Physicians writing on KevinMD about hospital practice: employment by health systems and corporate owners, hospital closures after debt-financed acquisition, productivity quotas, the electronic record as hospitalists live with it, from alert fatigue to copy-and-paste, the errors hospitals count and physicians remember, and the nurses physicians work beside. Four maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words, The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and Nursing: what nurses and physicians say, in their own words.
Part 3 of a series.
Patients with advanced cancer are particularly vulnerable to infection due to a compromised immune system. Moreover, the typical symptoms of serious infection, such as fever and chills, may be absent in cancer patients. If not identified and treated early, infection can lead to sepsis, a life-threatening reaction of the immune system that causes organ failure, shock, and death, as …
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Why did it take over a week for doctors to initiate treatment?
I entered residency self-assured, if not in my scholarly achievements, at least in who I am as a person.
I left slightly broken.
Something happens to you in residency, and you don’t realize the transformation as it occurs. It may be the loss of a patient who died on your watch, or the realization that you have not changed the world. It could be the constant fear of failure or punishment by …
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A reflection on the last day of residency
Pain usually cannot be “treated” like a standard ear infection. Treating patients in pain requires setting realistic expectations, using a variety of approaches, and patience. One patient I treated months ago highlights these points.
At 6 a.m., I was ready for the change of shift at the hospital. The night doctor who took care of my patients was frustrated. He snapped, “You really should have had a better plan for her. …
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Break the reaction to high pain scores
“For the rest of my life, I’ll never see her again or smell the scent of her unwashed hair. I’ll never hug her soft squishy hips or sigh when she tells me to stop sleeping, get up, and enjoy the day.”
This runs through my head before I start sobbing in my car. Most of the time I feel fine, but when I confront the finality of my grandmother’s existence, tremendous …
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How long life doesn’t mean dignity
During rounds, in between seeing patients, the medical student pulls out his phone and scans a dating app for new matches. In the team room, a resident opens Facebook before responding to a non-urgent page. Each of these instances may seem trivial enough, but I’ve seen both lead to poor evaluations, reprimands, or others whispering terms like “unprofessional.”
In the medical world, there’s an implicit understanding that while you’re at work, …
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Don’t judge when trainees use dating apps in the hospital
We as physicians need a dose of our own medicine as a booster ever so often.
I went in for a simple procedure. A lumbar epidural steroid injection for pain which has recently become more than tolerable at times — nothing disabling. Nothing that stops my everyday life and living. I didn’t think much of the procedure at all because I am at the other end of operating room procedures on …
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Only when you are a patient do you experience the frailty of being one
About halfway through the internal medicine residency, there comes a time when a resident must decide on what he or she plans to do after three years of training. We may come across a second-year resident saying: What should I do next? Should I become a hospitalist or plan for a fellowship? But in what? Cardiology and gastroenterology are fascinating careers, but is my resume ready for a competitive match? …
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For residents unsure about their choice of specialty
I would like to offer some words of encouragement to what many call the “non-traditional” students pursuing medicine.
The term encompasses people in different aspects in their lives. It may be someone in a different line of work looking at medicine as a second career or another just getting started that didn’t take the traditional path in undergrad.
My own journey
I started medical school at 28 after spending six years as a …
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10 tips for non-traditional medical school applicants
My local hospital in an affluent suburb of New York City displays its Outstanding Patient Experience Award 2018 and Magnet Recognized status on its website. My experiences tell a different story. This hospital is located approximately five to seven minutes from my home and is my go-to in an emergency. I have multiple medical conditions, which despite my best efforts sometimes require emergency care and unfortunately admission. I was working …
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What happens when your go-to hospital is overcrowded
The news has recently reported the story about the Cleveland Clinic resident, Dr. Lara Kallab, who was fired after making anti-Semitic comments on twitter. Among them, she tweeted that, “I’ll purposely give all the [Jews] the wrong meds.” Not only were people horrified by her comments, but she also lost her job (and possibly career) because of it. However, was her punishment too harsh or not severe enough?
My opinion is …
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There is no room for racism in medicine
1. Very little revolves around the patient. For a place dedicated to healing, the hospital does a poor job accommodating patients. Labs are drawn in the middle of the night, so the doctor has them early in the morning. There is no standard rounding time, so the patient is constantly awakened throughout the day. Vitals must be measured every few hours. Patients often comment about being happy to be discharged …
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10 surprising things you need to know about the hospital
I have been a neonatologist for 30-plus years. Throughout my career, nurses and neonatal nurse practitioners (NNPs) have guided me, assisted me and comforted me through difficult patient care issues that arose. Even more importantly, they allowed me to leave the neonatal intensive care unit (NICU) without worrying about how my patients were being taken care of.
I am writing this because our profession (MDs and DOs) continue to devalue these …
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The discrimination against nurse practitioners must stop
How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the ordeal.
When I get to work, full of nervous energy, I am relieved to find out …
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Your first 24-hour shift
Exhausted. Aching. Hungry. Slightly delirious.
Mile twenty-four of a marathon? Or hour twenty-four of a twenty-eight-hour shift?
I am a resident. I am a runner. I am also a rather tired human since, as I type these words, I’m both post-call and post-run. However, this post-call/run state of body and mind is one I have learned to love and embrace during this residency whirlwind.
I’m not myself unless I’m wearing scrubs or running clothes. …
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Residency training, and training in residency
I am a pediatric hospitalist in middle America. I believe in you, and I hope that you believe in me. Many of my patients’ parents do not believe in me, you see, and it makes it hard for me to do my job and to take care of these children in the way that I have been trained and believe to be in their best interest.
A toddler has just died …
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A physician’s plea to Santa Claus
Even though physicians do not talk about transferring residencies, it is more common than is often believed. According to the AAMC website, about 30 percent of residents do not finish the initial program they started. Quantifying that number further, the ACGME recently reported 1,044 residents transferring from their program.
There are a variety of reasons for transferring residencies: A spouse being accepted for a …
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How to transfer residency programs
Beeeeeeeeeeep.
The unmistakable long beep of my bright-red code pager broke the rhythmic sound of my trusty breast pump. I grabbed the pager silently praying it was a “test page.” No such luck. As I read the Code 45 message, I heard the overhead announcement echo: “Code 45, East Tower.” I quickly disconnected the breast pump, whipped off my pumping bras and was mostly dressed as I ran from the lactation …
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Having a baby makes you a very different physician
One time, I applied for an emergency department (ED) nurse manager position. I thought I had the job locked up until I was asked during the interview how I would “enforce metrics.”
“Enforce.”
My holistic, qualitative research-based response to this authoritarian-style question was: “I’ll find more organic ways to achieve your metrics without shoving numbers down their throats.”
I didn’t get the job. Someone told me I wasn’t “MBA enough.”
Yet, I stand by …
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Stop shoving metrics down nurses’ throats
There has been a profound deterioration in the education of our medical students. I only make this contention after having taught over a hundred medical students across five continents, often one-on-one and for extended periods. Although the majority of those I’ve taught have been students educated at international medical institutions, a substantial number have been those from U.S. medical schools. While I do recognize that those that find their way …
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What’s the biggest problem with medical education?
