My baby was crying non-stop as soon as we got her home. She tried to latch and did well, but I had no way of knowing how much nutrition she was getting. I counted the diapers, and the numbers were just barely on track, and she was making small quantities. I was trying to Google more tips with one hand and nurse her with the other. She was suffering, and …
The story of a new physician mother
As luck would have it, I flew (figuratively speaking, of course) down the highway to work this afternoon while listening to the sweeping saga of Harry Potter.
As you may know, not unlike the medical students we teach, no student enters the hallowed halls of Hogwarts without a gift. All possess the potential to master — after years of study and practice, of course — the art and science of magic.
Despite …
Teaching attendings: Are we Dolores Umbridge?
Jerry and his wife, Pam, were not “medical people” and wouldn’t be considered high achievers. They seemed to be taking life in stride with a “mom and pop” disposition. Jerry had Alzheimer’s disease and was returned to his care facility after having a pacemaker inserted. The staff noticed Jerry slumped in his chair and called 911. Jerry’s blood pressure was low, and EMS transported him to the nearest hospital. He …
The lost art of reassurance medicine
It was 5:27 p.m. on a Friday evening when the pager went off. “Ahh,” said the intern, “Three minutes before shift change, and the ER is paging for another admission!”
I could see the dismay on his face as he dreaded the thought of staying late on yet another Friday night. I decided to take care of this patient myself and relieved the intern of his duties. As I went downstairs …
Establishing a medical career inevitably requires signing a number of contracts along the way that we are not trained to evaluate, leaving us at risk for malignant retention strategies. At the beginnings of our careers, we were obligated to sign all contracts offered to us without question. The medical school match did not leave much choice, and salary negotiations were nonexistent. This lack of choice later changed, as most of …
3 malignant retention strategies in health care contracts
We are human, we are not indestructible. We have feelings and emotions that can get hurt, probably more than the average person based on the careers we have chosen. Yes, we will pass up on our well-being (such as sleep, hygiene, exercise, relationships with family and friends) to be there for our patients. To receive our critical training to be able to care for others. This is our sacrifice, and …
We’re doctors, but we’re humans too
“Yes, there is a pay gap. Female physicians do not work as hard and do not see as many patients as male physicians. This is because they choose to, or simply don’t want to be rushed, or they don’t want to work long hours. Most of the time, their priority is something else … family, social, whatever. Nothing needs to be “done” about this unless female physicians actually want to …
Pay women physicians equal pay for equal work
I’ve been river rafting just one time in my life. We paid for a guided trip down Idaho’s famous “River of No Return — the Salmon,” and spent the day traveling stretches of rapids and stretches of calm. It was exhilarating enough for a newbie but not enough to ever feel like my life or livelihood was seriously at risk.
But I’ve also seen that same river at flood stage, and …
Let’s reshape the river of burnout
Do you ever wonder
what compels someone to walk away from their current life
to leave all they worked for — jobs, spouses, kids — behind?
The community around them are caught off guard
of how unhappy or unfulfilled or
the silent suffering
that made their life so hard.
We say it is shocking and act so surprised.
But that seems a pretense.
It’s no secret that compassion fatigue and physician burnout
are both on a steady rise.
For us in …
Physician resilience: cause or symptom?
Recently, a patient came in around 11 p.m., just as the chaos of the day had settled, and I was thinking of rest after 16 hours of work. He was an older gentleman with vague and concerning complaints that would demand a thorough workup. I suspended my thoughts of self-preservation and stepped in to evaluate him.
After an hour and a half, I had found a source of infection that explained …
A day in the beautiful life of this doctor
The pay gap between men and women has been a subject of interest recently, particularly in 2018 reports by Doximity and Medscape.
Notably, the gap favors men, is not explained by obvious factors such as hours worked or choice of specialty, and does not seem to be improving. In-depth studies published in the medical literature have examined the relationship between gender …
The antiquated conversations on the gender pay gap
Will physicians go extinct? Artificial intelligence, legislation, profit motives in the health care industry, and clever lobbying by non-physician providers may all contribute to our demise. However, I believe the existential threat to our profession stems from the ranks of physicians themselves.
1. Unwillingness to embrace activism
Pathologist and writer Rudolph Virchow once said: “The physician is the natural attorney of the poor.” Like most physicians, my goal is to provide evidence-based …
4 reasons why physicians will become extinct
“I give up! I can’t help these people.” Emily was completing the final month of her emergency medicine residency and flopped into her chair with exasperation.
“What’s up?” I asked. We were on the final two hours of our shift together. And I, as her attending, was already feeling apprehensive about the patient encounter that awaited me.
“They want so much from me, and I can’t fix them!” She began to tell …
Sometimes what patients really need can be surprising
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 49-year-old woman is evaluated during a follow-up visit. She is overweight and has hypertension and type 2 diabetes mellitus, both of which are well controlled. For several years, she has attempted to lose weight through various commercial diets; dietician-monitored, calorie-restricted diets; and physical activity. She has worked with a behavioral therapist, and …
MKSAP: 49-year-old woman with obesity, hypertension, and type 2 diabetes mellitus
Physicians are overwhelmed by patient loads, 10-minute visits, the wealth of documentation dictated by health insurance requirements and the overwhelming overtaking of medicine by non-physician personnel.
Wellness programs abound, which addresses the symptoms of a problem.
As medicine changed from patient to profit-centered, it marked the beginning of the end. We see articles on physicians fired or coerced into resignation for speaking up about non-physicians overstepping boundaries putting patients at risk. Physicians …
The demise of medicine: A neurologist advocates for patients and is silenced
While hundreds of doctors have submitted (mostly unfavorable) comments to CMS on the proposed evaluation and management changes, other issues seem to be receiving much less attention than they deserve. And one of those may hit physicians who perform procedures in the wallet.
In 2015, Congress asked CMS to analyze the global period data to ensure procedure weighting accurately reflected the actual work done by physicians. Of course, when Congress asks …
Are Medicare procedure payments in jeopardy?
So last week, I did the bravest thing I have done in a very long time — I quit my job. Yes, I put in my 60-day notice. This was my dream job post service in the U.S. Air Force. I had dreamed of working in this establishment for months before my service time was up. I could not have been happier when I joined their team, a group practice …
Why this physician quit her job
The upgraded responsibility and authority given to starting residents is both a blessing and a curse. Suddenly, the need for co-signatures vanishes. There is greater autonomy in clinical practice. Residents get paid. However, residency can also be a time of significant stress. Residents are forced to navigate the demands of preceptors, other residents, medical students, nurses, patients, family members, and administrators. Residents have very little control over what they do, …
10 ways to make residency less stressful
“It kind of strips you of any pride that you have. It was very humbling.”
As a care manager, Mary helps patients follow their care plans by coordinating medical visits and community resource referrals, but this was the first time Mary shadowed one of her patients out in the community. At the food bank, Mary watched her patient, who was living with diabetes, receive one box of macaroni along with other …
How to be aware of patients’ non-medical needs
The summer is an exciting time for fourth-year medical students. By this point in the year, many fourth-years have decided on a specialty to pursue, are traveling to new institutions for away rotations, and starting to work on their residency application via the Electronic Residency Application Service (ERAS). Since I was part of the inaugural class of a brand-new medical school, there weren’t recent graduates available …
Which residency programs should I apply to (and how many)?
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