We want competent physicians, but we also want compassionate ones. How do we get them? Is it nature or is it nurture? Is it more important to search out more compassionate students, or should we instill compassion somehow in the ones we start along the training pipeline? I think the answer lies in nurturing what nature has already put there.
My background is in pediatric critical care, which I have practiced …
Can empathy be taught to physicians?
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 …
Nurses are always right. And 28 other tips for new residents.
I was recently interviewed by someone on the topic of clinician burnout. The interviewee asked me how I respond to those who say that burnout does not exist, is being overstated, or is the result of a weaker generation of practicing physicians.
I find this difference in opinion interesting. Most of the time, when a physician complains to me about the focus on clinical burnout, they are 1) of an older …
Clinician burnout: Be part of the solution
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 …
The simple, powerful question doctors should ask their patients
Anyone who has worked in medicine for a long time well understands the power of the statement coming from an experienced person: “This kid looks sick.” That person could be a physician or nurse. Years of experience does tend to give one a sort of sixth sense for when to worry something serious is going on that just hasn’t shown itself fully yet. Seasoned parents can often provide the same …
When you hear these words from an experienced clinician, believe them
“After this, there is no turning back. You take the blue pill — the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill — you stay in Wonderland, and I show you how deep the rabbit hole goes. Remember: All I’m offering is the truth.”
– Morpheus from The Matrix
Many physicians submit to a life of sterility and dullness — …
A good physician will never be out of a job
As an advanced heart failure and transplant cardiologist, I witness plenty of tragedy. But I don’t lay awake at night anymore grieving bad outcomes — that is the privilege and purview of loved ones. While family and friends may move through Elizabeth Kubler-Ross’ classic stages of grief, doctors do not have that luxury. To give tragedies a purpose, I take three steps when faced with bad outcomes: Separate fault from …
3 steps for doctors who are grieving
“I remember you,” said Gracie with the look of having found a long-lost friend. “You gave my husband the option to be treated aggressively in the hospital or return home with palliative care. He chose to go home.” I hesitated to ask, “How did he do?” Gracie went on to say that her husband had passed in the last month, yet lived nine months following our brief encounter in the …
Be willing to fail your patients
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. …
NP/PA vs. physician: Why is there a productivity gap?
In a matter of less than a decade, “shared decision-making” (SDM) has emerged as the uncontested principle that must inform doctor-patient relationships everywhere. Consistently lauded by ethicists and medical academics alike, it has attracted the attention of the government which is now threatening to penalize doctors and patients who do not participate in SDM prior to providing certain treatments, even if the legal process of informed consent has been …
Is there a case against shared decision making?
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 …
A return to the problem-oriented SOAP note
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 …
What is proper work attire in medicine?
It’s peculiar, I think, that we live in a time of physician shortage and yet some things remain abundantly clear:
1. Physicians can’t work together to fight, either for their own good or the good of their patients.
2. Like hostages, or abused spouses, they just keep going back for more of whatever bad policies they endure.
3. They are devalued.
Now, this isn’t about money. I’m not enough of a medical economics expert …
Being a commodity takes away the joy of medicine
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July is upon us again: that New Year celebrated only by those in the medical field. A time when medical students begin as doctors, interns become residents, residents become fellows and, basically, everyone in every position is one year less experienced at it than the person who held that position the day before.
This July marks the end of my first year of pediatric hematology/oncology fellowship. Finally, after college, grad school, …
A physician’s mistakes as a rookie MD
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 …
Medical students: Welcome to the wards
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 …
When attendings come to work rounds
Repercussions.
Every action that is taken, especially when it comes to healthcare, has ripple effects, which often end up being more far more significant than we anticipate, turning that ripple into a tidal wave.
Every time somebody besides actual health care providers steps into the mix and tell those of us taking care of patients that there is “something else that we have to do,” we often see it open up a …
Why are we treating outpatients like inpatients?
Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to their rural roots? The story of Prashant, a physician raised in rural Bihar, India, is …
The social determinants of a physician’s path
My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader.
Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a …
Guidelines, multiple specialists, and the science versus the art of medicine
When a patient is unwell and seeking help, a vast number of emotions could be going through their mind. Their whole life could have been turned upside down, they may have been fearing this moment for a while, and stressing over the implications of their illness. To physicians, it may sometimes feel like just another name on our list or almost become a routine mechanical interaction, but for …
Reading the body language of your patients
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