Hospital-Based Medicine

The degradation and devaluation of nurses

Conditions
September 19, 2021

Where do I begin? Maybe at the beginning.

Let’s start with the degradation and devaluation of nurses across this country.

For decades, I lived the devaluing of nurses. Daily huddles from our nurse managers, ER nurses, ICU nurses, and behavioral health nurses. Emails and huddles about downsizing. Nurse-patient ratios. Decreasing nursing staff and increasing patients. ICU nurses typically had a 2:1 ratio and, depending on the patient’s acuity, a 1:1 ratio. But …

Read more…

Unsolicited advice from unmatched residency applicants: Hope for the best, plan for the worst

Education
September 5, 2021

When you enter medical school, you put your trust into an unspoken promise: Work hard, pass all your classes, and you’ll come out as a doctor after four years. While mostly true, this perception doesn’t take into account the residency application process and the possibility of graduating without a position as a physician-in-training. This thought didn’t cross my mind until I decided to apply for otolaryngology, one of the most …

Read more…

The Apgar Olympics: The race is on

Physician
July 28, 2021

The page comes during a lull on an otherwise busy day in the well-baby nursery (WBN). My pager’s shrill cry rouses me like the blast of a starting pistol.

DI-DI GESTATION. 37 WEEKS. BABY A WITH NON-REASSURING HEART TONES. BABY B BREECH. OPERATING ROOM A. COME STAT.

Translation: Twin birth. Baby A is STRESSED. Baby B attempted a front flip but got stuck. HURRY.

The race is on, and I am determined to …

Read more…

Physicians: Stop dreading call

Physician
July 10, 2021

Even though I completed residency almost 15 years ago, it is easy to remember the dread I experienced before taking hospital call. The sinking feeling in my stomach as the call date loomed near, the hypervigilance and terror every time my beeper went off in the middle of the night, the fear of imagined catastrophes that would by necessity be my fault.

My anticipation of call was usually worse than reality. …

Read more…

Reflections from a former intern

Physician
July 10, 2021

July 1 is a day that marks the new era when student truly becomes doctor, where hundreds of residency programs start day one of the three-year or longer residency, a life-changing rite of passage. Where the initial hours start the tens of thousands of hours of experiential full immersion training. Looking back, intern year was one of the hardest years of my training and definitely one of the hardest years …

Read more…

Questions of a canceled whistle-blower

Physician
June 26, 2021

This is not a story about the before.  It is about the after.

When I blew the whistle on the gender harassment I experienced and witnessed within my workplace, I naively thought doing so would help. I thought opportunities and experiences for women would get better.  I thought it would be worth the risk.

And yet, two years into the after, I am still struggling. My experience taught me that I am …

Read more…

Mansplaining in medicine and how to solve it

Physician
June 23, 2021

My friend (I’ll call him Dr. Mensch) reached out to me because he fears that a gender war is unfolding in his division. He is worried that current cultural concerns about gender equity are degrading the previously harmonious relations between male and female professionals on his team and that the mounting tension could have a negative impact on patient care.

Mensch told me that several female physicians, including residents and fellows, …

Read more…

It’s not every day the head nurse on a medical floor accompanies a physician on a consultation

Physician
June 18, 2021

An excerpt from Act of Negligence. Copyright © 2021 by John Bishop. All rights reserved. Published by Mantid Press.

Beatrice Adams

Monday, May 15, 2000

“Morning, Mrs. Adams. I’m Dr. Brady.”

There was no response from the patient in Room 823 of University Hospital. She was crouched on the bed, in position to leap toward the end of the bed in the direction of …

Read more…

How photography made me a better doctor

Physician
June 5, 2021

In my first year as an attending hospitalist, I personally discovered what Hippocrates realized millennia before, “Life is short and the art long.” Clinical reasoning is an intellectual labyrinth that can only be mastered with deliberate practice, introspection, and perseverance.

However, I soon found that spending hours poring through manuscripts and cases was not only cumbersome, but often counterproductive.  It dawned on me then that athletes faced a similar predicament, one …

Read more…

Here’s the secret to establishing a great physician reputation

Physician
May 24, 2021

Summer marks a flood of young new attendings hitting hospitals all over the country. There will also be many doctors whose first contract is coming to an end, and they are moving to a new position. Both of these scenarios create an opportunity to make a first impression at a new job. The effects of that first impression will linger for years to come.

What lingering effects do you want to …

Read more…

ADVERTISEMENT

A police shooting in a hospital forces a family to rethink American justice

Policy
May 23, 2021

The beer bottle that cracked over Christian Pean’s head unleashed rivulets of blood that ran down his face and seeped into the soil in which Harold and Paloma Pean were growing their three boys. At the time, Christian was a confident high school student, a football player in the suburbs of McAllen, Texas, a border city at the state’s southern tip where teenage boys — Hispanic, Black, white — sung …

Read more…

A nurse is to a patient what a mother is to a child

Physician
May 6, 2021

I was on inpatient service and had already seen most of the patients on my list. I just had to see one more before I could call it a day and rush out just in time to take my daughter to her tennis lesson. I reviewed the patient’s chart to find out that her cancer had spread to her spine, which had incapacitated her to the point that she could …

Read more…

Bloated notes are a huge problem and a time suck

Physician
May 4, 2021

In a moment of caffeine-depleted delirium, I volunteered to head the creation of a “notes committee” for my 80-member hospitalist group.

I placed myself on a 72-hour hold and quickly established a group consensus: “Bloated notes are a huge problem and a time suck. I’m glad you [rather than me] are working on this. My notes are fine, though. It’s other people’s notes that are bad. Other people’s bad notes are …

Read more…

ADVERTISEMENT

My 10 Commandments of a Servant Leader

Physician
April 18, 2021

I have seen great leadership and bad leadership. As a leader, I have also made my share of mistakes, and I am sure I will make more. When I do, I will immediately take ownership of it, learn from it, and do all I can not to make the same mistake. However, there will be times I may not recognize my failure, as can happen with any leader. This points …

Read more…

When it comes to medicine, what kind of practice makes perfect?

Physician
March 31, 2021

The old saying that says “practice makes perfect” is a basic rule taught to every resident starting their training. The follow-up questions that pose themselves: Is it true? How much time does it need to become perfect? What type of practice?

Time was answered partially by the journalist Malcolm Gladwell and his famous 10,000 hours rule; if one dedicates 10,000 hours for a skill, one will become an expert. If you …

Read more…

ADVERTISEMENT

The rise and fall of Hahnemann University Hospital

Physician
March 28, 2021

In March, thousands of medical students received their residency match results. For most specialties, match rates for graduating U.S. MD seniors have typically remained above 90 percent. This almost certain job security is what allows most medical students to consider taking on astronomical amounts of student debt.

The individualist message is clear throughout medical school: Focus on yourself, your achievements, and hope for the best.

Absent from these …

Read more…

45
pages