What seems like a tidal wave of pages washes over you. Drowning in a torrential sea of order clarification, bowel regimens, and vital sign deviations — you struggle to stay afloat. Medical school did not prepare you for this. Patients and nurses are calling you, “doctor,” you wish to return to that minimal responsibility role as a medical student.
Welcome to your first on-call weekend.
These first few days, weeks, and months …
The intern who knows everything
“Let me order some labs, and then we’ll discuss where we go from there once I have the results.”
I walk out of the patient’s room and right into one of my nurses. “Zoe, can we start that lady on pressors like we talked about? Her blood pressure is still low after the fluids. I need you to put the order in so the pharmacy can send it up.”
I smile my …
The difference between shallow and deep work in medicine
The first time a woman went into the final stage of labor, I watched from a corner of the room. As a third-year medical student, I was on my six-week clinical rotation in obstetrics and gynecology, and it was day one of the two-week portion on the labor and delivery floor. As a loudspeaker announcement projected over the woman’s screams, and nurses and doctors rushed in response, I instinctively clasped …
The excitement of clinical rotations: Not just learning medicine but doing medicine
I have been fortunate in that I have not had to hospitalize any patients in the past four weeks. This means I have an extra 60 minutes or more to prepare for the workday in my office. The streak ended this weekend when my associate, taking his rotation of being on call, hospitalized one of my patients with pneumonia.
In many cases, pneumonia is treated as an outpatient. You receive an …
Why this primary care physician still rounds at the hospital
There’s so much negativity out there when it comes to health care, it must be a concern to any young person thinking about entering the field. I certainly spend a lot of time writing about all the challenges we face, and have to hold my hands up to (occasionally) spreading some of that negativity as well! Guilty as charged. That’s why it’s important for anyone outside of health care (or …
This doctor has no regrets to becoming a physician. Here are 3 reasons why.
Over the past 40 years, the number of U.S. hospitals declined by 12 percent, from more than 7,100 in 1975 to 6,200 in 2017, according to the latest American Hospital Association survey. And, yet, despite shuttering nearly 1,000 facilities, hospitals remain the nation’s largest source of health care spending, accounting for $1.1 trillion annually (or 33% of all national health care expenditures). Much of that money goes …
5 improvements needed to modernize the American hospital landscape
Prior authorization — a utilization management (UM) process used by health insurance companies to determine coverage for a prescribed procedure, service, or medication — is now becoming a mandatory requirement by the vast majority of large insurance companies.
While prior authorizations are pursued at the front-end for almost all planned medical services, there has also been a steep increase in denial of payment for services at the inpatient level for both …
The burden of prior authorizations and denials in health care
One of the least motivating requests I received routinely as a new intern was something like, “… and can we make sure this is a discharge before noon?” I recall a particularly eager nursing manager surveying the resident teams on her unit to gauge our interest in arriving even earlier each morning (5 a.m., perhaps?) in order to prepare potential discharges before pre-rounding. We shared a nice laugh.
The tension between hospital administrators and medical residents
Harvard Medical School student Chloe Li typically dressed in scrubs or an efficient, professional outfit as she went about learning to care for patients in the intense, year-long clerkship program where I teach.
For her capstone presentation on graduation day, though, she wore a cream-colored wrap-around dress of luscious silk, tasteful jewelry, and an up-do hairstyle. She had clearly put a lot of care into these preparations. She …
The unintended consequences of #MeToo in medical education
I paced in the hallway outside of the patient’s room, going over my mental checklist of items to do during the history and physical examination. Bringing in a paper list was discouraged; we were meant to “flow” through the exam “naturally.”
I stuffed my hands into the pockets of the white coat I’d received three weeks earlier, during the White Coat Ceremony for first-year medical students. Feeling around the deep pockets …
The first lesson in medical school: Say you’re sorry
In the current health care system, patient outcomes, and patient satisfaction are increasingly important. With the hospital value-based purchasing program, Medicare adjusts payments to hospitals based on the quality of patient care they provide. Hospital consumer assessment of health care providers and systems scores are tied to Medicare reimbursements. Under the hospital-acquired condition reduction program, hospitals in the highest quartile of hospital-acquired conditions are subject to a 1 percent payment …
3 things every hospital should invest in
It’s difficult to imagine a world now without Google and the internet. It’s also strange to think that most people alive right now received the bulk of their education in the pre-internet era. I remember in the United Kingdom, where I went to medical school, Google only became a thing perhaps midway through university. Since then, of course, the internet has exploded and penetrated every facet of our lives. And …
Don’t judge patients for researching their health issues
Just before I induced anesthesia, he said, “Doc, I want to apologize beforehand. I am incontinent due to a previous surgery so I might wet the sheets.”
I told him not to worry and that we understood and that “these things do happen.” His response has stuck with me: “Doc, but there is still some shame.”
I nodded, told him not to worry since he was going to get a catheter anyway, …
Don’t forget to manage your patients’ dignity
I am a middle-aged, full-time emergency physician, and part-time law student. Usually, I practice medicine during the day and attend law classes in the evening. Sometimes I have law classes in the afternoon or early evening then work in the emergency department all night.
So, what’s harder: medical school or law school?
Absolutely the most common question I am asked by physicians, attorneys, and students at all levels of training.
The other most …
Doctor by day, law student by night
What is your gut reaction when you hear the words “hospital chaplain?” Maybe it’s an eye roll or confused stare about what you believe to be an incoming attempt at religious conversion. As a family member anxious about a loved one in the hospital, maybe it’s a sigh of relief. As a patient, maybe it’s an overwhelming fear of incoming bad news. Health care chaplaincy is chronically misunderstood, beginning with …
It’s time to stop being skeptical of hospital chaplains
Residents and fellows around the country have bought into the “medical training myth.” The myth states: “Life will get so much better when I finish residency/fellowship.”
Sadly, too many house staff buy into this false belief and experience tremendous letdown when they graduate.
Residents often see their attending stroll into the team room with a cup of coffee at 8 a.m., ready to round. Meanwhile, they think, “I’ve been …
Debunking the myth that life gets easier once you finish medical training
If you’ve ever been in the hospital for a surgery, you probably had a resident speak to you about the procedure; you were presented a laundry list of risks, the benefits mentioned, asked if everything was understood. And finally, you initial in several spots before signing your name on the dotted line. You looked at the wall clock and noted that the conversation took a mere six minutes.
Is this proper …
Patients: Be proactive in your health care
Women who become doctors must often choose between motherhood and medicine. I’m a mother and a surgeon. I never thought of choosing between the two, even though my employers often asked me to.
Today I work as a trauma surgeon in a busy practice. It’s been a long journey since the day five years ago when I …
The stigma of motherhood in medicine
Nowadays, patients are used to seeing physicians who are not their doctors. Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician. A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that: Your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely.
The medical universe …
Patients are used to seeing physicians who are not their doctors
The doctor opened the door after a gentle knock. He was greeted with warmth, offered a seat by Mary, and promptly sat down on the end of the hospital bed. As he sat, the family stood to greet him. They discussed the grandkids, the trips taken since they last saw each other. The room felt peaceful. Time slowed down.
Walking in behind my attending, I had been ruminating about the lengthy patient list, the work to be done. Then …
When we walk into a patient’s room, we are entering a story
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