Imagine that you are a brand-new attending in a hospital. You have your new starched white coat and stethoscope around your neck. Before you enter your patient’s room, the nurse says, “Whew! Good luck! The patient’s dad is really angry! He’s been yelling for the last ten minutes!”
Are you prepared? Do you know what to do?
The boundaries of unacceptable behavior have eroded in the past few years. Politicians, law enforcement, …
New resident physicians who have earned their MD degrees will be heading to hospitals to start their residencies during the last two week in June and the first week in July. What can a beginning doctor do during the first month of internship to get his or her career off to a good start, and in so doing, also learn to provide the best care to patients? Here are 10 …
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, …
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? …
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.
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 …
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 …
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 …
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 …
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 …
“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.
Just over seven years ago, on April 22nd, my father heralded his 88th birthday with a thoracentesis to drain the fluid from his lungs. On May 3rd, less than two weeks later, he died, due to a blockage in his abdomen leading to sepsis, most likely from two 20-plus-year-old sarcoma surgeries.
Between these events, he went through a series of seemingly unstoppable medical issues. There was the discovery of that sarcoma …
“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 …
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 …
“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 …
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 …
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 …
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 …
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 …
