What is the narrative that you hear when faced with uncertainty?

Physician
July 15, 2022

The first week of my big attending job, I saw a patient with fever, sore throat, no cough, and tonsillar exudates. Well-trained to manage septic shock, but having no idea how to practice in a primary care clinic, I crafted a vast array of infectious and inflammatory diagnoses. With a quick glance, my senior partner said, “You don’t know that this is strep?” Flushed and wanting to hide, I thought, …

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What is the narrative that you hear when faced with uncertainty?

How did quality and safety become 4-letter words?

Policy
July 14, 2022

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.

A decade of working in quality and patient safety has taught me a painful lesson: Don’t say “quality” or “patient safety” to frontline health care workers. Too often, they become immediately defensive or evasive. How did q#^l&ty and s^f*ty become four-letter words? …

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How did quality and safety become 4-letter words?

To admit or not to admit

Physician
June 25, 2022

Imagine that you hired a teenager to sell hotdogs at the local fair, but the teenager started telling customers that hotdogs were really not very healthy, that the price was ridiculously high, and that they could find healthier, cheaper options just around the corner. Is he wrong? From a business perspective, he’s a nightmare, but from a human perspective, he’s absolutely correct.

Where does your current work setting fall …

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To admit or not to admit

5 reasons physicians are afraid to leave medicine

Physician
June 19, 2022

At age 33, I got my first job as an outpatient pediatric attending. With great pay, nice coworkers, and exceedingly better hours than in training, to everyone around me, I had finally “landed.” Soon after I began working, however, I woke up with trepidation every morning, forcing myself to get out of bed.

Why wasn’t I relishing the fruits of my labors? After all this time, I no longer trailed the …

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5 reasons physicians are afraid to leave medicine

Delivering unpalatable truths in medicine

Education
June 18, 2022

Many providers enter medicine to comfort patients and their loved ones. However, much of what I do doesn’t live up to that intention. In the past few months and particularly the past few weeks, I’ve spent most of my afternoons making little difference in the course of my patients’ hospital stays, and instead of having multiple conversations with the loved ones of these ill patients, providing daily updates, reiterating expectations …

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Delivering unpalatable truths in medicine

A call to stop overworking

Physician
June 5, 2022

After being a coach for a couple of years now, there is an immediate danger I see right now.

Many of you are doing too much. Unsustainable, dangerous amounts of work. Dangerous to yourself and dangerous to others, which makes it dangerous for you, too.

I’m not trying to be overdramatic, but I am shocked by how much overworking we are accepting.

Everyone’s definition of “overwork” will vary. And the hustle culture and …

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A call to stop overworking

How patient education can save lives

Conditions
June 4, 2022

A patient undergoing chemotherapy for breast cancer was diagnosed on April 20th with profound secondary adrenal insufficiency (hypophysitis: ACTH undetectable, cortisol 0.2) caused by immunotherapy (pembrolizumab). She was started on corticosteroids and sent home from the hospital on April 24th with a prescription for only five days of prednisone. After completing the five days of prednisone, she predictably began to feel profoundly weak and nauseous. She continued losing weight …

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How patient education can save lives

What do doctors do when they get sick?

Physician
June 1, 2022

Doctors don’t get sick. Right?

We’re certainly not supposed to. Throughout our training, the consequences of illness are dire—if you have to miss a day, someone else, someone you know well and care about, will have to fill in. They will probably have to fill in on their one day off that week. You know they’ll be angry and sad. If you’re still a med student rather than a resident, the …

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What do doctors do when they get sick?

Why Congress should extend acute care at home waivers [PODCAST]

Podcast
May 28, 2022
YouTube video

“More studies are needed to fully understand the impact of in-home hospital care programs on quality and cost. Extending the waivers will give physicians, health systems, health services researchers, and policymakers the opportunity to further analyze these programs’ results to determine the future for this person-centered care model.

The movement from inpatient …

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Why Congress should extend acute care at home waivers [PODCAST]

Toxicity, gaslighting, and passive aggression in fellowship

Physician
May 9, 2022

“Yeah, I mean, whatever, it’s a master’s! Have your own damn party.”

My jaw dropped in disgusted shock. The wall was thin, very thin. Come to think of it, it wasn’t even a wall. It was a partition: the separation of space between different office spaces. My mentor uttered these words: Assigned to support, encourage, and guide me through training; the person supposedly invested in my personal and professional growth. This …

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Toxicity, gaslighting, and passive aggression in fellowship

What it is like to watch someone die

Education
May 1, 2022

At the start of my medical school’s clinical rotations, I was prepared with new scrubs, minute facts about diabetes and kidney disease, and a stethoscope that I struggled to hear murmurs with. What I was less prepared for was the emotional toll that seeing patients would exact.

I began on my obstetrics and gynecology rotation, one known mostly for happy events with the delivery of newborn babies. Yet this was the …

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What it is like to watch someone die

Why is it hard to find grace in medicine?

Physician
April 29, 2022

“If I make a mistake, my patient could go home in a body bag.”

I don’t recall whom I first heard this from, but it stuck in my mind as terrifying thoughts do. And we wonder why burnout in medicine is a thing.

Mistakes in medicine can cause mortal consequences. They can harm another human being. We can’t escape this reality. We can’t undo it. We don’t get “three lives,” as in …

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Why is it hard to find grace in medicine?

Hospitals are some of the least hospitable places

Physician
April 24, 2022

Dear new intern:

As you embark on a year that will prove at different times stimulating, frustrating, rewarding, and exhausting, you’ve likely already been inundated with suggestions on how to thrive, or at the very least, survive what lies ahead.

While I have no pithy advice or intern life-hacks to offer, I suggest one (perhaps strange) practice I hope you will consider and strive to exhibit as you weather the highs and …

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Hospitals are some of the least hospitable places

A physician’s personal great resignation

Physician
April 14, 2022

It’s been a year since I retired from almost 40 years as a pediatrician (most of that time as a pediatric hospitalist). What have I learned? What surprised me?

1. I have finally caught up on my sleep. I have been convinced that I still had a cumulative sleep deficit dating back to med school. After one solid year of sleeping 8-9 hours a night and waking up without an alarm …

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A physician’s personal great resignation

Mixed emotions on Doctors’ Day

Physician
April 11, 2022

So many mixed emotions as I scrolled the multiple acknowledgments on social media this recent Doctors’ Day. Although it is nice to be recognized, are we just supposed to forget the recent hostility and disrespect? Can we ever really thank those on the frontlines who risked their lives during the pandemic? The recognition comes too late for the many doctors and trainees who did not survive. How do we honor …

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Mixed emotions on Doctors’ Day

Losing my first patient

Education
April 8, 2022

I had known AR for eight days before she passed away.

AR’s medical record was littered with phrases all too familiar in the field of medicine: she had “poor insight into the severity of her disease” and was “insisting on all resuscitation measures despite poor prognosis.” But quite frankly, I could not blame her. She had been diagnosed with metastatic gastric cancer, bilateral Kruckenberg tumors and additional metastases throughout her abdominal …

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Losing my first patient

A photographic exploration of the physician’s inner life

Physician
March 23, 2022

I entered my Manhattan apartment around midnight, roughly an hour after observing a transplant team recover kidneys and a liver from a young patient newly pronounced dead. Still wearing scrubs, I sat down on my bed, and, like a ghostly twin or guardian angel, watched myself spill tears.

The scene I witnessed in the operating room that evening as a second-year medical student was at once grotesque and hallowed, shocking and …

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A photographic exploration of the physician’s inner life

The first time of death

Physician
March 18, 2022

Keeping someone alive? I could do that. After all, that’s what medical school taught, ways to save lives. Give me a disease, and I could find the algorithm. Death, however, was murky, messy, and confusing. An algorithm does not exist. There is no uniform response to provide grieving family members at bedside. Death was its own master, chose its own rules, and decided its own course. Death was something I …

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The first time of death

How a code profoundly affected this physician [PODCAST]

Podcast
March 17, 2022
YouTube video

“There is a small amount of literature about secondary trauma. This means that the people who respond to trauma (firefighters, police, doctors, EMTs, etc.) experience PTSD from experiences they were not the primary victims of. I haven’t read the literature, and I don’t know what qualifies. I do know …

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How a code profoundly affected this physician [PODCAST]

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