I retired from my pediatric cardiology practice almost two years ago, and I keep circling back to one of the final days of my career. For a long time, I told myself I had simply burned out, worn thin by the pace and the paperwork. Only with time and reflection have I realized I didn’t step away because I was tired, I stepped away because of deep moral injury.
I remember …
Why I left pediatric cardiology: a story of moral injury
While it appears we are on the downhill slope of COVID-19’s integration into everyday life, burnout rates are rising, and organizational trust is taking a nose-dive. Aren’t we supposed to be in the post-disaster recovery phase? What is the bottleneck holding us back from moving toward our new horizon? On the surface, issues like operating losses, staffing shortages, and scarcity of supplies appear to be a few of the big …
Healing from the pandemic: a journey to recovery
It has finally happened, I have transitioned to viewing myself as a widget, a depersonalized interface between the EMR and the patient. I am the unnamed device that collects the patient data and subsequently transcribes it into prose for billing purposes and maybe the occasional colleague review. There is a bit of curious comfort in identifying myself as a mere cog. I’m imagining I will now fly below the radar, …
The transformation of doctors into “Dr. Widgets”
“Between stimulus and response, there is space. In that space is our power to choose our response. In our response lies our growth and our freedom.”
– Viktor Frankl
In the post-pandemic practice environment, the autonomy-squishing “big ask” within many organizations is for providers to see more patients and improve practice efficiency with dwindling resources so as to buffer the bottom line and allow for system recovery. This mandate may make us …
How clinicians can respond to the “big ask”
The pandemic has brutalized health care such that the term “institutional betrayal” (IB) is becoming part of the physician vernacular. This cringe-worthy term is being used to point a finger of shame at health care leaders and systems who presumably are failing to support and protect their workers adequately.
Indeed, we depend on our employers for our safety and well-being. With staffing shortages, lack of supplies and lower revenue, employees bear …
Institutional betrayal vs. courage
Fifty-six patient messages wait to be answered by telephone while two nurses work busily to assist two providers administering injections and other procedures in the pain clinic. This is an example of an average clinic day in September 2021 in a medium-sized health care institution in the Midwest. How will these calls be answered in a timely fashion so patient satisfaction is preserved? The task is impossible and repeats itself …
Peer coaching as a burnout buffer
Some clinicians say we have lost the art of physical examination with medical technology having increased presence in our practices. In my cardiology practice during a patient examination, I must remain mindful so as not to miss something unexpected or new, despite often knowing the echocardiogram results before entering the room. Sir William Osler might very well think this is like putting the cart before the horse, and perhaps the …
The case of the yellow sticky note
Recent events in our mid-west region prompted us to bring the topic of physician suicide forward with our residents and fellows. They received this information in a weekly mindfulness email they receive as part of our internal coaching program:
Losing a colleague or friend to suicide is a tragedy to those who survive and it can be devastating. With such tragedy can come feelings of sadness, grief and confusion. The feeling of loss that can …
Reflecting on the tragedy of physician suicide
I spent an hour yesterday with a new patient who has complex repaired congenital heart disease. In our initial conversation, it became apparent she and I had differing agendas. I was on a mission to efficiently evaluate her heart, sort out any ongoing issues, document the visit, and then move on to the next patient. Her desire was to tell her story and be listened to. So, in the moment …
How listening is a huge part of what we do for our patients
With any new illness comes metaphor. It is humanity’s attempt to incorporate the mystery of disease into our own stories. We like to personify illness, give it human characteristics as a way of visualizing it. We name its actions to help lessen its unpredictability. Tuberculosis consumed. Syphilis punished. AIDS invaded. Cancer grows. COVID-19 quarantines separate and spread fear.
How long does it take for a disease or illness to become a …
The new words from the coronavirus pandemic
The pandemic has revised the triple aim framework of health care. The simultaneous triple pursuit of improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care is currently not possible. With widespread forced lockdowns, we are unable to provide the optimal patient care experience, the health of the population is declining (limited access, postponed procedures, delayed vaccinations, etc.). And while …
The triple aim revised: financial shock, burnout, and imposter syndrome
I recently attended a cardiology conference where a dear friend of mine was presenting on the topic of hypertrophic cardiomyopathy. She discussed how fibrosis within the ventricle causes diastolic dysfunction, an inability of the myocardium to relax. My ears perked up. Just the week before, while on vacation, I personally experienced the inability to relax.
Though I was free to lounge around New Orleans while my husband attended the annual CHEST …
5 steps to improve your diastolic dysfunction of life
Physicians are excellent at floccinaucinihilipilification, which is seeing something as unimportant or worthless. We engage in floccinaucinihilipilification every time we see a patient. We listen to their story and symptoms, and quickly filter, accept, or discard information until we arrive at our presumed diagnosis.
The 18-second rule
In 1984, Beckman and Frankel wrote in the Annals of Internal Medicine that the average time it takes a physician to interrupt …
Physicians are excellent at floccinaucinihilipilification. What is that?
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