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The debate over how many hours an intern can work misses the point

Education

January 17, 2017

I still don’t know how I did it. I don’t know how I got through life as a lower-level neurosurgery resident. I vividly remember the horrific call nights and weekends. There are certain sensations you get when you have gone weeks without more than two or three hours of sleep at a time. It wasn’t the foggy thoughts that bothered me most, or continually feeling cold, or even when I …

My primary care doctor sent me to the emergency department

Joshua W. Elder, MD, MPH and Ashley N. Elder, RN

Physician

January 16, 2017

My wife who is eight months pregnant went to a routine prenatal appointment last week. She told the OB doctor that she was concerned she had pink eye. OB providers, along with pediatrics, family medicine, and internal medicine all constitute primary care providers (PCP) and pink eye is a common primary care condition.

Surprisingly, the OB physician referred her to the nearest acute care facility. Attributing this provider’s recommendation as rare …

Obesity and empathy: A physician’s New Year’s resolution

Stephen Spencer, MD

Physician

January 16, 2017

Empathy is the cornerstone of quality patient care. It is no surprise that the fundamental moral code that has facilitated human kindness for thousands of years is what drives physicians to commit to their oath today: Treat others as you would have yourself treated.

When it comes to the disease that is obesity, I can empathize. I’ve struggled with obesity for as long a time as I can remember. There are …

An order of ceviche, please. With a hospital visit on the side.

Kirstin Hirni, MD

Physician

January 16, 2017

It’s October, and I’m a second-year medical student. My best friend Carly and I have just finished a backpacking trip through South America. We fly out tomorrow from Lima, Peru, and we have just one thing left to do: eat shrimp ceviche, the classic South American dish of raw seafood marinated in lime or lemon juice, oil and spices.

We wander along the busy streets until we find the restaurant our …

A day in the life of a radiologist

Samuel M. Chen, MD

Physician

January 16, 2017

“Life is just a short walk from the cradle to the grave, and it sure behooves us to be kind to one another along the way.”
– Alice Childress, American playwright, actor, author (1912-1994)

I am awakened in the wee hours by the sound of rain. Ordinarily I would return to bed in hope of stealing more sleep from night, but this particular day I know I have to rise at 4:30 …

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A day in the life of a radiologist

A medical school goes pass-fail: Why this change must happen everywhere

#LifeofaMedStudent

Education

January 14, 2017

Well, I’m officially that old, bitter resident. I had to walk uphill to medical school 10 miles there and back. “In my day,” medical school was fail, pass, high pass, or honors. I recently found out that the medical school I graduated from has changed the first two years of basic science courses to simply pass/fail (while retaining the honors/high pass grades in clinical rotations). I am so annoyed! Why …

The psychiatry rotation terrifies this medical student. Here’s why.

Anonymous

Education

January 14, 2017

Most third medical students look forward to their psychiatry block. After twelve plus hour days and six day weeks on internal medicine, OB/GYN and surgery, the reasonable hours on psychiatry seems like a dream. While my classmates viewed psychiatry as a break, I dreaded it. This was not my first time on an inpatient psychiatry ward.

My world and fate forever changed when I was twelve years old. Sometimes depression is …

The deadly risk of being treated by a male physician

Dr. Saurabh Jha

Physician

January 13, 2017

Halfway through the “Bell Curve,” which is an analysis of differences in intelligence between races, I realized what had been bothering me about Charles Murray’s thesis. It wasn’t the accuracy of his analysis, which concerned me too. It was what he analyzed. The truth, I used to believe, was always beautiful, whether it was what happened in the multiverse at T equals zero or the historical …

Medical school applicants: Waitlisted? Want more interviews? Here’s what you can do.

Jessica Freedman, MD

Education

January 13, 2017

You submitted your application in July. You completed all of your secondary essays by mid-September. Other than one interview that resulted in a waitlist decision you’ve heard nothing but radio silence. What can you do?

Whenever I work with medical school applicants I emphasize that the application process is ongoing because the admissions process is fluid. It is not as if you submit your primary application and secondary essays and the …

There is a direct connection between inefficiency and burnout

Paul DeChant, MD, MBA and Diane W. Shannon, MD, MPH

Physician

January 12, 2017

An excerpt from Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine.

Mark Linzer’s research identified workplace chaos as one of the key predictors of physician stress, burnout, and intention to …

We must tell sad medical stories too

Richard Young, MD

Physician

January 11, 2017

This post is based on a “friend of a friend” situation. Important details have been changed to protect anonymity, but not the basic realities I want to discuss.

A 49-year old man was diagnosed with a rare form of lung cancer about a year and a half ago. This sad situation is compounded by the fact that he was in a stable marriage with a wife and two children, ages 10 …

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We must tell sad medical stories too

The one lesson I learned working in a psych unit

Anonymous

Education

January 11, 2017

I was incredibly nervous going into my first day in the inpatient child/adolescent psychiatry unit. “Was this where the truly psychotic kids are? Am I going to be safe here?” I wondered as I casually introduced myself to the staff on the floor. After a morning of sitting in on group therapy led by psychologists and occupational therapists, I calmed down. Against the backdrop of the soothing soft pastel colors, …

The double meaning of despair in the hospital

Kjell Benson, MD

Physician

January 10, 2017

How can a doctor resist an essay entitled, “The Sickness Unto Death?” Kierkegaard, the darkest of the bleak existentialists, begins by asking, “Is despair an excellence or a defect?” Can despair be an excellence?

It is December in Oregon, the rain comes down in sheets, with only a few hours daily of half-light. Kierkegaard’s winters in 1840 Denmark must have felt a lot like this, so I press on.

“In despairing over …

Planned Parenthood and my decision to go to medical school

Melanie Jay, MD

Physician

January 9, 2017

As my co-workers and I peered out the window of the Planned Parenthood in Philadelphia, we saw over 200 protestors chanting the name of a man who had killed 2 people and injured several others at reproductive health centers the day before. They kept coming closer and padlocked the entrance gate so that we were trapped. We worried they might have weapons. The stand-off lasted for three terrifying hours. As …

Involuntary discharge from dialysis: A health care practice like no other

Robert Allan Bear, MD

Physician

January 9, 2017

Chronic kidney failure is a serious disease. When progression to end-stage renal disease (ESRD) occurs, dialysis is required to sustain life.

It is shocking, then, that in the United States, it is estimated that over 1,000 patients annually are involuntarily discharged from their dialysis clinics. Further, they are often “blackballed” from other local clinics. The consequences for such patients, predominately African-American, are dire. A patient may be unable to find a …

Do primary care physicians increase life expectancy?

Niran S. Al-Agba, MD

Physician

January 9, 2017

U.S. life expectancy declined in 2015 for the first time in more than two decades, according to a National Center for Health Statistics study released last week. The decline of 0.1 percent was ever so slight ― life expectancy at birth was 78.8 years in 2015, compared to 78.9 years in 2014. However, this reversal of a long-time upward trend makes these results significant.

While many researchers are scratching …

Rule #1 of emergency room diagnostics

Lawrence Schlachter, MD, JD

Physician

January 9, 2017

An excerpt from Malpractice: A Neurosurgeon Reveals How Our Health-Care System Puts Patients at Risk.

It is not possible to live life in a way that every choice and decision awaits a definitive, double–blind study with a statistically significant …

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Rule #1 of emergency room diagnostics

Medical students need to fail more often. Here’s why.

Tyler Scaff

Education

January 7, 2017

We need to fail more tests in medical school. I’m serious.

In first year, our class had two of the most memorable weeks of our schooling: A crash course on biochemistry taught by a professor who is widely accepted as one of the best teachers in our medical school. His in-class lecture style kept students engaged and entertained; I, and many of my classmates, learned tremendous amounts of his material and …

Don’t engage in fishbowl emergency medicine

Sandra Scott Simons, MD

Physician

January 6, 2017

How in the heck would three nurses and I ever orchestrate ECMO in the middle of the night in my community ED? I pondered this over tuna tartare while listening to ivory tower docs discuss cutting-edge modalities like they were part of treatment algorithms everywhere. The conversation turned to REBOA, and I wondered how many academicians had ever manned a single-coverage ED.

Ivory tower medicine and my world, where there is …

Stop saying these 7 shaming words in medicine. Right now.

Pamela Wible, MD

Physician

January 5, 2017

In medicine, our motto is first do no harm. Words matter. Choose them wisely. Here are 7 words that shame, blame, and injure people who need our help.

1. Don’t say COMMITTED suicide. Committed implies a crime. Committed rape, burglary, murder. Suicide is not a crime; it’s a medical condition that has been taboo for too long. Let’s come out of the dark …

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