The eulogy of a profession should be a relatively uncommon undertaking. And yet, the death of the physician appears to be such a fait accompli that one feels late to the wake. It has been a long and lingering death, like the proverbial frog in the pot, and but there are moments, increasing in frequency in my day-to-day clinical practice when it seems so sudden, unexpected and even surreal. This …
The self-inflicted death of the physician
Physician compensation in most employed positions is based on how much a physician “produces.” I work as a psychiatrist, and this amounts to how many patients you see per hour. The more patients you see, the more “productive” you are, the more money you generate, the more valued you are by your organization and the more RVUs you churn out for a larger paycheck. But, in human terms, what exactly …
It’s time for physicians to be less “productive”
“I don’t know what happened” is probably one of the most common phrases any parent hears. Last weekend, while wrapping my son’s bleeding head in gauze from our first aid kit, this was the best explanation my daughter could muster as to why her two-year-old brother was screaming, holding tightly to a blood-covered plastic ice cream cone. In the end, it was a complete accident (he hit his head on …
Our broken health system is your fault
In many countries around the world, women giving birth still face substantial risks to their own lives and that of their baby. Women travel for days to reach facilities that are understaffed, unsafe, and unequipped to provide life-saving surgical care. They are pushed into financial catastrophe as a result of paying for surgical care, if they are able to afford it all, and they return home with little support in …
Digital health and artificial intelligence provide solutions to the global crisis in surgical care
President Donald Trump held a rally near my medical school last week.
While sitting in a small conference room during a lecture the morning of the event, my professor chuckled while clutching his phone. He looked up and around at all of us, remarking that his friend had texted him about the Trump supporters waiting outside for the rally to start; the message read, “Jesus, the maggots are already here!” My …
Bias when treating supporters of President Trump
As an elder millennial physician, I’ve been straddling two worlds, that of the “old-school” mentality of training and this newer one of “wellness.” I’ve become disheartened with new physicians being increasingly unable to tolerate any criticism by teaching faculty, even when patient harm is at risk. However, it wasn’t until I was accused of bullying and bullying exclusionary by a group of colleagues — not trainees — that I grew …
When did people’s feelings start mattering more than patient safety?
“Why did you wait to schedule this meeting until September, why not July or August?” Candidly, I replied, “I have a family and being on nights, spending those 90 minutes with them a day is very important to me.” It was then, behind closed doors, in an office where he held all of the power that he said: “You know, I don’t think women with families make as good of …
In medicine, maternal discrimination is real
Rural hospitals are closing their obstetric wards and stopping all obstetric services — at least those hospitals that manage to remain open at all. The tertiary care centers don’t seem to mind.Always wary of those rural hospital disasters in the middle of the night. Accepting transfers from a place where they must not have the latest technology, clearly, your little hospital must be behind the times, only subspecialty care is …
It is for these patients that the doctors at rural hospitals continue
In my first year of medical school, I attended a lecture on health disparities that focused on the difference in patient outcomes based on race and socioeconomic status. The lecture cited multiple peer-reviewed studies that extensively demonstrated these disparities and how health care professionals, not solely social determinants of health, contribute to them. The lecture concluded with an appeal to improve our cultural awareness and acknowledge our conscious and unconscious …
Respect the duty to care for all patients equitably
At some point in my career, I had the crazy idea that if I could scale the patient-centric work I was doing in my community at a small rural hospital — then I could make more of an impact. This is why, when a technology company came calling, dangling a carrot in front of my nose to “disrupt” health care, it seemed like a no brainer to make the leap …
A new health care dawn is coming
I remember September 27, 2018 like it was yesterday. When Ashley* picked me up from my apartment Thursday morning, I thought it would be like the 138 past Lyft rides I’ve taken since 2017. I was wrong.
After I waived to Ashley from the curb, I got settled into the right back seat. The doors locked, and she asked me the usual question.
“You from here?”
“Yes, I’m a local.”
“That’s great! I’m from …
When you identify your Lyft driver as potentially having bipolar disorder
I was a resident. He was a physician in a position of power. He took things too far, and I spoke up. Here are some of the actual comments I received.
“He’s just a flirt.”
“You must have misunderstood him.”
“What were you wearing?”
“Somebody must have hated him, to do that to him.”
“Perhaps, he just really, really liked you.”
“Maybe you had a crush on him too and encouraged him.”
I had started a new …
When I was a third-year resident, I was invited to join a practice owned by a doctor who had once been my chief resident. This was considered by all of my fellow residents to be the plum job in town, and I was thrilled. The doctor, whom I shall call “John,” was smart and funny and had a huge practice that he had purchased from a retiring physician. We figured …
A physician’s ex-business partner is in prison. Here’s what this doctor learned.
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I have spent the greater portion of my 20s enduring a premature quarter-life crisis. Patterns of self-doubt and debilitating anxiety became my new normal.
I was rejected from medical school — again.
After taking time to process the reality that I would have to wait another year to re-apply, I fervently journeyed through a messy jungle of introspection that led me to these six lessons. Although I learned more than I could …
6 things learned from being rejected from medical school
We learn about it in school as a formula. There is a checklist that we are given, and we ask our patients these eight questions and then calculate whether or not they have depression. It’s so simple. Anyone can do it! I never once thought that I would be calculating my own score at the prime of my education.
I entered medical school full of hope after years of failures and …
How this student took care of his severe depression in medical school
As a first-generation college graduate with the honor of earning my MD and PhD at a federally funded medical scientist training program (MSTP) and nearly no debt upon embarking on the journey of residency, I have a lot to live for and am grateful for all that life has offered me with regard to both mental health and capacity. I am a product of the Baltimore City Public School System. My …
A loss of physician support at a time of need
About two months ago, a 15-year-old Native American male was riding around in a stolen car on the reservation. “M” and the driver were drinking. And somehow, after he exited the vehicle at 4 a.m., the car struck him. Hours later, it became clear that something was wrong. M was transferred to our pediatric hospital as a trauma and was found to have an unstable vertebral fracture. Conservative treatment with …
Non-therapeutic relationship or human kindness?
In response to the increasing burdens of administrative work and cumbersome charting levied upon healthcare providers in recent years, medical scribes have been touted as a potential solution for streamlining the documentation process. Interest in the use of scribes has certainly been increasing, with the American College of Medical Scribe Specialists estimating that the number of medical scribes nationally will increase from 15,000 in 2014 to more than 100,000 by …
Are scribes the solution to our documentation woes?
To my wife,
Let’s just start at the beginning.
When we first met, you thought I was arrogant and prideful. For two and a half years we would rarely talk while we walked past each other in our small college town. At the time, we never could have imagined that one day we would get married. In a twist of irony, two weeks before we started dating you still didn’t know as …
A physician’s letter to his wife
I woke this morning at 3:30 a.m. My mouth was dry. I tried to urinate, but something roughly the color of quinoa came out in small quantities. So I assumed I was dehydrated. It could have been the bourbon and scotch before dinner — or the two IPAs at dinner. Or the four IPAs after dinner at trivia. Or the scotch after trivia. But something told me I was dehydrated.
I …
An ode to residency interview season
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