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, …
3 reasons why patients are unhappy
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 …
Here’s the secret to establishing a great physician reputation
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 …
When words mislead in the exam room
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 …
A Black physician’s perfectionism
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 …
The life cycle of emotion in medicine
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. …
A student’s volunteer experience at a mobile outreach clinic
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 …
Physicians should heal themselves first
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 …
Bloated notes are a huge problem and a time suck
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 …
Medicine is very much like driving. But don’t be a passive driver.
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 …
Training rural physicians is racial justice
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 …
When are we going to start talking about patients’ bedside manner?
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 …
The psychology of fear: How to use it to your advantage
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 …
My 10 Commandments of a Servant Leader
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. …
“Difficult” patients: Is it them or is it us?
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 …
The daily micro- and macroaggressions of being an underrepresented minority in medicine
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 …
Avoiding the pitfalls of integrating primary care into community-based mental health centers
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 …
How to be a “good girl”: confessions of an (im)perfectionist
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, …
A doctor’s life is absurd, but can it still be worth living?
I have been a physician for 26 years. I have been a fierce patient advocate throughout my entire career. It never occurred to me that physicians do not have the same rights of citizenship that the very patients I fight for do. I always thought I lived in a democracy. Medicine is not what it used to be. Articles relentlessly speak of physician burnout as though we are responsible for …
A physician applies to law school. Here is her application essay.
A guest column by the American College of Physicians, exclusive to KevinMD.
There is a tremendous amount of anger raging in our society today.
The profound uncertainty posed by COVID-induced cataclysms and the cultural, civil, and political unrest we’ve experienced over the past year has significantly skewed our sense of normalcy and well-being. Thus, responding with …
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