I was sitting in the tea room out the back of the country hospital where I occasionally work as an emergency doctor, and we started to discuss the case of Dr. Hadiza Bawa Garba. Dr. Garba is a pediatric registrar from the UK who has been all over the news after being struck from the medical register for doing almost exactly what any one of us would …
The case of Dr. Hadiza Bawa Garba is a tragedy
Bruce Wilson, MD, is a hospice doctor and former cardiologist who was diagnosed with pancreatic cancer in February of 2017. In the months that followed, he publicly discussed events as they unfolded on a CaringBridge blog. The irony of the situation was profound: a hospice doctor being handed what some consider a death sentence. A physician who dedicated his career to changing the conversation about end of life care now …
Radical realism: A hospice doctor prepares for death
Apparently, I wanted to become a doctor since I was four. My mother tells the story of me getting ready for bed and simply saying: “Mommy, when I grow up I want to be a doctor so I can make people better.”
This notion stuck with me, and, luckily, I took a liking to biology, anatomy and all the sciences throughout school making my little four-year-old dreams come true. And now, …
When a patient dies, do you cry?
Recently, I wanted to find some inspirational articles for female doctors. This letter to the young female physician by Dr. Suzanne Koven was one of the first things I came across. I wish someone had written me a letter when I was young and dumb and entering internship. Maybe it would have been a good warning. I mean, I was clueless about what lay ahead. I …
5 lessons every woman doctor must learn
For the past four years, this is James Beck’s routine: After a morning spent guzzling $5 vodka, he stumbles into a Dunkin’ Donuts parking lot, lying on the cement with his dusty oversized coat splayed open to reveal a cachectic chest. A concerned patron (cigarette and coffee in hand) will call 911 and, in accordance with protocol, an ambulance will deliver him to our emergency room.
Upon his arrival, we unpredictably …
In tragedy, practicing medicine both an honor and a privilege
As part of my medical school’s inter-professional learning, I shadowed a hospital chaplain this afternoon. While physicians principally attend to the physical healing of patients, chaplains also fulfill an important role in health care: meeting the spiritual needs of patients. When faced with disease, patients often grapple with deeper questions about their illness beyond just what the diagnosis and treatment plans are.
Immediately upon arriving at the hospital, there was a …
The irony of me observing death on a day celebrating my birth
In my second year of residency, I was on the hematology/oncology service where we were taking care of a pleasant lady in her 80s who was admitted with pancreatic cancer. It was apparent that the disease had spread rapidly, and when we discussed her at rounds, we knew that she likely had a few months to live, at best. We also knew, however, that there were life-extending treatment options we …
A physician sees end-of-life care through a religious lens
After being prescribed opioids for just one day, individuals can face significant challenges with addiction, with six percent continuing to use opioids a year later, according to the Centers for Disease Control and Prevention (CDC). The likelihood of long-term use increases sharply after five days of use.
While much of the discussion around the opioid epidemic has centered on the challenges of opioid use and recovery, to get …
You’ve prescribed an opioid: Now what? 5 key strategies to prevent addiction
What if each doctor who interacts with medical students and residents acknowledges that they are a diverse group with their own inherent strengths and weaknesses?
Some residents will have mastered the knowledge within the pages of the textbook and can easily recite it during attending rounds. Others will have a natural bedside manner, making patients feel comfortable so that the admission history and physical exams are more complete. Others will be …
What if we treated physicians in training the way we want to be treated?
Lots of mergers have been announced lately, but there’s still one transformative merger that will define and reshape the U.S. health care market in 2018: the CVS/Aetna $69 billion deal announced last December.
CVS is best known for its 9700 retail pharmacies and 1100 walk-in clinics, but its most significant profit driver is its pharmacy benefits manager (PBM) enterprise — a middleman between pharmaceutical manufacturers and dispensers like drugstores. The company …
The CVS-Aetna merger is still the one to watch in 2018
Performance appraisals are an integral part of an organization’s assessment of employee and trainee standing. Management and human resource literature is full of analysis and debate regarding how to best rate subordinates. Regardless of evaluation system utilized, some of the common goals of individual appraisals are to monitor progress, identify areas for growth, set goals, guide development, provide and elicit feedback through open communication, and document issues that may require …
Influencing your resident evaluations for success
It is 3:30 p.m. on a Wednesday, and I am bringing my last patient out of the operating room. Everyone is in great spirits: a smooth case and an early finish at our surgical center. The patient has already awakened, stretching his arms, and clearly comfortable.
“Everything went alright, doc?”
I smile, knowing that I will be repeating what I am about to say a few more times as the anesthesia wears …
A doctor to a patient: Please call me when you get home
In a recent issue of the Annals of Internal Medicine, Terwiesch and colleagues propose “reimagining provider visits as the new tertiary care.” Initially, their arguments seem sound, even reasonable. Then, they conclude with this:
The conceptual change is to see every engagement with a clinician not as something to be celebrated but as a kind of failure — an inability to accommodate patient needs by any of …
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After a complicated stay in the hospital, my patient was finally ready to be discharged. After all he had been through, I was excited to tell him the good news.
“You will be leaving this afternoon,” I said, heartened by the smile I saw spreading across his face. He thanked me, and then said something that made me cringe.
“Finally! I thought you guys were going to keep sticking me with needles …
Are all of those morning labs really necessary?
As women in the medical workforce increase, women physicians are faced with the unique position of training the hardest they ever had in their lifetime cutting into precious childbearing years. Many women physicians seek time off or engage in part-time jobs to address the dilemma of fulfilling the obligations of their careers while enjoying the tender years of their babies. Others pursue non-clinical routes such as medical chart reviews or …
How to get back into the medical workforce if you’re a mom
Why are there vending machines in hospitals? This seems like an odd question to ponder, and it certainly would seem to have nothing to do with the current state of medicine and health care in our country. But it is a question that I am having a hard time wrapping my brain around. Certainly, most hospitals do have vending machines that sell snacks and soda, and they are by no …
Why are there vending machines in hospitals?
As I walked in the room, I noticed it immediately: Norman was worse. The recurrent invasive cancer in his neck was impairing the drainage of fluid from his face making it difficult for him to turn his head, and it had progressed overnight. Despite his alarming appearance, he seemed calm.
There were no more cancer-specific treatment options: the surgeons had declined to operate again; he had received maximum dose radiation; and …
You don’t know what your patient’s end-of-life wishes are
As a third-year medical student, fresh and green on my clerkship rotations, I was determined to stand out on my general surgery team. I knew this was not going to be easy; I was often the last item on many surgeons’ minds as they rush through morning pre-rounds at the hospital, flying around corners, their Nike sneakers squeaking on the polished white floors.
In the OR, I observed from the corner, …
The dark side of negativity bias in medical school
The ancient Greeks were one of the first groups of philosophers to recognize and describe the complexity of love. Eros: an intense, passionate form of love. Philia: a deep friendship or affection. Philautia: love for one’s self. Agape: an unconditional love for humanity.
These same complexities in love forms described by the Greeks play an important role in how we treat our patients in medicine.
Eros allows us to have the passion …
Don’t let burnout impact our ability to provide selfless love
This was a momentous week for me. After 14 years of carrying a hospital-grade old-school text pager to receive messages at work, I finally traded it in for a cell phone app. It should have been easy to get rid of my beeper. But instead, I felt waves of nostalgia when I turned it off for the last time. Those 240-character, pre-Twitter, low-resolution LCD messages follow the arc of my …
Farewell pager, I’ll always cherish the memories
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