My last admission on my last call day of the year; only one patient stands between me and freedom. Freedom from the endless calls. Freedom from self-doubt and anxiety. Freedom. She sits propped up in the ER bed, her husband dutifully by her side with encyclopedic knowledge of her long medical history. She is visibly weakened by the daily fight, yet her smile remains radiantly defiant as if to announce: “I’m ...

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Your brain is a three-pound hunk of biological tissue. And though it’s nothing more than a conglomeration of specialized cells, it generates the taste of cheesecake, the ecstasy of enchantment, and the misery of suffering. Amazing, right? I certainly think so, though I find myself among a shrinking minority. Whereas the eyes of our medical forefathers were turned toward the heavens in search of answers to seemingly unknowable questions -- ...

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My hospitalist medical group consists of as great collection of atheists, agnostics, and skeptics as you will ever find.  But we all agree that quality is our religion.  We believe to our last breath that patient care is sacred and an invaluable gift.  And so, as with all faith, there is no halfway.  You believe, or you stand around scratching your head asking what those other fools are worshipping.  Just ...

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"Management's overall aim should be to create a system in which everybody may take joy in his/her work." - W. Edwards Deming "Your skin is not thick enough to hear me yell for even ten minutes!" a 92-year-old patient's family member shouted at me while attending a care plan meeting. I was soon asked to leave the room left with case manager, social workers and mid-level managers. Later that evening, as I claimed ...

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I was approaching 24 hours in the hospital and waiting for my partner to come into my operating room so we could do “hand-off." That's when I spend 15 minutes going over all of the events of the surgical case and explain my patient’s health history, his current status, my current treatment strategies, the heart ultrasound findings, and our plan for the rest of the case. As I was awaiting ...

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Every time I walk into a bookstore, I pass Paul Kalanithi’s When Breath Becomes Air and am reminded of a specific anecdote he shared. Kalanithi, MD, was a seventh-year neurosurgery resident and his lung cancer had metastasized – a process which was only being controlled by a new drug his oncologist had decided to try. But one day, Kalanithi had severe nausea and had to be hospitalized to stay hydrated. A ...

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I receive a significant amount of email in response to my blog posts about locum tenens work. Curious colleagues (from surgeons to internists and emergency medicine physicians) ask for insider insight into this “mysterious business” of being a part-time or traveling physician. I am always happy to respond individually, but suddenly realized that I should probably post these conversations on my blog so that all can ...

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Without question, the interconnectivity created by social media is a plus when it comes to talking about physician burnout, suicide and policies affecting our practice of medicine. We are no longer in independent silos with the surgeons suffering in one corner and pediatricians elsewhere. Physicians are no longer isolated contemplating if what they are experiencing is just unique to them. We are developing collective voices. It is incredible to believe ...

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Throughout training, I had an idea. And that idea was — I would be a great academic physician. I had the right training. I had done research from college through fellowship. I had received research grants from medical school through fellowship, published numerous papers and started defining a niche. Everything was going great. Academia — here I come! Then attending-hood arrived. I looked for positions in academic centers. I was limited by ...

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Illness is a disappointing and frustrating time. Nothing could be worse than a sickness which suddenly jolts you out of your daily routine, and forces you to confront a harsh new reality. That’s something that physicians should always remember as they go about their hectic work days. Doctors see patients at extremely low points in their lives. The vast majority of physicians, and indeed all other health care professionals, are among ...

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