exhaustion, eat too much and evade exercise. We comfort the families of our patients while ignoring our own.

There is one contradiction, which, by its very …

Going to a walk-in clinic? 6 essential things you must know before you visit

Peter Ubel, MD

Physician

January 2, 2017

A friend of mine recently had a very sore throat. She knew how to manage her symptoms — lozenges, warm tea and the like. But she was worried she might have strep and would, therefore, need antibiotics. That should be a simple question to answer with a quick trip to the primary care clinic. Except that her primary care physician was booked, and if she wanted an unscheduled appointment with …

Corporate health care is doomed. Here’s why.

Suneel Dhand, MD

Physician

January 1, 2017

As health care increasingly propels itself into the world of corporations and big business, it may seem like the practice of medicine has entered an irreversible new era. Gone are the days of good old Dr. Wilson in his solo private practice around the corner, loved and respected by all his patients and the community. Nowadays, it’s all about mega multi-specialty groups, health care mergers and hostile corporate takeovers.

Being someone …

A letter to her physician husband

Charity Williams

Physician

December 28, 2016

Dear Husband, MD

I see you. I hear you cough all night, knowing your flu vaccine has failed and you have it. I hear you wheeze with your post-flu pneumonia. I feel you shiver in the bed beside me while you sleep for 5 hours before you get back up and start getting ready for the next “shift.”

I put quotations around “shift” because we both know you will not work 8 …

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A letter to her physician husband

The word that best describes this medical student’s experience

Anonymous

Education

December 28, 2016

It’s 4:17 a.m. as I begin this entry. I’m scheduled to be at the hospital in 43 minutes for one of my last days on surgical rotation, and I’ve been working on the following text message since 3 a.m.:

“Hi, team. Im afraid that im burned out and anxious. I will be taking today off. Sorry to be blunt but i felt it better than to make up an excuse. Thanks …

A different consequence of 28-hour shifts

Stephanie Waggel, MD

Physician

December 26, 2016

Sleep deprivation and medical errors are not the only issues that arise from long shifts. Aside from being dangerous, working 28 hours straight can teach new doctors that their health and even their life is not a priority. With extremely high rates of depression and suicide in this field, increasing work hours is not the step we should be taking. When I was interviewed by Public …

Are surgical residents really doing the cases they scrub on?

Skeptical Scalpel, MD

Education

December 25, 2016

According to the Residency Review Committee for Surgery, “A resident may be considered the surgeon only when he or she can document a significant role in the following aspects of management: determination or confirmation of the diagnosis, provision of preoperative care, selection, and accomplishment of the appropriate operative procedure, and direction of the postoperative care.”

In nearly all instances, resident “determination or confirmation of the diagnosis, provision of preoperative …

How an oncologist used Pac-Man to teach his patient

Prateek Mendiratta, MD

Conditions

December 20, 2016

The most exciting and difficult part of my job is keeping up with all the rapid changes occurring in the field of cancer treatments. It is amazing how each day there seems to be a breakthrough treatment coming along, shifting old cancer paradigms. Although this is a good problem to have, finding time to stay current is easier said than done. Even more difficult is making sure we can explain these …

Essentialism for health care professionals

Timothy E. Paterick, MD, JD, MBA and Elizabeth Ngo, MD

Physician

December 18, 2016

An excerpt from Physician—Time to Invest in Yourself: Work-Life Balance, the Needs of the Patient, and Medical-Legal Risk Management.

What is an essentialist? What is an essentialist lifestyle? Essentialism focuses on identifying the important signals in life and eliminating the noise. The noises are the distractions that add no value to your life and frequently monopolize time and meaning. When you assume the role of an essentialist you will discover that you …

Listen to your patient’s story: It’s their diagnosis

Hans Duvefelt, MD

Physician

December 14, 2016

Sir William Osler wasn’t exactly wrong when he said, “Listen to your patient, he is telling you the diagnosis.” But he didn’t mean it literally. His patients did not offer up esoteric and complete medical diagnoses on a silver platter. They left him clues in plain language that he listened to carefully in order to make the correct diagnosis.

He penned his words in an era when medical information was scarce …

Telemedicine: What could go wrong? A lot.

Roy Benaroch, MD

Physician

December 14, 2016

Someday, we may miss the quaint idea of going to see your doctor for your medical concerns.

I realize taking your children to see their doc is a pain. So is taking your car into the mechanic, waiting for the cable guy or going out for groceries. There are other things you’d rather be doing with your time. Can a quick phone call substitute for a doctor visit?

At least one huge …

Is there a difference between a good and bad prognosis? It depends.

James C. Salwitz, MD

Physician

December 14, 2016

It was recently pointed out that one of my partners had made an error in a patient’s electronic hospital chart. Did I want to correct the mistake? Curious, I looked at the computer screen. There in 12-point-black-on-white Cambria was the culprit documentation. The words were:

“Our therapy goal is palliative. Prognosis is good.”

Now, this was clearly not what the author had intended. In common practice when someone is so sick that …

Please tell me what a “mommy-friendly” medical career is

Heena P. Santry, MD

Physician

December 13, 2016

I had a familiar conversation the other day with yet another female medical student.

“I really loved surgery!” she said, “but I was concerned about the lifestyle, so I decided on ______.”

Lifestyle — it turns out — almost always seems to be code for having a family.

Maybe it’s just the kind of students who seek me out. I have yet to encounter someone concerned that a surgical career will hamper their …

Medical students can make a difference in health care

Roosevelt V. Campbell, PhD

Education

December 12, 2016

I recently read an article that my future in medicine would be mediocre. It made me reflect on some things. Like the author of that article, I am a fourth-year medical student waiting to graduate and start my training in residency, the training that will prepare me for a successful career as a physician.

Like the author of the article, I decided to become a doctor with the hope …

This resident works 100+ hours per week, but is still a poorly trained surgeon

Anonymous

Education

December 11, 2016

I am forced to write anonymously because of gross neglect by my residency program regarding standard ACGME duty-hour rules. If my name were published, it would identify my program.

As a PGY-2, I worked 100+ hours per week on average last year while taking primary call for my urology department. (Admittedly, the PGY-2 is the historic “worst year” for any urology resident.) On a quarterly basis (depending on manpower), we take …

10 questions to frame the health care debate

Umbereen S. Nehal, MD, MPH

Policy

December 10, 2016

We are at a watershed moment for health care, both nationally and in Massachusetts.

Massachusetts, the state that first piloted the model, “Romneycare” in 2006, that was disseminated to the nation as “Obamacare” is now going full steam ahead with ACO models under the newly approved 1115 waiver, that received the CMS green light in early November. Having expanded to near universal coverage in 2006, now, at the end of 2016, we are taking on …

My experience as a patient has made me a better physician. Here’s how.

Farrell Tobolowsky, DO

Physician

December 9, 2016

The medical assistant swabbed my nose and my throat multiple times. Pricked my finger too. Then, the phlebotomist (or vampire?) drew bottles and bottles of my blood. Along with the physical discomfort, there was emotional discomfort too. What would the test results show? If they were all negative, would I be satisfied without having an answer?

Being a patient can be extremely vulnerable. Not only do you often divulge to a …