Safety in aviation has been compared with safety in healthcare. As the only physician in a family of career pilots, I think about this often. While the aviation industry has been used as a safety model at the systems level for healthcare, I have not seen any data comparing burnout between the two industries. I…
1 CommentIn last week’s blog post, I wrote a line that’s been stuck in my mind: “Shame, the ever-present companion of medical culture, once again getting in the way of an honest conversation.” Shame wasn’t the main topic of that piece, but I think my subconscious was telling me I needed to write more on it. I…
2 CommentsA memory from before the pandemic came to me the other day of a time when we gathered in clinic to witness patients’ bell-ringing ceremonies, signifying the end of their cancer treatment. I didn’t always make it to these. Often, I’d be with another patient already. But there was one, in particular, I’d set aside…
Comments closedRecently, one of my clinic patients 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…
Comments closedMedical oncologists often find ourselves needing to advise people who do not look or feel sick to take chemotherapy. This concept, of course, is what we call adjuvant therapy — using chemotherapy in healthy people as an adjunct to surgery to increase the cure rate from surgery alone. I’ve been thinking about the concept of…
Comments closed(on why anyone would choose to be an oncologist) Oncologists are often asked our motivation for entering the specialty. My standard response is to smile, and state that I followed a calling. But to explain that calling is a longer story that I’ve never shared. Twenty years later, here is my first attempt to do…
Comments closedupdate 11/2020: recipient of an Honorable Mention Award in the 2020 Writer’s Digest Writing Competition (print/online article category)! My patient is middle-aged, morbidly obese, with undiagnosed (until now) alcoholic cirrhosis, and a vaguely documented history of cardiac disease—per the chart “noncompliant” with medications. “Noncompliant” in this case turns out to mean he had no insurance…
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Spoiler Alert: Contains minor spoilers for the memoir “Educated” by Tara Westover “You seem very angry,” I say to my patient. It’s a basic technique in our physician tool chest, but I’d forgotten to try it—reflection. He hesitates. Surprise crosses his face. “I am,” he says. “But not at you.” I allow the space of…
Comments closedWhen I first turned to writing as a method to cope with the stresses of my practice, I had no knowledge of the field of narrative medicine. In fact, I had been through 4 years of medical school, 3 years of residency, 3 years of subspecialty fellowship, and over a decade in the practice of…
Comments closedIs the duty of the physician to capture the patient stories, or capture a billing code? In July 2018, the Centers for Medicare and Medicaid Services (CMS) proposed revamping Medicare payments for office visits. CMS plans to collapse Medicare fees for levels 2 through 5 office visits into a single price beginning in 2019, as…
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