To our leaders: Is physician burnout your fault?

Physician
December 26, 2019

Burnout and moral injury are terms that litter the landscape of ongoing research and debate about what is happening with American Physicians.  With increasing awareness and acknowledgment, there is an increasing number of leaders and health care organizations willing to attempt a solution.  However, while there is utility and looking below you to the physicians you lead and to the organization around you, you also need to be looking inward …

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To our leaders: Is physician burnout your fault?

Your medical career won’t last forever

Physician
December 25, 2019

“Slowly comes the hour, it’s passing speed how great.”
– Samuel Cowper

Our careers will end someday.

Of course, we know this deep down, but I think we lose sight of it amid our training and the day-to-day grind of our jobs.

But just this past week, I was given a little reminder.

At our Christmas party, we took some time to honor one of our colleagues on his journey to retirement. He had spent …

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Your medical career won’t last forever

Getting pregnant may have saved her life

Conditions and Diseases
December 25, 2019

Mary Beth is a female in her early 30s, quite obese and mildly mentally repaired, as well as suffering from schizophrenia. She lives in a housing authority apartment, which is not a great place. But being highly subsidized, it is cheap! Her apartment is in a perfectly dismal condition. She lives in absolute squalor with garbage strewn around, and I am unable to figure out what to do about it. …

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Getting pregnant may have saved her life

When physicians are so emotionally drained, they have nothing left for their families

Physician
December 25, 2019

The other night, while I was getting out of my car, my oldest son, standing on the porch, excitedly yelled out, “Mom, look at this lego structure I made!”

I couldn’t see it, but I could tell how happy he was to show it to me. “It looks neat from here. Let me get closer.”

My husband appeared, knowing how tired I was, “Mom worked a long day. Why don’t you let …

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When physicians are so emotionally drained, they have nothing left for their families

This doctor has no regrets to becoming a physician. Here are 3 reasons why.

Physician
December 24, 2019

There’s so much negativity out there when it comes to health care, it must be a concern to any young person thinking about entering the field. I certainly spend a lot of time writing about all the challenges we face, and have to hold my hands up to (occasionally) spreading some of that negativity as well! Guilty as charged. That’s why it’s important for anyone outside of health care (or …

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This doctor has no regrets to becoming a physician. Here are 3 reasons why.

Data mining, artificial intelligence, and angels of death

Physician
December 24, 2019

Google is universally well known as a search and advertising company. Now Google is tapping into the $3.5 trillion health care market. To compete with the Apple Watch, Google acquired Fitbit, the wearable exercise, heart rate and sleep tracking device.

Data is king.

Voluntarily worn fitness tracking devices are one thing, but Google has entered the realm of the brave new world. A government inquiry has brought …

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Data mining, artificial intelligence, and angels of death

Waking up to the sexual violence in America’s psychiatric units

Physician
December 24, 2019

It wasn’t until I first had to manage the aftermath of a sexual assault on a psychiatric unit one night during my residency that I realized psychiatry might have a problem with sexual safety.

My fellow residents and I had never been informed of a management policy for inpatient sexual assaults, and my program’s curriculum was silent on how to handle the issue.

Because the assault involved a psychotic patient who was …

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Waking up to the sexual violence in America’s psychiatric units

The robot will see you now

Health Technology
December 24, 2019

The year is 2050. You enter the room, ready to speak with your next patient, a 60-year-old white male with recent episodes of chest pain when he climbs the stairs to his office. Before sitting down to speak with him, a monitor in the room pulls up his recent lab work and current medications. Your patient note is being filled in, but nobody is typing; the computer is avidly listening …

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The robot will see you now

The pain score must go. Here’s why.

Conditions and Diseases
December 23, 2019

One of the most important purposes of a physician is to alleviate pain and suffering. Pain is the most common symptom prompting an emergency department (ED) visit. Emergency physicians are responsible for managing both acute pain and acute exacerbations of chronic pain resulting from a broad array of illnesses and injuries.

It has been shown that emergency medicine providers are not necessarily good at treating patients uniformly. Since the 1990s, numerous …

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The pain score must go. Here’s why.

How ocean plastic picking made me a better pediatrician

Physician
December 23, 2019

It has been over a month since I started this new hobby. I told my middle-school-aged daughter tonight, “I am going to write a post about how ocean plastic picking has made me a better pediatrician.”

She replied, “You mean better than other pediatricians?”

“No, I mean a better pediatrician than I was before,” I answered in all seriousness. I know where her thoughts were coming from. I have always thought that …

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How ocean plastic picking made me a better pediatrician

Physician burnout as a consequence of systematic design, not an individual issue

Physician
December 23, 2019

Burnout in health care is an epidemic across the nation, contributing to a lack of empathy for patients, poor care, providers electing to leave the workforce, substance abuse, depression, and even provider suicide. In a recently published case study in the American Physicians Group Case Studies in Excellence, Iora Health made a move to shift the conversation around burnout from an individual phenomenon to a …

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Physician burnout as a consequence of systematic design, not an individual issue

A doctor dies twice

Physician
December 23, 2019

I have had the opportunity to consult with several physicians who needed to abruptly and permanently give up the practice of their chosen career without their consent. Causes of this involuntary termination included illness, burnout, and loss of license. What became very clear to them and to me was that the standard strategies for managing a work transition (e.g., defining transferable skills, exploring a range of job/work opportunities, learning new …

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A doctor dies twice

Physicians have been given weed killer. Administrators have been given Miracle-Gro.

Physician
December 22, 2019

Since I last published a blog post dedicated entirely to the above graph a couple of years ago, very little has changed. In fact, I’m sure the divergence of the curves has only grown bigger, as more and more administrators are added to the ranks of health care.

Quite often in life, the answers to some of the biggest questions we have, are staring us right in …

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Physicians have been given weed killer. Administrators have been given Miracle-Gro.

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Would you buy a smartphone if it had this warning label?

Conditions and Diseases
December 22, 2019

Imagine if every “device” (smartphone, tablet, laptop, etc.) had the following warning label:

This device is not intended for any individuals under the age of 16. Purchasers of this device frequently cite their child’s “safety” as a reason for their purchase. Prospective purchasers, upon reading this warning, may feel otherwise.

Use of this device in early childhood has been associated with delayed language acquisition.

This device has been linked to emotional dysregulation in …

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Would you buy a smartphone if it had this warning label?

The brother I never knew. The mother I never had.

Patient
December 22, 2019

The brother I never knew.

He was buried in an unmarked grave with other dead babies. 1960.

I am now the age my mother died. She was 64 years old: colon cancer.

She was a vacant, negligent mother.

During one of my psychology classes in nursing school, we learned about the baby monkey experiment (the Harlow experiment), where a baby monkey was laid against a mother made of wires. It was an inanimate object …

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The brother I never knew. The mother I never had.

A psychiatrist can’t help patients anymore

Physician
December 22, 2019

I bid farewell to four people this month who I’ve been caring for in my outpatient psychiatry practice — all under sensitive circumstances but ultimately moving in positive directions. As I write formal discharge letters, the unique role psychiatrists and other mental health clinicians play in the lives and minds of the people we care for is on my mind.

It is the nature of our healing practice to build trust …

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A psychiatrist can’t help patients anymore

What is the Trump health plan for 2020?

Health Policy
December 21, 2019

The Republicans don’t yet have a health care plan less than a year before the 2020 elections.

But based upon their 2017 Obamacare repeal and replace efforts, as well as a major document recently issued by the House Republican Study Committee, what might a Republican plan look like?

First, let’s review the plan House Republicans passed in 2017 during their failed repeal and replace efforts.

House Republicans would have repealed the Medicaid expansion …

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What is the Trump health plan for 2020?

Let’s do better for patients with limited English proficiency

Physician
December 21, 2019

I’ve noticed a theme in my clinic since I started practicing medicine: when a patient understands what is being said about their care, treatment, and services, they’re more likely to fulfill critical health care responsibilities. No one should be surprised by this, but as our nation and hospitals increase in diversity, the issue of health care equality for LEP (limited English proficiency) patients is becoming more pronounced.

Today, this population of …

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Let’s do better for patients with limited English proficiency

Why a new TV show offends physicians

Physician
December 21, 2019

Relaxing on the couch, my family already in bed, watching TV to calm my mind before leaving for a busy night shift in my emergency department, I was shocked to see an advertisement that insulted me, my colleagues, and my profession.

A trailer for a show called “Nurses” is shameful.

The idea behind the show is admirable — nurses do not get recognition from society for the work they do and the …

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Why a new TV show offends physicians

MKSAP: 60-year-old man with exertional chest discomfort

Conditions and Diseases
December 21, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 60-year-old man is evaluated for a 5-month history of exertional chest discomfort that improves with rest. His symptoms have progressively worsened such that he has reduced his activity to a minimum. Medical history is significant for hypertension and hyperlipidemia. Medications are low-dose aspirin, losartan, hydrochlorothiazide, and atorvastatin.

On physical …

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MKSAP: 60-year-old man with exertional chest discomfort

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