Being a hospitalized patient is perhaps one of the most disempowering experiences an individual can face (besides being in war, or a prisoner). Patients face constant uncertainty; having no idea what time their physician will visit, when they will be taken for their tests, or who will suddenly interrupt them again with a demand – perhaps an early morning blood draw, or yet another round of interrogation and uncomfortable examination …
The supervising resident’s Voalte phone dinged: “Dr. Mel: Please meet Dr. Rosemond at room 514 for Cardiology rounds.”
She scrolled up a few texts and saw that her male counterpart who had rounded the previous day had been addressed as “Dr. Stearnes.”
When Mel mentioned the discrepancy to Jacob Stearnes, he just shrugged and said, “The cardiology nurse probably doesn’t even know my first name.”
When Mel mentioned the discrepancy to her husband, …
In 2002, when I began my first hospitalist job, I was a dyed-in-the-wool hospital medicine convert, convinced that the transfer of inpatient care to true specialists in hospital medicine (hospitalists) would dramatically improve the quality and efficiency of inpatient care, increase patient satisfaction and decrease costs.
By 2008, I had developed serious doubts, which prompted me to publish an editorial in the Journal of Hospital Medicine, entitled “The Expanding or Shrinking …
I started internship July 1, 2008, as a terrified 25-year-old blank slate. Most days started with a combination of nausea and dread as I pumped myself up in the resident parking lot — conveniently located a mere 1/2 mile from the entrance to the ivory tower I called home.
The days were long. The nights were longer. Every month I had the chance to be a brand new idiot as a …
We all have that one patient. That one patient who can always find a way to turn a good day bad, who just knows how to push your buttons in all the wrong ways.
Who’s that patient for me? Let’s just call him Elton Reed.
Oh, Mr. Reed … where to begin with him?
When we first met, I remember being so excited and energized by him. He just had this fresh feeling …
“Tell me something you love.”
I love warm chocolate chip cookies — straight out of the oven.
“Thank you. Tell me something you love.”
I love to read, to write, to dance. I don’t know yet if I love medicine.
We were gathered in a ballroom, a group of doctors and dancers, to explore the art of medicine through movement. I sat cross-legged, looking into the eyes of a person I did not know, …
I began practicing as an internist/nephrologist in the early 1960s. Having rented an office in Los Angeles, I introduced myself to the local medical community and set out to build a practice.
With a growing family, a mortgage and an office to support, I was hungry for patients. Hospital emergency rooms were good referral sources, so I took ER call at three different hospitals.
Late one Friday night, I got a call …
A natural part of life is emotionally growing (hopefully) with experience. If I was to look back at my own journey, when I was in medical school and just graduating, I would say that without doubt, one of the biggest things I would tell my younger self, would be to not take things too personally. This would be particularly true in professional situations.
I look back at how personally I used to …
What makes a good doctor or, for that matter, a great one? Most patients want physicians who are excellent clinicians and diagnosticians. But we also want doctors who are caring, empathetic and maybe even telepathic — doctors who seem to know intuitively what we need without any awkward discussion of sensitive issues.
After all, patients may not want or know how to talk about substance abuse, domestic violence, sexually transmitted disease …
When we studied ward attending rounds, the thought process represented the top attribute that learners valued. Learners can learn facts from textbooks, but using those facts requires experience and role modeling.
I have given many lectures on clinical reasoning, and I have attended many lectures on clinical reasoning. These lectures can entertain, but one lecture does little to help our colleagues and our learners.
We must structure case conferences as a primary …
This one’s for the new interns.
You’re excited, you’re about to start residency. You’re a doctor. No more short white coat. You’ve got the long white coat that you’ve been waiting for. You’ve arrived.
But actually, there’s one more thing you need before you really feel like you look like a doctor. It might be a few months. There’s going to be a long process. Someone in your program, maybe the chief …
Putting physicians in charge of hospitals seems like a no-brainer, but it isn’t what usually happens. A study published in Academic Medicine states that only about four percent of hospitals in the United States are run by physician leaders, which represents a steep decline from 35 percent in 1935. In the most recent 2018 Becker’s Hospital Review “100 Great Leaders …
Fake news is a term that’s become notorious over the last couple of years. For notorious reasons perhaps. But there’s actually another serious arena where there is inadvertently an awful lot of “fake news” on a daily basis. And that is, well you guessed it: in health care throughout our nation’s hospitals and offices!
Let me explain, and I suspect anyone who works in health care will be familiar with the scenario. …
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This summer, new resident physicians begin their training all across the United States. Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a sideline) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school. Anxiety-filled and debt-ridden, they will embark on four …
As physicians, we are used to asking our patients lots and lots of questions. It’s our job to elicit information, listen, and then come up with a management plan. There’s a standard script every doctor goes through, based on the science of medicine, and we usually have this memorized to a tee. And that’s all very well and good. However, as with many things in life — especially those that …
So out in the varied land of hospital medicine, I have noticed something that I have no clear explanation for. It turns out there is often a gap in productivity between that of NP/PA providers and physicians. The range of the gap varies wildly – I just got off the phone with a group leader who has observed a 50 percent difference to a smaller gap of perhaps 10 percent. …
CMS is changing note requirements, among other changes. Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.”
As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction. To me the most important change is a focus on notes: “Allowing medical decision making to be …
I’m a creature of habit. My first activity every day is to read the New York Times. Depending on my schedule, some days I read more articles than others. This week I was away at a conference and found myself with some early morning extra time before the first meeting session, so I delved into the Arts section. I began to read the first article: “Women …
Dear third-year medical students,
Welcome to the wards.
I remember this stage — basking in the glory of completing pre-clinicals, in the excitement of finally switching heavy textbooks for living, breathing people, in the realization that medical education now lies in the hands of those I wanted to heal. I would be sleeping less, but living more, because this was my purpose.
Remember this moment because this will be the most difficult year …
Learners value efficiency. As I recall my residency, nothing caused more angst than unnecessarily long rounds. In the 1970s just like in the 2010s, I had much to do after rounds ended.
As an attending physician, my responsibilities involve patient care and aiding learning. I have always worked hard to do that within a time constraint. The time constraint requires that rounds run efficiently.
Like many things in medicine, efficiency only works …
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