Nothing compares to the apprehension of starting residency. OK, that’s not true, but it’s really high up there on nerve-wracking firsts. I remember my first day as a resident. In a matter of a few hours, I went from being human furniture to being asked to make life-altering decisions. I was overwhelmed, to say the least. Here are some pieces of advice that I wish senior residents would have emphasized before I started this ...

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In November of my intern year, I had trouble finding the sun. It was dark when I woke up for work, and it was dark when I headed back home. I'd picked up the service on the cancer ward from an intern named Bob, and he left me six handwritten pages on the subject of Jim Franklin. This was the deal: Jim Franklin, thirty-seven years old, was in the cancer ward ...

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A recent story in U.S. News & World Report described how a Seattle hospital is taking a systems approach in improving health care quality and cutting costs. It said, "Virginia Mason Health System ... has looked to adopt many of the much-admired and often-emulated business philosophies from Toyota." The best-known of those philosophies is the so-called lean methodology which is based on eliminating waste and focusing on things that add value. Attempts ...

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As a family practice resident, I've found that a premium is placed not only on my clinical acumen but also on how well I respond to my patients' mental and emotional experience of illness. Yet the work of learning to be a doctor is just that — work. (And in overwhelming amounts.) Time management becomes ever more vital: As I take the time needed to gently break bad news and to ...

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In a time when the deep divisions in our country have become increasingly apparent, I, perhaps like you, have been seeking hope. I supposed hope would come in the form of an enlightened article or a profound speech, but it did not. Hope came to me in the form of my patients. The division you have been seeing in our country is barely visible in the hospital. Here, patients are assigned ...

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OSH, or "outside hospital," is one of those abbreviations that has crept into the lexicon of hospital jargon that merits additional scrutiny. What are the implications of calling another health care facility “outside”; does that make your hospital the “inside” hospital? I suspect that it is, as many patient-related conditions are described, multifactorial. Or, if you like the band Fort Minor, “Remember the Name” (apologies to the band):

This is ten percent ...

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"If you do not cooperate, doctor, we will have no choice but to label you as being 'disruptive' and take whatever steps are necessary to remedy the situation." What physician does not dread hearing these words? Over the past several years, the term "disruptive" has been increasingly used to characterize and intimidate a physician who is perceived as not being a "team player." With hospitals increasing the difficulty in navigating a ...

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Not long ago, I overheard a frustrated hospital leader ranting about the poor performance of a physician. It was not that the doctor was screwing up surgeries, ordering the wrong drugs or missing obvious diagnoses. Actually, the physician was rather adept at healing his fellow man. The doctor’s failures concerned length of stay (far too long), sloppy medical records (incomplete, loaded with cut-and-paste) and a temper, which while not directly abusive ...

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I often avoid putting my politics on my sleeve, as I don’t want that to get in the way of our relationship. I want you to know that I treat you as a fellow human being, no matter your race, gender, sexual orientation. With the election results, what will change about how I treat you at the bedside? Nothing. I may know about your criminal past. I see that tattoo underneath ...

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Today I saw a news story about Walnut, an 18-year-old whippet in the UK, who had his last "walk" on the beach with his owner who had asked social media followers to join them. Shortly after that walk, surrounded by hundreds of family, friends, and supporters (human and canine alike), Walnut was put down. His last moments were spent as near to Heaven on earth as his owner could create ...

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