Do physicians in training take better care of patients or perform better on their exams when their work hours are restricted?  Two recent studies in the Journal of the American Medical Association suggest that the answer is no.  In one, patients of surgery residents showed no difference in morality or postoperative outcomes after duty hour restrictions were implemented.  Their test scores did not improve either.  In the other, hospitalized Medicare ...

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A while ago, I wrote about a medical student whose school tried to dismiss him just prior to graduation for unprofessional behavior. A judge ruled that the school could not do so because it had tolerated some similar behavior earlier in his medical school career and had not considered it important enough to mention in his letters of recommendation. In that post, I said, "'Professionalism' is difficult to define, especially when trying to ...

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You’ve made it. Four years of college, four years of medical school, and three years (sometimes four or five) of residency, depending on the specialty you chose. You’ve earned a prestigious title. You are a doctor. But wait, you are not done yet. Want to be a cardiologist, oncologist or gastroenterologist? Add another three years to the eleven spent to become an independent practitioner. Another three years of interest rate on that six ...

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He was known to the hospital as someone who would try to manipulate his caregivers. And I fell for it anyway. Frequently admitted for pain crises associated with a chronic illness, he spent most of his hospital course avoiding eye contact with the team. So, too, were avoided answers that involved more than a few words. Providing care for him was business-like; we knew better than to expect pleasantries. The day of ...

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In our transition to medical school as first-year medical students, one significant part of our learning has been adopting the dress of the medical profession. Twice a week, in our first-year practice of medicine course, we wear professional attire and don our white coats, the famous symbol of the medical profession. As we learn how to interview and interact with patients, the white coats encourage us to fully embrace our ...

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Despite the changes around us, the training of physicians has stayed much the same. Sure, there are new work hour limitations and a push to move towards competency-based assessments, but the overall structure of our training remains largely untouched. We spend the vast majority of our time training in hospitals, with the remaining time spent practicing in traditional outpatient clinics. However, health care is being increasingly delivered outside these two arenas. ...

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The issues around race and how it plays out in modern day American society are numerous, deeply personal to many and utterly complex to most. The incidents in Ferguson, Mo., which began in August and erupted late November in nationwide protests, are an example of the many problems with race relations that persist in our country. While I believe we have made significant progress since the civil rights movement began, ...

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“All of you want to help people and save the world now. But, by the end of medical school, only two of you -- if we’re lucky -- will remain idealistic.” Within the first three days of medical school, I had heard three different lecturers tell me that I would lose my compassion and empathy. By the end of the first three weeks, that number had grown to six. During the ...

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I'm on my family medicine rotation right now.  One of my preceptors is about 80 years old and went through medical school in the 1960s.  He is still sharp as a tack; he used to do C-sections, hernia repairs, appendectomies, fracture repairs and get this -- emergency burr holes for subdural hematomas (a.k.a. neurosurgery).  He stopped around 1997, mostly because he got tired of his morning cases getting bumped constantly ...

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As part of the second-year clinical skills course, each member of my class is required to complete two 8-hour emergency department (ED) shifts. I had my first ED shift last week, and when I walked in, I introduced myself as a second-year medical student who needed to practice IV placements, EKGs, and any other procedures that happened to come my way. Three hours later, when I walked out of the ...

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