Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision-making in the ICU in a large survey published in JAMA Internal Medicine.
About 1,300 staff at 13 academic hospitals in Canada rated barriers to end-of-life goals of care on a 1 to 7 scale. Doctors and nurses considered the largest barriers to end-of-life …
Doctors and nurses need to be better trained in palliative care
The outcry over antipsychotics has ranged far and wide. Everyone from governmental agencies to senior advocacy organizations have pointed to the abysmal data. Antipsychotics have a negative impact on morbidity and mortality. They say we are chemically restraining those who are too fragile to stick up for themselves. They say we are sedating instead of treating.
And I disagree wholeheartedly.
I manage a …
Antipsychotics in the elderly: Sometimes it’s excellent palliative care
I’m a physician, and I’m adrift. I am pretty much lost at sea. I’ve often thought of writing this column, but afraid I’d be recognized, I’ve hesitated for years. Even now, I’ll most likely remain anonymous, because I’m in a vulnerable position. Let me preface my remarks with the reassurance that I’m not a bad person.
I developed dependence on opioids several …
A physician enters rehab. What happens next should disturb you.
I work in a place where nobody calls me by my name.
They all address me by a moniker of their choosing that I have asked them not to use. I have asked them to use my name. Aside from a few who respect my wish, most of my co-workers just call me by the impersonal-sounding phrase they’ve selected instead. It creates …
I’m a physician. But please don’t call me doctor.
Before I got into medical school, while I was still in my first year of graduate school, I learned what hell was like.
The hospital was a rabbit warren. Walking down the long empty beige halls fueled my hatred for hospitals. And, of the color beige.
When I volunteered during college, I would press myself up against the wall whenever a gaggle of doctors passed by. They ruled the hospital: powerful, scary, …
Hospitals are not built for doctors. Hospitals are for patients and their families.
As a patient, I would like a primary care visit that is pleasant, comprehensive, convenient, and efficient. As a future practitioner, I hope for a visit that is unhurried, educational, efficient, and holistic. We may have through all these years grown accustomed to the status quo — on both ends — that is, we have come to expect the 45-minute wait in the atrium prior to our beckoning by the …
A vision for a more efficient, more elegant health care visit
Medicine is an area of study that is bursting with countless gut-wrenching ethical debates. Throughout our medical training, even in some medical school interviews, we are asked and tested on how we would personally navigate the delicate tightrope of right and wrong.
Trying to maintain equilibrium between our personal beliefs and those that are best for our patients can often be difficult. On one side of our acrobatic act, we are …
Abortion: Caught between an oath and beliefs
Over the course of pre-professional and professional education, my colleagues and I have had numerous moments of self-doubt. Would the next organic chemistry exam eliminate my 3.99 GPA? Would the MCAT decide what medical schools would immediately ignore me without ever meeting me? Would the sheer volume of material weed out the persons sitting next to me in medical school or …
I’m not apologizing for my part-time role in medicine
To the staff overseeing my medically-complex child,
My child has been in this world much longer than you expected; thus I’ve been in this relationship with you much longer than I expected. If I could break up with you and find someone new, believe me I would (I’m sure so would you some days). But that isn’t possible; we’re in a dysfunctional relationship. If we recognize this together and just come to an …
A message to those taking care of my medically-complex child
Three years ago I received some of the best news of my life — that I have dopa-responsive dystonia. (Yes, a neuromuscular disorder was welcome news.) Painful, life-interrupting muscle contractions had made the dystonia diagnosis likely several years before, despite poor response to standard treatments, and I was fighting through graduate school: trying to compensate for medication-induced memory problems, increasing need to work from bed, and a disappearing social life. …
A domperidone dilemma: A patient’s perspective on ordering from Canada
This place sucks had become my mantra as I powered through every bloody, chaotic, understaffed shift.
Fresh out of residency, I had accepted a job in the ER of a community hospital which — though it had appeared calm, functional, and replete with helpful consultants during the 15-minute tour I took during my interview — had turned into exactly the opposite when I …
A doctor quits. Before doing the same, consider these 5 things.
We recently had a session hosted by the medical education staff at our school where we were encouraged to share any difficult situations encountered in clerkship (submitted anonymously beforehand if that was preferred) and discussed them as a class. Issues regarding ageism, sexism and racism were brought up and addressed with the group. While I have not encountered any of the …
Sexism in the OR: What’s a medical student to do?
You’ve made it. Four years of college, four years of medical school, and three years (sometimes four or five) of residency, depending on the specialty you chose. You’ve earned a prestigious title.
You are a doctor.
But wait, you are not done yet.
Want to be a cardiologist, oncologist, or gastroenterologist? Add another three years to the eleven spent to become an independent practitioner. Another three years of interest accruing on that six-figure …
What I learned after going through the fellowship match
My department had a problem that harmed patients on at least a weekly basis. It was well-known, but it seemed there was no viable solution.
My supervising attending was in his seventies and highly regarded at my hospital, having held powerful administrative positions for decades. About ten or so years ago, he stepped down from running the hospital, and …
An attending threatens patient safety. A resident blows the whistle.
I’ve wanted to be a physician for as long as I can remember. As a teen, the choice to become a doctor seemed to perfectly meld my affinity for science, academics and helping others. Better yet, pediatrics offered the ability to work with families and children of all ages and developmental abilities.
For fifteen years, I lived, breathed, and worked toward my …
Confessions of a burnt-out physician
I thought more highly of business folks until I started working for them. I thought CEOs and boards of directors of companies had a vision, whether to maximize shareholder profit, or to produce a stellar product or provide a singular service, etc. Once the vision was elucidated, everyone worked together like a team to make it happen.
Then I became employed by …
From a physician: A plea to big medical corporations
As an employed physician specialist working in an underserved community, I am thrilled with the Affordable Care Act (ACA). I was initially a skeptic of the program because of the cost to taxpayers, but I have since witnessed first hand the tremendous benefits. People with limited resources and real problems can now get help without suffering financial harm. Those with chronic …
Health reform: Great for patients, but this doctor lost his job
There is a saying in the world of education, “You have to care to teach.” Why is it then in health care, a profession of and about caring, we do such a poor job of teaching our patients? Is it because we are too busy or too rushed when we are sending our patient’s out the door of our hospitals, clinics or offices? After all, we have treated the patient …
Teach back: Reduce the costs of poor patient education
It was 4:30 a.m., and I was on the side of the road, drenched in sweat and tears. I had finally slowed my breathing to normal. I was going to be late for rounds. No time to obsess over possible questions. No time to memorize lab values, or practice regurgitating them.
I thought of home. My family and friend, who I hadn’t …
I never understood the loss of empathy during medical training. Until now.
I’m a second-year medical student, and quite recently, a lecture left me with serious doubts about the state of social awareness in the medical field and schools. The dermatologist lecturing described a patient with secondary syphilis, stating he felt the case was odd since, “He [the patient] didn’t look gay or anything,” as if only homosexual men could contract that disease.
I was hurt. I not only belong to a racial …
A lack of social education in medical schools today
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