I’m breaking up with you.
I fell in love with you when I was just a child sitting in my grandfather’s family practice office. He put that magical white coat on me, sat me at his desk, welcomed in my first patient, and I was smitten.
I grew up playing medical guessing games with him and his best friend, the town surgeon. They told stories of home visits, generations of families they …
Dear medicine: I’m breaking up with you
Student G.M is a 228. When she came to our school, she was a 31. When she went to college, she was a 1270.
Now we must make this number a caring, feeling person who has the empathy to impact the lives of patients for decades.
Makes sense, right? Wrong!
I played basketball in college — intramural. I was not bad, but I was not good. I liked to go to the gym …
Medical students are more than just numbers
He was a logical man. A northeast Ohio man. Who worked all his life and worked hard. I can see it in his hands. They are entirely calloused with traces of grease impervious even to pumice soap.
A family man. His wife and sons and daughters are at bedside. And proud grandson, just a man, not dry-eyed, stands in the corner, in his college jacket, the spitting image of his bedridden …
Proper endings like this feel right
In 2019, residents organized coast-to-coast to protest low pay, unsafe working conditions, and insufficient benefits. Residents at the University of Washington and UCLA walked out of the hospital in reaction to stalled contract negotiations. Residents at Yale interrupted a meeting to introduce a “Resident and Fellow Bill of Rights,” outlining basic rights such as …
I am a 57-year-old female physician, and I remember an incident that involved a cardiologist on the other end of the phone, roughly fifteen years ago. I had recently started work as a hospitalist, and the cardiologist and I had never met. He clearly didn’t pay attention to my introduction, because when he heard my female voice calling from one the hospital floors to tell him that the twenty-seven-year-old patient …
Is medicine a minefield of gender discrimination and abuse?
In medical school, I was taught to sit down at eye-level when speaking to a patient, ask them how they’d prefer to be addressed, make sure to ask questions in an open-ended manner to allow patients to express themselves, and interject with “that must be really difficult for you” or “I can only imagine how that makes you feel,” as a way to show empathy and foster better connection with …
Can empathy be taught, or is it innate?
A radical change is emerging from within our health care system: Rather than deny or defend medical errors, some hospitals are acknowledging them upfront. This enlightened response has been gaining ground since 2001 when the University of Michigan Hospital introduced one of the first medical error disclosure programs: the Michigan Model.
Hospitals that adopt the model also promise to explain why the error occurred, apologize, offer fair compensation, and learn from …
Medical error disclosure programs: Old habits die hard
Just to give you my background, I manage a large hospitalist program for a busy downtown community hospital that is part of a large health system consisting of a total of 29 acute care hospitals in the same geographical area.
One of the reasons why our team was hired recently to manage this hospitalist program was to change the existing work culture, which had resulted in poor team performance, low physician …
Start a hospitalist program with these 6 steps
In medical school, physicians learn how to diagnose and treat medical conditions. We learn about all the different presentations and revel in catching a complex or rare diagnosis. In essence, we learn to categorize disorders based on a cluster of symptoms and match them with appropriate treatment plans.
Of course, you want this quality in your physician. This system works well until you enter independent practice and learn quickly that patients …
System failure: We need a reboot to better handle intersectionality
As a child, when I first read The Little Prince and saw the picture of the boa constrictor swallowing an elephant, I would often ponder what it felt like to be the elephant. Later in seventh-grade science class, when I learned of amoebae and how they surround and digest neighboring life forms for their sustenance, the same wonder followed. Enlightenment to what it feels like to be subsumed came to …
When physician leaders get acquired and squeezed
I work for a hospital network with the world’s slowest computers. I timed it: Last shift, it took me fifteen minutes to log on. The first computer obtained didn’t function at all. It had been worked on the day before by information technology services (IT).
Efficiency and time management appear to be amongst top priorities in medicine. “Did they get their aspirin 24 hours after getting their clot-busting drug after cleared …
IT deficits are eating hospital profits. CEOs need to wake up.
About three months ago, something awful happened. The oncology nurse practitioner (NP) whom I trained for the past two years in my subspecialty decided to seek employment elsewhere in order to have a more flexible work schedule.
My team and I lamented we had a going-away dinner to say thank you for her work. And for the next three months, I trudged through my days in a busy oncology clinic, seeing …
Should nurse practitioners complete medical residencies?
If you or a loved one has ever been hospitalized, by day two or three of your hospital stay, you likely remember the doctor visiting you every day but not staying more than seven or eight minutes or 10 to 15 minutes max.
It may have felt like he or she was just “dropping by and laying eyes on you.” A month or two later, you get a bill with the …
A peek behind that 8-minute $300 doctor visit
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I believe in the practice of medicine and enjoy teaching others this amazing art. However, after experiencing nine months of interactions through medicine as the daughter of a sick patient, I struggle with my pride in the profession and fear of the health care system.
My mother would proudly tell all her physicians that her daughter was a doctor. I knew she was proud, but I didn’t believe in using my …
I struggle with my pride in the profession and fear of the health care system
Every day we get bombarded in the news with health statistics. Coffee causes cancer! Coffee cures cancer! And so on. Many of these are meant to grab headlines (and, these days, web page clicks), and the articles they accompany are often very poor at telling the reader what they mean. They often have statistics, and health statistics can be complicated. Sad to say, even many physicians are pretty poor and …
Everyone needs rudimentary statistical training
At nearly every stage in our education and training, we find “our people.” Maybe it’s your table-mate in kindergarten, or the kid with the really cool light-up sneakers in preschool who becomes your best friend. Maybe it’s your next-door neighbor who you play with after school or a coworker from your first job in high school. These people become part of our squad — even if their membership is only …
How to find your squad in residency
It was my first week of internal medicine rotation. A newly-minted third-year, I was rotating on the wards back in the spring, when I met a 90-something-year-old gentleman. He had come in for confusion after a fall.
There were no relatives or friends in the waiting room.
I was assigned to follow him. During his stay, his words were few; it was often difficult to engage him in conversation. Whenever I pre-rounded, …
Here’s why you should get a chaplain for your patient
Physicians across all levels of training are familiar with the widely recognized truth that our medical system is broken. This damage is evidenced by a paradox; perhaps it will become the great paradox of our time – physicians who were driven to a profession by a desire to help others are now the same doctors who secretly hope they don’t have to help you.
It is 9 p.m. on a fairly …
The physician’s paradox of healing
I recently started watching the HBO series Chernobyl, chronicling the events surrounding the 1986 disaster. For anyone who hasn’t seen it yet—I’d highly recommend this excellent production (It’s already deservedly won multiple awards). The great thing about TV like this, which documents real-life events (and I’d put another HBO series John Adams in the same category), is that they can really bring complex consequential events to the mass audience, in …
What Chernobyl can teach physicians about avoiding medical errors
Do you think I went too far in my last blog post, calling out some journalists as “pontificating parasites” who love nothing more than to slam physicians and blame us for the cost of health care?
If you do, then you must not have read Elisabeth Rosenthal’s latest salvo in the Feb. 16 New York Times, where she says physicians are in “a three-way competition for …
Keep attacking doctors: What the New York Times gets wrong about surprise medical bills
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