Some of you may know that I started out in an internal medicine residency and quit for physical medicine and rehabilitation (PM&R). Switching residencies? Not recommended. But entirely doable.
I spent most of my first half of internship being really, really miserable. I remember sitting in the call room during my ICU month, talking to my mother about how badly I wanted to quit and what my options would be if …
Why I quit internal medicine for physiatry
I am three months into my medical residency, and I am getting fat. Not the noticeable change-in-pant-size fat, not yet. But I am most certain that what was once muscle is now just “padding,” and I can no longer solely attribute the words “muffin top” to the anatomy of the snacks that I scrounge to stay alive during the long hours in the hospital.
I am three months into my medical …
Medical residents need to be accountable for their own well-being
Virtually every medical school graduate immediately enters at least three years of post-graduate medical training (internship-residency). The exceptions are those who:
1. combine the MD with a JD or PhD;
2. leverage the not-yet-dry diploma into a post as health policy advisor to a state or federal legislator, usually one of Dad’s chums;
3. are named Michael Crichton.
Commencement is in late spring, so post-graduate training begins on July 1. Every year my surgery …
My first day as a surgery intern
As this is the season for spanking-new physician trainees to flood hospitals around the U.S., I decided to chronicle my own very first 24 hours as a doctor so the reader can get a better insight into this annual event.
2000 hours, evening before: With my newly starched white coat, stethoscope and light pen packed neatly into my Tumi man-purse, I make believe that I am sufficiently prepared for the first …
The first 24 hours of being a medical resident
It was a challenging transition, when I shifted from being a medicine resident to supervising medicine residents. There is much to be said about this shift (and similar shifts of ever-increasing responsibility at various stages of doctors’ training). The aspect on my mind at the moment is the role of clinic preceptor.
When I was new to the role and new to the clinic, I was paired with a more experienced …
The delicate balance of supervising medical residents in clinic
Would you rather your physician be an astute diagnostician or a compassionate and empathic practitioner? Of course, we want our physicians to be blends of these qualities. We want it all. We want them to be chimeras of Drs. House and Welby. But, is this possible?
I can’t say. I suspect that it is easier to cultivate soft bedside manners than it is to teach medical acumen, although the latter was …
Choose your doctor: Astute diagnostician or empathic practitioner?
While new doctors in Europe “enjoy” 50 to 60 hour work weeks, doctors in the US work up to 80 hours a week, and sometimes beyond that. But the situation is changing.
One year has passed since new limits on the number of hours doctors can work in their first job. For first year physicians, shifts are limited to 16 hours, and in other years, the limit is 28 hours.
There has …
Work hour reform is a moral imperative
Last week, I tried something new with our residents. We tried to talk about why physicians overuse tests. This is the topic of the moment, as the American College of Physicians (ACP) just dropped their long-awaited new High Value Cost Conscious Curriculum for what has now been dubbed the “7th competency” for physicians-in-training.
In addition to the ACP curriculum, which I served as one of the reviewers for, I also …
Teaching the cost of tests in medical education
I love being a medicine attending in the summer. It’s often more intense work since everyone’s in a new role. Bright, fresh interns. Excited new residents. And the medical students – the new third-year students who have toiled in the classroom finally get to focus on patient care.
Their enthusiasm over hearing a mitral regurgitation murmur, over watching a paracentesis, and, well, their enthusiasm over everything, is infectious. Perhaps it’s a …
Being a ward attending: A job I am so lucky to have
When I was a surgical residency program director, I often wondered what the establishment, you know those guys who ran surgical education, was thinking. Some may remember the rule that a resident had to see at least 50% of the patients he operated on in the clinic or the private surgeon’s office in order to claim credit for having done the case.
There was the emphasis that still exists today on …
Why do we teach surgery the same way we did 40 years ago?
“Dr. Fisher, can you teach our residents EKG lecture series?”
Naively, I said “Sure!”
What I didn’t realize is how hard this is to do today.
Much of this is not residents’ fault. They only have so many hours in so many days to attend lectures while caring for patients. Thanks to residency work-hour restrictions, those hours have become even fewer. To make matters much worse, through the year residents are torn to …
EKG reading: It’s shocking what medical residents don’t know
“Look left, look right”, our group leader told us. No, I was not learning to cross the street. Rather it was my first day of employee orientation at the IBM Software Lab over a decade ago. I was fortunate that our CEO was Lou Gerstner, arguably one of the greatest CEOs who has ever existed. Gerstner stepped into IBM in the early 1990s when the company was struggling. One of …
The first step to changing the culture in healthcare
Across the country, newly minted doctors have started their internships. The first night on call there won’t be an intern – anywhere in the country – who will sleep. Every new intern is absolutely convinced that the beeper is going to go off and they won’t know what to do. (You get over this by about the 2nd or 3rd call night, by the way).
Graduating from medical school …
Tips to be the best intern you can be
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June in the United States heralds the month when residencies end and new ones begin. While much will be written soon about the dangers of entering hospitals this time of year (this story never seems to tire with mainstream media), I would like to step back and reflect on why doctors should consider attending residency graduations. I had the pleasure of doing so recently.
Excitement. With all of the dreary news of …
Why doctors should attend residency graduations
“What about combined psychiatry-family medicine-neurology-internal medicine programs? Should I try to do a triple board program in psychiatry-child psychiatry and pediatrics?”
Every April, I field such questions from a slew of rising fourth year students who have become, to their surprise (and sometimes dismay), passionately interested in psychiatry. Psychiatry is a shortage specialty and psychiatric issues rank high among the challenges facing medical care systems here and around the world. For …
Should medical students consider a combined psychiatry residency?
I was recently asked to speak at hematology-oncology Grand Rounds at Rhode Island Hospital. Instead of my usual topics on gynecologic cancers or sexual health, my colleague, MaryAnn Fenton, had asked me to speak to them about promotion in academics. I was both touched and taken aback that I was now in a position to give that kind of advice. …
Always remember why you are a doctor
It’s been two days now since I basked in the glory. I still find myself floating above the ground. I can still feel the weight of the heavy gown and the velvet tam. I can feel the tickle of the tassel on my ear. My eyes fill with tears at the thought of my classmates – those who toiled alongside me – experiencing the same emotions. The reminders of our …
The selfless people in medicine are the people a patient never sees
When it comes to medicine and social media, much of the attention is negative.
Doctors losing their hospital privileges because of Facebook.
Or other health care workers taking pictures of patients and posting them on the web.
It’s no wonder that many hospitals are taking a heavy handed approach when it comes to their doctors and social media.
Consider this story, Doctors warned …
When it comes to doctors and social media, hospitals fail miserably
I recently wrote about the ways in which residents’ lives change dramatically during the transition to practice. For many, this transition feels like a complete 180.
I’m going to devote today’s post to introducing the concept of a “Life After Residency Alliance,” which is a group of people you can rely on for support, guidance and direction as you transition to practice.
The concept is taken from Napoleon Hill’s Mastermind Alliance, …
A Life After Residency Alliance to ease the transition to practice
The end of my residency and beginning of my practice was the most wrenching experience of my life. I was woefully prepared for the transition. Full disclaimer: I was trained many years ago when residencies were acknowledged brutal demeaning processes. Things have changed considerably, but the psychological passage I endured still holds.
I think my process of becoming a surgeon was fairly typical, with the exception that there was no one …
Medical school and residency aren’t places for human growth
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