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 …
An ode to a beloved ICU nurse manager
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 …
Should doctors’ personal judgments affect their patients?
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 …
Going to a walk-in clinic? 6 essential things you must know before you visit
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 …
Corporate health care is doomed. Here’s why.
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 …
A letter to her physician husband
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 …
The word that best describes this medical student’s experience
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 …
A different consequence of 28-hour shifts
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 …
Are surgical residents really doing the cases they scrub on?
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 …
How an oncologist used Pac-Man to teach his patient
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 …
Essentialism for health care professionals
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 …
Listen to your patient’s story: It’s their diagnosis
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 …
Telemedicine: What could go wrong? A lot.
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 …
Is there a difference between a good and bad prognosis? It depends.
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 …
Please tell me what a “mommy-friendly” medical career is
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 …
Medical students can make a difference in health care
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 …
This resident works 100+ hours per week, but is still a poorly trained surgeon
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 …
10 questions to frame the health care debate
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 …
My experience as a patient has made me a better physician. Here’s how.
As an internist and geriatrician, I deal with elderly patients all the time. We always end up talking about end-of-life issues:
“Should I be resuscitated if my heart stops and I stop breathing?”
“Do I want a feeding tube or gastrostomy tube if I stop eating and require nutrition?”
“Should I be kept alive on machines and for how long if there is no reasonable hope of recovery?”
“When should we refuse tests for …
End-of-life decisions aren’t any easier for a doctor
For a century, the white coat has been the symbol of the medical doctor. Today, the vast majority of medical schools in the U.S. begin with a white coat ceremony. There, the fledgling, future doctors stand together and recite a modified version of the Hippocratic Oath before being called up one-by-one to receive the white coats that they will wear throughout the upcoming trials and adventures of medical school. The …
What does a doctor’s white coat really mean?
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