Physician Heal Thyself

Let's face it, as physicians, we make the worst patients! I don't have high blood pressure! Eh, I'll go on a statin next year. My blood sugar isn't that high! Let me put off my colonoscopy until next year. And I'm not any better! For years I was struggling with fatigue. I blamed it on everything else outside of me—my job is too stressful, I have to wake up too early, I was on call, etc. And for years, my wife kept urging me to get a sleep test. There's no way I have sleep apnea, I reasoned to myself, I'm not overweight, I exercise daily, and I don't snore (at least not that badly). Finally, when I could take the fatigue no longer, I acquiesced and got my sleep test done. After the test was over, I felt stupid! There's no way I have sleep apnea! What a complete waste of time! There goes a hugh deductible thrown out the window. The next day, the result came back: I stopped breathing over 80 times that night!

Wow!

Yet, in a way, I was totally relieved! There was a possible cure for my fatigue. The first night I started using the CPAP machine, my brain started making up for years of lost sleep!—I had a crazy and vivid dream about standing on an cliff beside a frothing ocean teaming with sharks. It was so cool! That's when I realized that this was my first dream in years! YEARS!

Now I'll admit it... Using a CPAP machine is not the world's sexiest thing. But, since I am a Star Wars fan, there is something really cool about looking like a Kotobukiya Star Wars TIE Fighter Pilot! And beside, my kids dig it (and I like to chase them around the house with my mask on).

Of course, I'm just exaggerating—the mask and machine are much smaller than I anticipated! Frankly I was shocked by how far technology has come. And the CPAP machine is no bigger than a "breadbox" (whatever the hula hoop that is). It's a cinch to take on vacations.

So the take-home-message for me is this: Physician heal thyself! Before I can heal others, I need to work on healing myself first. 

So good night and pleasant dreams! Oooooooooo... SHARKS!!!!  

What to say to a patient after a miscarriage?

What do we say to a patient after a miscarriage?

1. You didn't do anything to cause this miscarriage...
2. You didn't do anything to cause this miscarriage...
3. You didn't do anything to cause this miscarriage...

Then...

Listen and weep with the patient.

(Or something like that)

Direct Patient-Care Face Time (DPCFT)

Most doctors see one patient every 15 minutes. The economics of our medical system dictate this. In order to pay salaries, malpractice, benefits, rent, electricity, and general supplies, we needs to see patients at this pace. But what does that mean to us practically in terms of time management? Let's think about it... Because we all have responsibilities outside of our direct patient-care face time (DPCFT)—typing up a SOAP note, filling out prior authorization forms, reviewing home nursing orders, answering telephone messages from patients, refilling medications from pharmacies, reviewing notes from specialists, reviewing labs from the prior day, calling patients, doing referrals, and so on—those 15 minutes of DPCFT really get cut down to about 10 minutes. TEN MINUTES! That's all we get folks! No jibber-jabber here! No shooting the breeze about Mrs. Johnson's grandson. Although we want to spend more time talking about family, fishing, and fun with our patients, the truth is that we don't have much luxury to do so. And this can be stressful!

So here are three imperfect solutions that I have come up with:

1. Just run late—Honestly, I'm not good at this one. My patients expect to see their doctor on time (since I'm usually on time). But every once in a while, it good to throw efficiency into the wind, take a deep breath, and truly enjoy looking at Mrs. Jone's photo album of her pet pig (true story). 
2. Schedule 30 minute appointments—I judiciously set up 30 minute appointments. They offer a breather for me with complicated followup visits. But obviously, if I set up too many 30 minute appointments, I will not be able to pay for the overhead of our office. 
3. Split up the visit—I do this especially if the patient has multiple complicated medical problems. I often feel like a heel for doing it. But patients are generally understanding. 

Other than those three tips, I can honestly say that I don't know how to increase my DPCFT. People are constantly complaining about how the U.S. medical system is broken. And from my perspective, the most broken aspect of medicine is that I have so little time with my patients. In a traditional practice, doctor who only see 2 patients an hour get themselves fired for being unproductive or bankrupt for not meeting their overhead. It's a strange predicament that we are in.

Surviving Medical School Tip #2: The Last Graduate

QUESTION: What do you call the medical student who graduates last in his class?

ANSWER: Doctor

This is not an excuse for slacking. But there is something amazing to be said about simply graduating from medical school. Also, there are some doctors who graduated from the top of their class who I would never refer my patients to. And there are others who graduated near the bottom who are intelligent, conscientious, and excellent physicians. It goes to show that MCAT scores, medical school grades, and board scores do not solely define a good doctor. Non-quantifiable traits such as common sense, a good bedside manner, being a good listener, compassion, the ability to set firm boundaries, discernment, organizational skills, communication skills, and integrity are arguably as important as medical knowledge in the making of a good family doctor.

Surviving Medical School Tip #1: The 90/10 Rule

Medical school is like drinking water from a fire hydrant. Way too much information! And the worse part is that, without any clinical experience, trying to separate the wheat from the chaff is nearly impossible. Is memorizing lipid metabolism important? Will I ever needs to read an electron micrograph of the basement membrane in the future? Will I ever need to know how many ATPs are produced by 4 rounds through the Kreb Cycle? In a word... no!

If you are a medical student, remember this: 90% of the stuff that you learn in the first two years of medical school, you will eventually forget and never use again in clinical practice (this is assuming, of course, that you are going through a 'traditional' program). The other 10% will be drilled and pounded into your brain ad nauseum until you learn it. Your clinical rotations during your third and fourth years (and your residency and thereafter) will provided that "pounding". 

When I was a medical student (a long time ago), I use to get stressed out because I couldn't retain all the information that I learned in my basic science courses. But as I moved from medical student to resident to attending, I slowly realized that almost everything that I needed to know was reinforced over and over and over again—and I didn't need to learn and retain everything with the first try. So take heart, take a deep breath, and do your best to enjoy learning about the wonders of the human body.