As hospitals everywhere have been using every health care provider available to them in response to COVID-19, the specialty of hospital medicine has shown itself to be uniquely suited for coordinating the effort, to be the front of the frontline responders. I suspect that many people don't understand what "hospital medicine" is, even though it's larger than almost any other ...

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"I can't take this, doc. It's gonna kill me. I can't. I just can't," exclaims my patient with persistent refusal of his medication. My frustration is met with my patient care team's hesitation to give him the medication with fear of further conflict and possible escalation to violence.  But who's at fault? Any of us? All of us? My second patient, lying on the MRI table, shaking his head swiftly in ...

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It was a Thursday. It was supposed to be one of those “regular” evening shifts. Then, at 6:15 p.m., my first page went off: Bed 11, Mrs. R., Dr. H. needs to talk to you. The page came from the COVID section of the emergency department. I immediately called back. It saddened me when I learned that our patient was a young woman health care worker in her early 50s. She ...

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An excerpt from Doctors' Orders: The Making of Status Hierarchies in an Elite Profession. Copyright (c) 2020 Tania M. Jenkins. Used by arrangement with the publisher. All rights reserved. I met Trevor on his very first day of residency, at the start of three years of practical, ...

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One aspect of medicine that anyone who reads my work knows I’m most passionate about is keeping excellent communication at the core of health care. It’s a vastly under-taught skill, and although medical schools are certainly getting a lot better at teaching the fundamentals than they were a few years ago, there’s still nowhere enough reinforcement throughout one's medical career. It’s therefore easy for all of us to slip into ...

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Many people wonder what it’s like to be an intern and how to succeed during your first year as a physician. Is it really as bad as everyone makes it out to be? Are you able to sleep without constantly thinking about your patients and the diagnoses that you may have missed? Were you compassionate and empathetic enough toward the family of the patient who was dying? Did your attending ...

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July is a very special time of year in the medical community. We welcome thousands of newly minted physicians donning their spotless white coats and nervous smiles as they begin what will be one of the most difficult but also most rewarding and exciting times of their lives. Reflecting back on that first day as a brand new intern, I can’t help but think of how nervous I was over ...

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Every July, the same tired “new interns: be scared to go to the hospital” memes and jokes appear. I disagree. I believe that July is as safe as any other month to go to the hospital. July should be celebrated. Medical students and resident physicians are the lifeblood of our profession. Clinical physicians have never felt more exhausted, harassed, commoditized, and defeated by the “health care machine.” We need your eagerness, ...

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"We are in the midst of a crisis in humanity. While we are still dealing with COVID pandemic and its deleterious health, economic and societal consequences, our troubling past of racism and inequality is rearing its ugly head. The senseless killings at the hands of police, the shameful subjugation of persons of color, the systemic prejudice of a person based upon gender, ...

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We sat down at a sun-drenched table in an outdoor restaurant enjoying the fresh breeze while sipping on our favorite drinks. He is a man with immense talent, a slight frame, and the art of the skill in dissecting the arborized vessels away from his main focus during surgery. He is also one with a keen perception of absolute relations between right and wrong. He has the finely formed hands with ...

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When you are a week out from finishing your intern year, you start to feel pretty confident. When you are a week out from finishing your intern year, and you spent the last four months of it on a COVID floor in a major New York City hospital, you start to feel particularly confident. Whether you’re about to become a senior resident, with interns of your own, or about to ...

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COVID-19 has made the inadequacy of our public health and hospital-based health care system to identify, mitigate, and resolve pandemic disaster self-evident. Gaps in hospital-based preparedness capacity are abundant, including the inadequacy of stockpiles for personal protective equipment (PPE), ventilators, medications, lack of surge inpatient and ICU capacity, and an inability to rapidly scale testing or interventions to meet pandemic demands. The initial outcry placed blame on Federal and State governments, ...

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It’s 4:30 a.m. as I trudge to the parking garage with a sense of defeat. I am an internal medicine resident wrapping up a swing shift, the magnanimous buffer to admission responsibilities between the day and overnight ward teams. Though clinically tucking in patients that arrive before six o’clock is often easily accomplished well before midnight, this time had been different. Not two hours into the shift, I reached my ...

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Seven years ago, I took a hot yoga class in a packed studio, an R&B playlist bumping loudly, the woman next to me sporadically singing along with the music. Afterward, she smiled at me and said, “It was nice to practice with you!” I was new to yoga, and this was the first time I considered yoga as a practice, a word signifying a skill performed repeatedly in order to ...

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Two-paged signouts This was the picture of the unusually higher than normal patient load we have in the wards. The hospital looked grim and eerie. Gone were the days when we would start with morning report and see plastered smiles on colleagues’ faces, relaxed and ready to conquer the day. I saw patients without visitors. I’d hear rapid response teams more frequently – so I made a habit of memorizing ...

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COVID-19 has upended the medical community. Nowhere more so than in the intensive care unit. Life as an intensivist with two young children and a working spouse is never dull. I liken it to tight-rope walking with a pole for balance. I wake up every morning and balance the clinical responsibilities, teaching, reviewing journals, learning, school assignments, lunches, after school activities, bedtimes, repeat, repeat, repeat.  The balance remains just ...

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“I stayed up all night, and for what, $10 a consult?” A clearly exhausted and exasperated colleague and friend said to me one morning after his very busy call shift. As a chief resident, one of my roles is to manage the call duty schedule. As such, I frequently hear about how residents feel about call. Interestingly, many comments have to do with the economics of call: “It’s just not worth ...

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As I come to the end of my internal medicine residency, I cannot help but experience a flurry of emotions. I am sure many of you, like myself, are feeling a whole host of sensations: relief at the fact that you have now completed over 23 years of education/training; exuberant joy when you click on your schedule and realize that you have no more 28-hour calls; and sadness when you ...

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Imagine there are two individuals who have been admitted to a hospital due to COVID-19, and both desperately need ventilators. One is a 60-year-old with a heart condition, and another is a 63-year-old with chronic kidney disease. Because of resource constraints, you have to decide which patient will be able to receive a ventilator. Both patients’ families are looking to you to help their loved one through this illness. With ...

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One of the most memorable milestones in my life was my journey to becoming a doctor. A path that I look upon so fondly as it marks a time that molded much of who I am today. Charles Dickens describes my experience perfectly, “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness …” Like many of ...

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