I remember the fervor of my first day of internship: expecting a daunting yet exciting time lay ahead, and I was finally going to be of some use to people. (And to my parents, relatives, and neighbors: “Oh, you’re finally a doctor.”) I felt like Tom Cruise on the airstrip of Miramar racing an F-14 with Kenny Loggins’ Danger Zone as he was about to join Top Gun.
However, these cinematic …
7 habits of highly effective interns
Walking through the dark construction zone of my now demolished kitchen, I made my way to the garage and out into the still, hot, humid July night. The air felt so thick, it was hard to breathe. At 1 a.m. I was headed to the hospital for a patient that just arrived in active labor. On the drive in, I had the air conditioner blasting to cool off the car …
Addressing physician self-care means getting doctors more sleep
First of all, I am far from a financial genius. I am also not a natural saver. Thanks to scholarships and jobs, I made it out of college without loans. But, I took out a $191K for medical school. In the middle of med school, I took a year off to teach. During that year, I didn’t put anything towards student loans and lived it up. Unfortunately, in forbearance, those …
How this physician paid off $100,000 in debt in 6 months
A store cashier sees dozens of customers during a shift. A car tire shop mechanic may work on 20 cars. Workdays can be hard across professions.
Medicine surely does not escape this. We just don’t deal with customers or goods, despite efforts to make it look like that. A simple runny nose visit may be the closest thing to a customer who is …
Chasing numbers contributes to physician burnout
So let’s get down to it. Everyone is tired of shooting sprees. If you’re a gun owner, you’re tired of seeing weapons abused and misused to harm the innocent. If you’re a gun opponent, you feel the same way but can’t imagine why anyone has these weapons in the first place. I get it. I hope both sides get it.
I’ve thought about this a lot. I’m a gun owner. I …
A physician gun owner’s suggestion
Burnout has been a descriptive term for years, but lately, psychologists and others have assigned it specific characteristics with a view toward being able actually to study and measure it. One common definition of burnout is a state of chronic stress that leads to physical and emotional exhaustion, cynicism, detachment, and feelings of ineffectiveness. The PICU environment is often one of high stress, so it’s a place where this …
Burnout in pediatric intensive care physicians
Why do we underestimate risk? This phenomenon isn’t unique to politics or natural disasters, and it contradicts our need to prepare for future events. It explains why it is hard to get healthy “millennial invincibles” to sign up for health insurance, why earthquake insurance policies skyrocket after an earthquake, and why people tend to underinvest for retirement. Two separate biases — availability and recency — explain why we make medical …
2 biases in medicine, and how to avoid them
A study published in the Annals of Internal Medicine explored the gender roles of career-oriented academic MDs in the workplace juxtaposed with domestic responsibilities. Dr. Jolly and colleagues hypothesized that by examining a specific cohort of younger physicians, more likely exposed to dual-income households, that there would be few, if any, differences in time spent on nonprofessional activities. The paper titled, “Gender Differences in Time Spent on Parenting …
Women aren’t to blame because the workplace isn’t accommodating
Believe it or not, the topic of work-life balance can be quite controversial. It’s a concept that can seem almost impossible to attain, so some people regard it as a myth: “a pie in the sky” idea of sorts. As surprising as it seems, work-life balance is very much attainable, and my personal experience is a testament to that.
This concept is the best thing since sliced bread. Honestly, why would …
Work-life balance doesn’t have to be a myth
Since the beginning of a new academic year is fast approaching, here’s some heartfelt advice. You might need it, I hope you read it and heed it. If you’re just beginning your medical school journey, the first line is written specifically for you, but the rest of the piece is pertinent for any doctor, at any age and any stage of their careers.
If this is your first day of med …
As you enter medical school: tips from a patient
Match Day is the culmination of a medical student’s education: the day all graduating seniors and non-traditional applicants find out where they will spend the next three to seven years to train in a desired specialty. I fell in love with obstetrics and gynecology (OB/GYN) as it was the perfect way to combine my passion for women’s health with medicine and surgery. I also liked that the patients were relatively …
What’s life like after not matching? A physician’s story.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical history is otherwise unremarkable, …
MKSAP: 25-year-old man with dark-colored urine
I woke up to the sound of a faint “ding” from my bedside table. It was 5:24 a.m. Shaking off my lethargy, I scrambled over to my phone because the ding meant one thing: my first residency interview invitation.
Looking back on that moment, as I responded in the dim light of the morning, I realize that I knew very little about what was to come over the next few months. …
The rewarding and grueling process of residency application
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How do we balance freedom and safety for those with dementia, particularly in the risky domains of sex, driving and money?
In 2014, Henry Rayhons, a 78-year-old Iowan, was arrested because he allegedly had sex with his wife.
Wait. What?
The Rayhonses, both previously widowed, met while singing in a church choir. Over time, Mrs. Rayhons developed dementia and went into a nursing home. At one point, a roommate reported hearing …
The fine line between dementia, sex, driving, and money
Recently I was saying goodnight to my oldest son, who is now 14 and about to enter high school. I was standing in his bedroom looking at his midnight blue walls, which are covered in each of the planets. He looked up at me from his Pottery Barn bunk bed and said, “Mom, I need a new bed … and new walls.”
I stared at him, realizing my son was no …
A physician mother and her son
When Amazon, Berkshire Hathaway, and JP Morgan (AmBerGan) announced their health care partnership, Berkshire CEO Warren Buffett declared “the ballooning costs of health care act as a hungry tapeworm on the American economy.” He is right. Our broken system is infested with tapeworms. Tapeworms are parasites; they exploit their hosts, drain resources, and suck the life out of their prey. Unfortunately, Buffet failed to call attention to the tapeworms specifically; …
Can direct primary care save us from the tapeworms of insurance?
In a prior post, I shared my heretofore reluctance to prescribe medications for my hepatitis C (HCV) patients. In summary, after consideration of the risks and benefits of the available options, I could not persuade myself — or my patients — to pull the trigger. These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another …
Why this gastroenterologist decided to treat hepatitis C patients
I usually simplify things here on the blog. Sometimes it is easier to glaze over a part of the story instead of pulling out all the details. Others, the point is clearer when not bogged down by tangentially related details. What’s lost in nuance, however, often adds shades of complexity to the picture. Occasionally another viewpoint is suppressed on purpose. I have frequently referred to the fact that I Read more…
A physician’s first financial advisor
July was an interesting month for artificial intelligence in medicine.
A study from MIT found when human doctors order tests on patients, they factor in something that artificial intelligence is not currently aware of. The authors analyzed charts of about 60,000 ICU patients admitted to Beth Israel Deaconess Medical Center in Boston.
By looking at physician progress notes with positive or negative sentiments in patient records, they derived scores which they correlated …
Artificial intelligence in medicine: not ready for prime time
This was the end-of-the-hallway conversation with an elderly patient after wrapping up a recent office visit, as we walked away from the exam room toward the front desk to schedule her follow-up appointment, and she realized that we were “celebrating” 20 years together.
I met her when she was admitted as an inpatient when I was on service as a junior attending just starting out, and after going home she came …
It’s time for an army of people to help take care of our patients
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