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Physician Visibility In Public: I See Patients, And They See Me

In the movie “The Sixth Sense,” there was that kid who saw dead people. I’m like that. But I see patients and their parents instead. They’re all around me.

They’re watching at the grocery store when my kids act up. We meet during anniversary dinners, at Christmas Eve service, and on the treadmill at the Y. I bump into parents when buying personal effects and even during the early morning coffee run in my oldest sweats. I see patients.

The follow-up dialog between the parents might go something like this:

Dad: “Marge, don’t you think Billy’s colitis might be better managed by a doctor capable of pulling himself together?”

Mom: “Don’t be ridiculous, Frank. DrV’s bedhead has nothing to do with his ability to care for Billy. And besides, I’ve heard that he can intubate the terminal ileum in under 10 minutes.”

It’s not that I necessarily mind being seen in the wild. I’m pretty comfortable in my own skin, even when it’s glistening after a workout. I’m bothered more by the fact that patients may be repulsed by my occasional bedraggled appearance. If I knew they were good with it, I might be less caught up with the whole matter. Read more »

*This blog post was originally published at 33 Charts*

When Doctors Raise Their Voices And Throw Their Weight

When we physicians don’t get our way, or don’t get the response we desire, we can be intimidating. I have seen this play out many different ways. I have been treated rudely by other physicians. I was once threatened by a very prominent one, who told me (in response to the fact that I dared question his tone): “Be careful son, you’re digging yourself a deep hole.” I don’t know what kind of hole, or where it would have taken me, but he was certain I was digging it. Oddly enough, I rather like digging holes. (Very zen.)

Physicians yell at one another, or curse. Physicians stomp around and slam down charts. I don’t like it at all. I think it suggests immaturity. I always tell students and residents that in the ER, especially, the physician is “Captain of the Ship,” and the Captain must never lose his or her cool.

But physicians, sadly, do the same to non-physicians. Nurses, in particular, earn their ire as they scream, curse, stomp and engage in all sorts of negative behaviors. It also happens to paramedics, unit secretaries, dietary workers, therapists, administrators and all manner of persons. Read more »

*This blog post was originally published at*

The Gift Of Being A Doctor: “What Are You Going To Do With It?”

I’m going to do something unusual: Reprint in its entirety a commentary from a fourth-year medical student, Jonathan. He posted it in response to comments from other readers to my blog about Dr. Berwick’s commencement address to his daughter’s medical school class.

I tweeted about Jonathan’s post, calling it a needed voice of idealism at a cynical time. This is what Jonathan had to say to his physician colleagues:

“To begin, I am a fourth-year medical student going into primary care and this directly applies to me. We have two options when reading [Dr. Berwick's] address. We can take, in my opinion, the weak road or the strong road. Our new generation, as well as the one that raised us, is one of apathy and selfishness. We are only concerned about how changes affect us. We have lost the sacrifice and the consideration of our patients and fellow staff. This address, no matter how hard your heart may be, springs up a humanism in you that is undeniable. You can choose to brush it off and make excuses about policies and money, or you can stand up and be the physician that is described. I agree that there are a lot of issues in medicine today (billing, paperwork, bureaucracy to name only a few). However, if those issues render you cold and uncaring, my friend, I strongly suggest you find another profession. This profession is one of nobility. It is one of selfLESSness. This is a high calling. A good book states, ‘To whom much has been given; much will be expected.’ Well, if you are a physician, much has been given to you. What are you going to do with it?”

Today’s question: How would you answer Jonathan?

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

When A Vacation’s Not A Vacation

I just got back from extended time off, which brings to mind a post I wrote two years ago:

Here’s an observation: most physicians in private practice don’t take enough vacations. I am often (rightly) accused of this sin. My staff, colleagues, and even patients regularly encourage me to take time off, but still I find it hard.

Why is this? Is it that I love my job so much that I can’t tear myself away from it? Is it that my self-worth is wrapped up in being “the man” for my patients, and being away from this makes me feel insecure? Is work my addiction –- the one place that I have control of my circumstances and positive reinforcement? Perhaps. But I think the reasons are more basic than that. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Should Doctors Go To Finishing School?

Thanks to KevinMD for pointing out a recent NYT article about “etiquette-based medicine.” The author, a psychiatrist, suggests that physicians should use a check list to ensure courteous behavior and that this sort of thing should be taught in medical school. His suggestions were also published in the New England Journal of Medicine:

• Ask permission to enter the room; wait for an answer.

• Introduce yourself; show your ID badge.

• Shake hands.

• Sit down. Smile if appropriate.

• Explain your role on the health care team.

• Ask how the patient feels about being in the hospital.

If this sort of thing isn’t intuitively obvious to a physician then I’d say the blame should rest with his parents not his medical school. I mean, do we really need to teach doctors to knock on doors and smile on cue? Aren’t those sorts of things taught in pre-school?

It grieves me that some of my peers do not display what some might call “normal behavior” when interacting with patients. But I don’t think that’s related to their medical school curriculae – it’s the sad result of a broken healthcare system that wears thin our common human decency. Doctors are exhausted by clinical volume, henpecked by bureaucracy, delirious from lack of sleep, and stressed out by the daily grind of bad news, disease progression, and death. When well-groomed adults of sound mind require a checklist in order to smile appropriately, you know something’s terribly wrong.

Now, I don’t excuse disrespectful behavior – we docs must rise above our natural urge to be irritable at times, and remember that our patients are vulnerable and need our help. But for heaven’s sake… let’s drop the smug check lists and finger pointing. We’re all in this together, and it ain’t pretty. 

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