No medical resident looks forward to working night float. The initial glamour of doing chest compressions in the rising light comes up against a litany of administrative tasks. As the glamour wanes, the gulf between the objective curriculum and actual practice widens. On paper, residents learn how to manage acute emergencies and learn deeper clinical reasoning. Actual practice, or the “hidden curriculum” of training, can be a different experience, involving ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is hospitalized for treatment of community-acquired pneumonia. Despite 4 days of treatment with intravenous fluids and antibiotics appropriate for the bacteria cultured from sputum and blood, he remains febrile with mild tachycardia. The patient subsequently develops mild hypotension and is transferred to the intensive care unit. Results of two ...

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Why do physicians behave badly? Maybe because theyre scared. A dozen set of eyes stared upwards.  The nurses ate their pizza and glanced back and forth between me and the dry erase board that I had recently filled with incomprehensible scrawl.  I had given this lecture many times and said the words over and over again.  And yet the response was always surprising. "Why do you think physicians get angry and ...

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Anyone from outer space reading the news and watching TV would think that the U.S. has some of the worst health care possible. The negativity appears to be pervasive. Controversy over this, outrage over that. Whether it’s inadequate health outcomes, policy debate, or scandals with patient care, the stories and discussion abound. As someone who grew up and went to medical school overseas and then came to the U.S. for medical residency (along ...

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I have never experienced a military boot camp.  I have however completed a rather intense three-year residency in internal medicine followed by another grueling, three-year fellowship in pulmonary and critical care medicine.  I like to think that my experiences were not unlike those of military training. As a matter of fact, being on the medical wards at the county hospital was referred to as being, “in the trenches.”  It was true.  ...

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I performed my first paracentesis in November of my intern year.  It was 3 a.m., and I was on overnight call in a packed ICU.  The patient, a 45-year-old male with hepatic encephalopathy, was hardly alert enough to remember my name.  He didn’t know I was an intern.  He didn’t know I’d never even attempted a paracentesis before. After I finished, I added the patient’s name to my procedure card.  I hurried to get an ABG ...

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November, 1999 was a watershed for physicians. It is then that the infamous "To Err is Human" report was issued by the Institute of Medicine claiming that close to 100,000 patients were needlessly dying due to preventable medical errors. The report was a bombshell, having a significant impact on how medicine was practiced. 15 years later we are still evaluating that impact. To anyone who took the time to read the ...

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July as a newly minted intern: It was the best of times, it was the worst of times. The only analogy I can make is you feel like a middle school kid sitting in a PhD course, desperately trying to back-learn everything in a language of acronym alphabet soup you've never heard before. If medical school is drinking from a fire hose, this is trying to sip from Niagara Falls. You have ...

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Working the night shift as a resident physician You’ve changed. No longer do we see you sluggishly walking en route to work every morning with refillable coffee thermos in one hand, robotically scanning some kind of social media feed with the other. We are concerned that the regular and cyclic day time group texts received from you are now occurring at odd hours of the night.  Your persistence to move ...

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I get it. It is a little strange. In fact, some people even think I’m crazy. Why? I’m a physician, but in my free time, I love helping my colleagues improve their patient satisfaction. Lately, I’ve spent a lot of time discussing a patient satisfaction survey known as CG-CAHPS (Clinician and Group Consumer Assessment of Healthcare Providers and Systems). I’m sure it doesn’t surprise you to learn that CG-CAHPS is ...

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