Walking through the dark construction zone of my now demolished kitchen, I made my way to the garage and out into the still, hot, humid July night. The air felt so thick, it was hard to breathe. At 1 a.m. I was headed to the hospital for a patient that just arrived in active labor. On the drive in, I had the air conditioner blasting to cool off the car …
Addressing physician self-care means getting doctors more sleep
I woke up to the sound of a faint “ding” from my bedside table. It was 5:24 a.m. Shaking off my lethargy, I scrambled over to my phone because the ding meant one thing: my first residency interview invitation.
Looking back on that moment, as I responded in the dim light of the morning, I realize that I knew very little about what was to come over the next few months. …
The rewarding and grueling process of residency application
Recently I was saying goodnight to my oldest son, who is now 14 and about to enter high school. I was standing in his bedroom looking at his midnight blue walls, which are covered in each of the planets. He looked up at me from his Pottery Barn bunk bed and said, “Mom, I need a new bed … and new walls.”
I stared at him, realizing my son was no …
A physician mother and her son
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 …
Physicians can’t take things personally. Here are some tips.
I have a theory. There is a simple thing hospitalists can do that can enhance relationships with our patients, and even, I bet, improve patient satisfaction scores. The catch is it is not something you can do for yourself; you can only “pay it forward” for somebody else.
We know patients who trust their physicians are more likely to follow recommendations, and that trust and confidence in physicians …
The simple thing hospitalists can do that can enhance relationships with patients
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 …
What is one thing that separates good doctors from great ones?
The trouble began when I needed to open the electronic health record (EHR) system for the tenth time that day. EHRs have significantly changed the way we practice medicine. They have completely eliminated the need for storage and transport of paper charts, reduced prescription errors secondary to illegible handwritings of physicians and provided an excellent platform to maximize billing for services rendered. However, in terms of creating a smooth workflow …
I didn’t become a physician to do data entry
Mr. Smith was a sixty-eight-year-old man who came to the Veterans Affairs hospital where I was a medical student complaining of chest pain.
“With chest pain, it’s all about the story,” my resident, the physician in charge of our team, said. We talked to him to find out what he was doing when it started, how long it lasted, how intense it was if it was still there.
His electrocardiogram hadn’t shown …
A case for at-home hospital care
With the transition to residency, I’ve spent a lot of time thinking about next steps in my career. I even did a self-reflection exercise for a class in which I listed out professional decisions that will come up in the next few years (including choices like fellowship selection, type of practice setting, whether to pursue management roles, and more). I then rated the different options on a set of six …
Medical schools should improve long-term career counseling
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 …
Structure case conferences as a primary way to teach and learn
“Better patient care” is the reason hospital and health systems usually give when they merge or acquire one another. Our research suggests that mergers and affiliations might, paradoxically, increase the risk of harm to patients in the short run. Improving the safety of patient care is possible during mergers and affiliations, but requires intentional efforts.
What happens after …
Hospital mergers and the risk to patient safety
It’s that time of year again.
The start of a new academic year, marked by the arrival of a brand-new class of interns starting out in their training.
Clutching their freshly-minted medical degrees, they appear so ready, so anxious, so excited, so eager to learn.
Now it’s our job to make sure they stay this way.
(Have I written this column before? Every year …)
We need to make sure we have a world where …
Making the world a better place for new medical interns
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 …
New interns: Get ready to be fleeced
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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 …
5 reasons you should put physicians in charge of hospitals
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. …
The best way to fight misinformation in health care
Let’s say your loved one is at the end of life. She’s 84, with advanced cancer that is no longer treatable.
A decision has been made to put her in hospice — which is a level of care more than an actual location. (Most hospice actually occurs at home.)
The patient waxes in and out of consciousness, sometimes lucid, but mostly not.
While no one is ready for her to die, this end-of-life …
Physicians on the front lines of health care today are sometimes described as going to battle. It’s an apt metaphor. Physicians, like combat soldiers, often face a profound and unrecognized threat to their well-being: moral injury.
Moral injury is frequently mischaracterized. In combat veterans it is diagnosed as post-traumatic stress; among physicians it’s portrayed as burnout. But without …
Physicians don’t just suffer burnout. They suffer moral injuries.
As we all know, the time around discharge from the hospital is a tricky one.
In more ways than one can imagine, patients are in a delicate state, judged by those caring for them to no longer be sick enough to need to remain in the hospital, but possibly not quite completely ready to be fully back in the community, on their own at home.
Over the past few years, there have …
A better way to handle patient handoffs from the hospital
This is based on a true story. The name and some details of the events have been changed.
She was the smarter nurse who floated to ICU, to CVRU, to CCU. She could handle any crisis: balloon pumps, CRRT, open-heart patients, respiratory distress, code blues — anything.
Sandy was quiet. She didn’t really have any nurse friends. She was a loner.
But we could depend on her to take the most difficult assignments.
She …
On one of my first days of medical school, I shuffled into a lecture hall surrounded by professional looking individuals as we had done the days before. This similar routine persisted for a few days as we became oriented to our new school. Leadership had indoctrinated us with professionalism, administrative staff had terrified us to the point of avoiding any patient information for fear of being sent wherever they send …
Doctors should let their patients’ religious beliefs shine
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