For over twenty years, I’ve had a recurring nightmare: I’m back in medical training, and my patient is crashing. To save them, I must enter my medical orders into the electronic health record (EHR). The only problem is, there are no open computers. I could give a verbal order in a real-life emergency, but those aren’t the rules in this nightmare world. I go from computer to computer, begging for …
The emotional toll doctors face: a book review
Recently, on an average workday, my hand brushed against the small safety whistle clipped beside my ID badge. Most days, I don’t even remember the whistle is there, a “Happy Doctor’s Day” gift from a few years ago. I dutifully clipped it on, but I can’t say it makes me feel safer.
I remember shrugging when I received it and thinking, well, it’s more practical than pizza.
I also …
A fictional monologue.
You’ve reached the prior authorization denial appeal line for insurance CEOs. Case number, please.
I’m sorry you’ve had to hold for over an hour, but we can’t proceed if we don’t have your case number, a copy of your business degree on file, GMAT score, three letters of recommendation, the middle name of your dentist, and your high school transcript.
Yes, I was only joking about the dentist! LOL! We’re …
Health insurance CEOs face “prior authorization”: a taste of their own medicine?
(Spoiler alert: contains spoilers for the movie Barbie.)
In Barbie, a singular scene resonated powerfully with Women in Medicine across the land.
You know the one. Shortly after Ken and Barbie leave Barbie Land and arrive in the Real World, Ken ventures off, discovers The Patriarchy, waltzes into a hospital emergency room, and demands the first woman he sees …
A monologue in the style of America Ferrera’s character Gloria in the Barbie Movie (original script by Greta Gerwig).
It is literally impossible to be a woman in medicine. You can be at the top of your class in medical school and residency, and yet you will never think you’re good enough. Like, we have to always be infallible, but somehow, we’re made to feel it’s never …
It is literally impossible to be a woman in medicine
I, like many of my peers in medicine, am a terrible sleeper.
And it’s no wonder, after all. I spent the better part of my twenties and thirties training my brain not to give in to sleep when I needed it. Then, in the rare hours I did sleep, I was forced to wake at a moment’s notice and go from deep sleep to high alert. Sometimes, I was asked to …
How medicine’s demanding training took my sleep away
An excerpt from The Committee Will Kill You Now.
“You couldn’t get her niece to budge on the hemodialysis decision?” Harper sank into the resident lounge’s threadbare couch and kicked up her feet.
“Nope.” Noah slumped in the chair across from her. It was late afternoon, and he’d almost finished checking off …
Medical ethics dilemma: a hemodialysis decision
“There’s no such thing as postpartum depression.”
These were the unsolicited words from my obstetrician in the third trimester of my first pregnancy.
“It’s only sleep deprivation,” she explained.
As an MD, I’d been taught there was indeed such a thing as postpartum depression. But as the patient in that interaction, a pregnant woman, I didn’t feel in any position to challenge her words. They would, however, stick in my brain forever. Even …
The harm of the “just do it” culture in medicine: a story of postpartum depression
My alarm goes off at 3:30 a.m. for some early charting. I love these pre-work hours, even though it’s my own unpaid time. I went into debt for hundreds of thousands of dollars to have the need for sleep trained out of me. A neat side effect of this is that it also wiped away my will to resist inane admin tasks.
While I’m pre-charting, my family wakes up, or at …
A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire
Well before the advent of chat GPT, popular culture has explored how technology might affect health care, often with a dystopian bent.
Take, for example, the 2013 sci-fi movie Elysium, set in 2154 (spoilers ahead). Matt Damon’s character, Max, is exposed to a lethal dose of radiation when his factory supervisor threatens to fire him if he doesn’t perform a dangerous task. Because he can’t afford to lose his job, Max does …
About five years ago, I did the first public reading of my non-academic writing. I was a 40-something-year-old physician, and I was terrified.
It was at a narrative medicine event, and I’d been selected to read one of my personal essays. A few days earlier, an experienced performer had given me some pointers. Identified which word in each sentence should be emphasized. Where I should add dramatic pauses, I now had …
How writing and storytelling helped me recover from burnout
It is 4:15 p.m. in my clinic, and I’m running an hour behind.
One of my morning patients arrived acutely ill and thus required more of my time and attention than the schedule allotted for. Accordingly, every patient after that has ended up waiting for me. And, as I’m a cancer physician, each of them requires—and deserves—all my time and energy. There are no “easy” visits here.
By the end of the …
The insurance denial process: one oncologist’s fight against a broken system
As a cancer physician, the amount of data I obtain on my patients is ever-increasing, along with options for cancer therapies. This is, as the saying goes, a good problem to have, but the amount of data management oncologists must do after hours (because there isn’t enough time in the clinic day) to keep up with the deluge of input contributes to burnout.
Many things keep oncologists up at night, …
I’m a medical oncologist. Here’s why AI isn’t going to cure cancer.
An excerpt from The Algorithm Will See You Now.
Jacie shoved her glasses up her nose. “For those not selected, when PRIMA gives its report, or whatever… and if it says the treatment won’t work, how do you tell the patient?”
“We don’t.” Hope paused. “That’s the nurse’s job, of course.”
Cecilia gave …
The algorithm’s dilemma: Navigating ethics in health care
After seeing recent images from OpenAI’s DALL-E-2 art generator, I decided to give it a try. I thought about a topic that I am interested in, others I know are interested in, and I was curious to see an AI’s ability to interpret. I decided on health care burnout.
In the prompt field for the art generator, I entered the words “healthcare burnout doctors nurses exhausted hope love disease …
I used OpenAI to generate art on health care burnout. The images were startlingly moving.
To: [Group: all employees]
From: Office of the CEO
Subject: A fork in the road
Going forward, we will need to be extremely hardcore to streamline a restructured Health care 2.0 and succeed in an increasingly diseased world. This will mean working even longer hours at high intensity. Only exceptional performance will justify a new N95 mask each week.
Health care will also be much more profit-driven. Physicians and nurses will still be very …
If the hospital CEO emailed employees like Twitter’s CEO
One of my clinic patients recently asked me to administer his intramuscular medication injection. I appreciated the vote of confidence but had to tell him he was mistaken in thinking that my skill would surpass that of our nurses’.
“Trust me,” I told him. “You’re in better hands with them.”
It reminded me of the time, some years back, when I inadvertently found myself “impersonating” a nurse for a school field trip. …
I was a doctor. Could I also be a nurse?
Before COVID-19, I left the practice of medicine for what would turn out to become an entire year. While away, I found a new way of seeing our hearts and bodies as humans in the medical profession, allowing me to return.
Here are five lessons I learned in the hope they might help others.
1. Perfectionism doesn’t make you perfect
If perfectionism isn’t an unwritten rule in our profession, it’s, at minimum, a …
What I learned from stepping away from medicine for a year
In a recent talk I gave for colleagues, I ventured outside the box.
I searched for a metaphor to make cancer treatments easy to understand. Around the same time, it so happened my kids decided we needed to re-watch all of The Avengers movies at home. (In order, of course).
Here’s where you get some insight into an oncologist-mom’s brain. While we watched the movies, another part of my brain cogitated on my upcoming …
Using the Avengers to explain how cancer treatments work
When I first turned to writing, I had no knowledge of the field of narrative medicine.
It took four years of medical school, three years of residency, three years of subspecialty fellowship and over a decade in practice before I learned of it. (That’s more than 20 years, for those counting.)
Throughout, I’ve struggled to hold fast to my core belief that the key to patient care is to allow the telling …
6 resources on the power of narrative medicine
Get free updates delivered free to your inbox.
