These articles are written by anonymous clinicians. They have been selected and edited by Kevin Pho, MD.

Concierge medicine sucks for specialists. Here’s why.

Physician
February 3, 2018

As a private practice specialist in an affluent metropolitan area, I am often inundated with requests for consultation by local residents and primary physicians. That’s fine — it’s what I do, and it’s what I enjoy doing. Hey, it pays the bills, and I won’t complain about that.

Concierge medicine has taken a foothold locally, and this means more referrals directly from doctors who insist we take care of their patients …

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Concierge medicine sucks for specialists. Here’s why.

Please change the culture of surgery

Education
January 8, 2018

It is December 2017. I have been on the road for the last five months, completing my five months of elective rotations. I am a fourth-year medical student aspiring to specialize in family medicine. I also want to learn procedures, so I did two months of surgery, three months of family practice electives. At the beginning of this process, I had wanted to be a general surgeon, but I ended …

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Please change the culture of surgery

Do physicians make the best politicians?

Physician
January 4, 2018

Even though we have probably 20 years of work remaining as physicians, like a lot of you, I like to think about how we will spend our retirement years. After all, in twenty years we will still only be in our early fifties, hopefully with no dependents and a lot of financial security. Of course, my wife and I are interested in traveling, spending time with grandchildren (hopefully), gardening and …

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Do physicians make the best politicians?

End the resident physician abuse now

Physician
December 21, 2017

Let’s talk about the cycle of abuse. No, I am not referring to the very serious issue of domestic violence. Instead, I am talking about the graduate medical education system. No one is a resident forever: the duration of each residency is predetermined with a wide range of three to nine years. The self-limited nature of this experience decreases the incentive for participants to advocate for changes. And the attitude …

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End the resident physician abuse now

This physician is burned out. But not for the reason you think.

Education
December 12, 2017

I am an Olympian. I am a retired All-American student-athlete.  I am a resident.  I am burned out.

Let me be clear: I love medicine and the opportunity to have privileged relationships with patients and their families.  I thrive on the fast-paced environment, growing to-do lists, and the chance to work in a field with endless learning.  I love working in team environments to provide optimal care for patients and their …

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This physician is burned out. But not for the reason you think.

What do you do when a colleague has cancer?

Physician
December 7, 2017

This year has brought about change — the theme of 2017. As it comes to a close and I reflect back, it is so hard to believe what is going on in the world today, let alone just the United States.

In 2017, I graduated from my internal medicine residency training program, passed my board exam and celebrated my one-year wedding anniversary. I helped my family cope with my grandmother’s progressive …

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What do you do when a colleague has cancer?

The hidden threat of the 80-hour resident workweek 

Education
November 27, 2017

In an article published by the Atlantic earlier this year, Ryan Park writes that neither truck drivers nor bankers work the kind of gruelingly long hours that doctors — particularly young doctors in their residency programs — do. It is no secret that residency life is demanding and exhausting. Over the last decade, it has also become controversial. Almost a test in itself, as if gauging doctors’ …

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The hidden threat of the 80-hour resident workweek 

4 problems with the Joint Commission

Physician
November 24, 2017

I’m passionate about patient safety. In no small part because I was raised to be. My mom has a lot of letters behind her name (RN, BSN, MSN), and she’s dedicated her career to the field.

Before I was accepted into medical school, I knew about “six sigma,” the “Swiss cheese model” and root-cause analysis. I’d been taught about creating a culture of safety and the example of the airline industry. …

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4 problems with the Joint Commission

Women doctors: Speak up, because #MeToo

Physician
October 29, 2017

“Aren’t you cute,” he said as he smiled and squeezed her cheeks. On the start of a new rotation, a medical student walked into clinic and introduced herself to the attending physician.

With all of the news surrounding the Weinstein debacle, Alyssa Milano has urged women to share their stories of sexual harassment or abuse using the words “me too.” What has transpired is that a whole community of women from …

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Women doctors: Speak up, because #MeToo

No female physician should have to feel that her gender is a factor limiting her success

Physician
October 11, 2017

A father and a son are in a car accident.  The father dies instantly, and the son is taken to the nearest hospital.  The doctor comes in and exclaims, “I can’t operate on this boy!”

“Why not?” the nurse asks.

“Because he is my son,” the doctor responds.

How is this possible?

***

I first saw this riddle in a Washington Post article in October 2016. I was four years out of residency, and for the …

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No female physician should have to feel that her gender is a factor limiting her success

A missed diagnosis haunts this physician

Conditions
October 10, 2017

Eighty percent of diagnoses can be made based on the history and physical.  Take the subjective and objective; throw in some medical history, family history, social history and you can figure out your assessment and plan. Doctors are the detectives of the body and the more facts, the easier it is to solve the mystery.

This is the fictional note that I wrote in my head concerning a fellow physician friend …

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A missed diagnosis haunts this physician

Please don’t tell me how brave I am

Physician
October 6, 2017

It’s 3 a.m., and I’m wide awake.  I’m giddy with excitement and scared.  I am 41 years old and tomorrow feels like the first day of school all over again.  Only it isn’t.  Tomorrow is my first day back at the hospital where I work as a surgeon.  Tomorrow is also my first day back at work after chemotherapy.

Two months ago, I was diagnosed with breast cancer.  I underwent bilateral …

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Please don’t tell me how brave I am

A physician struggles with customer service. Can she still be a good doctor?

Physician
August 15, 2017

I struggle with customer service. I truly never anticipated that it would be such a big part of my career. I never fathomed that it would be something that I struggle with on a daily basis. Well, honestly it does not happen every day and does not occur at every facility that I work at. Yet, it happens often enough that it has affected where I work, how I interact …

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A physician struggles with customer service. Can she still be a good doctor?

Medical students: Don’t take the easy way

Education
July 13, 2017

Dear fellow students,

I am addressing you today as a comrade, a peer, as someone who shares your concerns and understands the pressure and stress you experience in medical school. It is true that medical schools attract very similar kind of people: Medical students are smart, hard-working individuals who are striving for excellence and achievements. They want to help the sick, the poor and the needy and cultivate a sustainable change …

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Medical students: Don’t take the easy way

Resiliency training in medicine is a farce

Education
July 12, 2017

I knew that residency would be indentured servitude for (in my case) three years.

I knew it. I prepared for the fear, the shaming, and the isolation as best I could.

And I have for the past 11 months done OK. I am not the smartest or fastest. But I am told that I am passionate about my patients and have an “adequate fund of knowledge.”

Woohoo. Adequacy!

I have had dark moments. And …

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Resiliency training in medicine is a farce

Trauma in the OR. From doctors’ bullying.

Physician
July 1, 2017

It’s Friday morning in any operating room, USA. Nurses and techs are scrambling to get everything in place before the surgeon arrives because if not, there will be hell to pay. The first patient arrives late, the second patient needs to use the bathroom, the third patient needs blankets before the IV is started … and here he comes … and we’re not ready. The fear is palpable.

Down the street, …

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Trauma in the OR. From doctors’ bullying.

The last patient of the day gets the least care

Physician
June 13, 2017

He entered the hospital on Monday morning with a list of patients running through his mind. From the time he received a sign out of 22 patients from his colleague on Sunday evening, he was planning his workday. It was a ritual of his to pray and sleep early on Sunday night to prepare him for what lie ahead. What lied ahead was a busy week of inpatient medicine — …

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The last patient of the day gets the least care

Stop asking doctors for free advice

Physician
June 12, 2017

My husband is a doctor. Similar to any other career, this is what he spends most of his time doing. It’s also our family’s livelihood — how we pay our mortgage, our bills and send our daughter to preschool.

He went to through seven years of training after college, often working all night or even 24-plus hour calls. He’s had to miss family dinners, birthday parties, nights of putting our daughter …

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Stop asking doctors for free advice

Charges and costs aren’t the same thing

Policy
June 7, 2017

I once participated in a discussion about a research study that was drawing data from charges submitted to Medicare and patient outcomes. The head of the project was referring to the financial data as costs, and I simply asked, “Isn’t this really charges, what Medicare is being charged by the hospital?” The response was a sort of non-answer, and then the person concluded, “It probably doesn’t really matter whether we …

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Charges and costs aren’t the same thing

There’s no place for locker room talk in the OR

Physician
May 23, 2017

I am nearing the end of my training at one of the top surgical fellowships in the country. I chose this fellowship not just for the name, but also because the surgeons all seemed like genuine and altruistically motivated individuals. It was two-thirds of the way through fellowship when I found myself in conversation with two male trainees. We were discussing the younger trainee and his girlfriend; he would be …

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There’s no place for locker room talk in the OR

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