Doctors have a few dirty little secrets. We have the highest rates of suicide amongst all professions and are in desperate need of mental health reform.
For those who don’t know what it’s like to work in this area, it can be difficult to understand the pressures that doctors face daily.
Doctors live their lives balancing an intense workload with long hours, often without any time for themselves or their families. Many …
One of my clinic patients recently asked me to administer his intramuscular medication injection. I appreciated the vote of confidence but had to tell him he was mistaken in thinking that my skill would surpass that of our nurses’.
“Trust me,” I told him. “You’re in better hands with them.”
It reminded me of the time, some years back, when I inadvertently found myself “impersonating” a nurse for a school field trip. …
When I’m working in the hospital, I always find it interesting talking to patients about their medical history and experiences with outpatient physicians. I recently wrote about our broken primary care system. In fact, I’ll be stronger than that: Our primary care system is a tragedy, and it’s reflected in the comments I receive from patients. This is despite the best efforts of an amazingly dedicated number of doctors, …
Summer marks a flood of young new attendings hitting hospitals all over the country. There will also be many doctors whose first contract is coming to an end, and they are moving to a new position. Both of these scenarios create an opportunity to make a first impression at a new job. The effects of that first impression will linger for years to come.
What lingering effects do you want to …
Words can be misleading. Medical terms work really well when shared between clinicians. But we can’t assume our patients speak the same language we do. If we “run with” whatever keywords we pick up from our patient’s chief complaint, we can easily get lost chasing the wrong target.
Where I work, along the Canadian border, “Valley French” expressions tripped me up when I first arrived. The flu, or in French, le …
Since I was a child, I have been plagued by words and thoughts (spoken and unspoken) that said, “You are not good enough.” I remember this very vividly as I walked into my new school as a fourth-grader in rural Ohio. I was so excited to start a new school, as I had always enjoyed learning.
As I walked into this elementary school, something felt vastly different. I quickly realized that …
Interviewing for medical schools was intense, excruciating, and terrifying. Despite the difficult questions, there are three that stand out to me. The first was to differentiate sympathy from empathy, where I spent 30 minutes defending my answer to be met with complete silence. He could have asked me anything, yet he sat in silence for almost my entire interview and asked me to explain emotional differences between two incredibly similar …
In my junior year of high school, I applied for and went on an educational mission trip to the Dominican Republic. Being the son of Uruguayan immigrants, I felt at home in the rural setting while my many classmates marveled at their first view of a culture different from theirs. On that trip, my ability to fluently speak two languages formed a common ground on which I could build relationships. …
I was trained in delivering bad news.
I knew what to expect.
I knew the questions that would come.
I have learned the stages of grief.
More importantly, I had done this before many times in the past 15 years.
This is my job and my responsibility, I told myself.
I got to work earlier than usual, diffused some comforting essential oils, and did my routine 10-minute morning meditation. Then I slowly sipped my tea and …
In a moment of caffeine-depleted delirium, I volunteered to head the creation of a “notes committee” for my 80-member hospitalist group.
I placed myself on a 72-hour hold and quickly established a group consensus: “Bloated notes are a huge problem and a time suck. I’m glad you [rather than me] are working on this. My notes are fine, though. It’s other people’s notes that are bad. Other people’s bad notes are …
Medicine is very much like driving. As an emergency physician, when you see a patient, you ask the same questions, “What brought you in today? What’s bothering you?” and go through the normal flow of the history and physical. You order the same labs and imaging reflexively. When you’re driving to a location that you’ve been to many times before, when you get into your car again and turn the …
Training physicians to serve in rural areas is a vital piece of modern medical education. It’s also frequently overlooked. Most medical education institutions are in cities, because cities allow us to concentrate the learning opportunities: the specialists, the large hospitals, the high patient volumes. This creates an automatic, unintended bias among doctors—the idea that to be a good doctor, they need to practice in a city. After all, don’t you …
For years the trend has been a continued critique about physicians and their bedside manner, or lack thereof. It is an important topic as we have moved from a time of paternalistic care to a collaborative model where patients and doctors work together to improve wellness for each individual. This is a patient-centered model, so that autonomy and lived experience is taken into account when making medical decisions. These …
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Fear is something that most of us have felt at one time or another. That feeling of being threatened, when you feel as though your current state is in jeopardy. It’s an instinctive reflex to flee or fight the threat. This instinct has been with us since our earliest moments on earth. Fear can be seen as a driver, too: that force that pushes us into making changes and responding …
I have seen great leadership and bad leadership. As a leader, I have also made my share of mistakes, and I am sure I will make more. When I do, I will immediately take ownership of it, learn from it, and do all I can not to make the same mistake. However, there will be times I may not recognize my failure, as can happen with any leader. This points …
It was past midnight in the ED, and she was writhing on the bed, palms clutched over her abdomen. I pulled up a stool, notebook, and pen in hand. I was ready to listen to Mrs. Walker’s story. But I also felt a sense of dread rising: From a quick chart review, I knew that Mrs. Walker had 23 negative CT scans for abdominal pain within the last 18 months. …
I sat in a crowded auditorium listening to an attending at a renowned medical institution give a lecture. I didn’t know the answers, and shrouded in imposter syndrome, I avoided eye contact. The visiting medical student from Mexico answered the question, and the attending moved on. Another question came. Again, the medical student from Mexico answered. The attending chuckled and said, “OK, Cinco de Mayo,” an exaggerated emphasis on the …
Providing primary care to patients with mental illness is a challenging task that requires highly skilled and experienced practitioners comfortable with the full array of biopsychosocial problems with which these patients present. For example, understanding the side-effect profiles of psychiatric medications and their impact on problems such as diabetes and other complex endocrinopathies requires highly evolved clinical skills.
Optimally, the successful care of these patients is best provided in close collaboration …
Indian parents are perfectionists. This is what I had come to understand and believe, even before I had the vocabulary to define it. Perfection was the expectation. Not excellent, not superb, but perfection, and only perfection. After years of reflection, I don’t take issue with the expectation of perfection, but, rather, how I perceived it to be defined for me — a well-behaved, beautiful and academically successful girl who does …
I will speak for myself to say that I completely identified with, and fully agree with, all the sentiments shared by Dr. Klingberg in “A breakup with primary care.” Still, from my own life experiences, and a 30-year career in primary care solo practice, I have been forced to believe that these sentiments are ultimately narcissistic and self-destructive.
Yes, primary care medicine has become thankless, oppressive, cruel, …
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