Forty-two years ago, when I had finally finished the seven revisions of my first novel, The House of God, my editor said, “Why don’t you add a glossary and a list of The Laws of the House of God.” Writing the Laws, I hardly needed to refer to the text; they just flowed out. The Laws became common parlance, not only tacked up in on-call rooms but even, recently, listed …
The laws of The House of God and Man’s 4th Best Hospital
I saw a tweet recently from a medical resident training at another hospital that really hit home for me: “In response to a rumor that health care workers who treat COVID patients will be prioritized for vaccination in our health system, one of my co-residents asked unironically, ‘Does that include us?’”
“Resident” is a word coined in the twentieth century when physicians in training often physically lived (“resided”) at the hospital. …
Medical residents signed up to live in the hospital, not to die there
Throughout my time in medical school, residency, and now as a practicing physician, I have noticed physicians’ changing face. When applying for medical school, I remember choosing a medium-grey pantsuit to match my medium-brown hair to wear for my interview, paired with a simple necklace and conservative makeup. Nothing too flashy, as even choosing grey instead of black and a pantsuit instead of a skirt would stand out and be …
More physicians have tattoos, and how that makes them more genuine at the bedside
There were recently many news articles and coverage exalting a physician for working 250 straight days during COVID. 250 days, that’s nearly 8 1/2 months without a day off.
While this physician displays dedication and caring, I don’t think we should celebrate this as an achievement. The truth is he’s working every day all day for one of two reasons. Either there is no one else, and he’s a victim of …
Physicians who work themselves into the ground have nothing to be proud of
For most of us, medical training through all the pains of medical school and residency is often bearable when we fantasize about life on the other side of all of this. Life as an attending physician, when the sky suddenly turns all rainbow, when the money starts to fall from those skies — we’re finally our own bosses, and then we’re supposed to live happily ever after. The reality, however, …
Being an attending: What no one tells you in residency and medical school
I am a critical care and emergency medicine physician, I have had COVID-19 infection twice, and I’m tired.
My first infection was early on in the pandemic. I had to place a Blakemore tube in a young man who was going to die from his massive bleeding from cirrhosis. I didn’t know then that the patient was positive for COVID, as he didn’t have any “typical” symptoms. I placed the tube …
I am an emergency and critical care physician. I had COVID-19 infection twice and I’m tired.
For a bunch of folks striving to stomp out malignant processes in our patients, we sure tolerate a fair amount of destructive behavior among training programs.
I’ll be the first to say I’m not the most delicate flower in the garden. Before pursuing medicine, I was a college athlete. I’m no stranger to long hours, harsh coaches, or repeated failures.
Medical students get their first bitter taste of malignant …
Why we’ll never eradicate malignancy in medical training
It was distressing to hear and read recent and ongoing disparaging comments about osteopathic medicine, attacking one of our own, from remarks by Rachel Maddow to tweets by Cher and a derogatory video, since removed, portraying a female DO by Figs Scrubs.
Navy Commander Dr. Sean Conley, DO, serves as the Physician to the President. This emergency medicine-trained combat veteran graduated from the Philadelphia College of Osteopathic Medicine and is well-qualified …
Attacks on osteopathic medicine are attacks on all physicians
The era of the empowered patient and patient-centered health care has been upon us for some time. Only a generation ago, there was a much more paternalistic approach to medicine. This has changed for the better across the western world. As somebody who teaches and coaches physicians on how to improve their communication skills, I would say that the newer generation of doctors is much more receptive than many of …
Doctors already are actors, whether they want to be ones or not
A second opinion can be a powerful tool. It can help lower your risk of experiencing a medical error or misdiagnosis, allow you to explore all treatment options and their benefits and risks, connect you with physicians who have experience and success treating people with your diagnosis, and provide peace of that mind that your diagnosis and treatment plan are appropriate.
Research from the Mayo Clinic highlights the value of second …
5 situations when you should get a second opinion
My small community ED has a fairly high acuity. As such, I was recently trying to transfer a couple of patients, one of whom was an NSTEMI, pain-free but with a rising troponin. In the process of trying to arrange things, I learned that our main regional referral center was holding a staggering 150 patients in their own ED, all waiting for inpatient beds.
I’ve spent the majority of my career …
We can’t expect large medical centers to absorb every case
Thinking, Fast and Slow is a well-known masterpiece of psychology by the formidable Daniel Kahneman. He diligently illuminates two different pathways of thought, which he arbitrarily titles System 1 and System 2. System 1 describes our quick thinking, our snap judgments, our gut feelings. System 2 encapsulates our deeper thoughts, the way we systematically review information, the analysis that requires time and mental effort. The work thoroughly lays out many …
My Danskos literally disintegrated last month.
I was in the hospital team room, finishing up my patient notes at the end of a busy hospitalist shift. I happened to look down at the floor, and there they were: black chunks on the carpet.
I thought, “Who left such a huge mess under the desk?”
I looked at the bottom of my black Danskos. There was a sizable chunk of the sole missing.
Finally, the …
After 4,380 days, a pair of Danskos — and a calling — fall apart
“We are transitioning.” In July of my intern year, this was the sentence that the CEO of our community hospital used to tell the staff that the hospital was closing its inpatient services. The emotions that traversed my mind were quite vast, to say the least. Anger was undeniably at the top of the list, but mostly directed at myself.
Initially, I thought medical school definitely did not prepare me for this. …
What can residents do to prepare for hospital closings?
In today’s increasingly technological, data-driven, depersonalized world of health care, I wonder if the concept of “a good death” is even possible. The COVID-19 pandemic, in particular, has caused me to reflect on this. What does it look like? How do you define it? As I did, a patient came to mind. He was a retired minister in his 80s. I had cared for his wife as well until she …
A physician’s work is hard. And it is sacred.
I distinctly remember one of many times I was reminded of “my place” in medicine. It was during the third year on a call day shift that had been lighter than most for our bustling hospital. As the residents were discussing who it was that had brought the good energy, I slipped in to mention that I often felt I had a white cloud energy myself. And the senior on …
The next time you’re on call, please rethink what white and black clouds mean
Have you ever been faced with an upcoming shift at work and felt an impending sense of doom? This type of anticipation can be a real killjoy. However, taking calls, working nights, weekends, and holidays is all part of the job, right?
Worst. Call. Ever.
I was just drifting off, entering the first phase of sleep when the whole body is relaxed, and you’ve entered that sweet twilight zone. …
4 ways to decrease your dread of being on-call
Oh, how we all learn and change with our experiences. It’s one of the greatest things in life that most of us (hopefully) are not the same person now that we were a few years ago. Looking back to when I first become a physician at the age of 22 (yes, that’s the typical age that most medical students across the world become doctors, because medical school comes straight after …
Doctors: Never pass judgment on the human being in front of you needing help
“It’s not my fault that you chose to have children.”
Years after leaving my job, I still hear my boss’s words in my head. He did not want to get married and or have children. He made that clear during my interview. He was also clear that he did not want anyone to perceive that I got special treatment for having a family. When I left, I did not sue. I …
Wife swap: a physician’s toxic work environment
As hospitals everywhere have been using every health care provider available to them in response to COVID-19, the specialty of hospital medicine has shown itself to be uniquely suited for coordinating the effort, to be the front of the frontline responders. I suspect that many people don’t understand what “hospital medicine” is, even though it’s larger than almost any other …
Why COVID-19 is a threat to hospital medicine
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