In 1999, the American Board of Internal Medicine and Association of Program Directors in Internal Medicine defined a “problem resident” as a “trainee who demonstrates a significant enough problem that requires intervention by someone of authority, usually the program director or chief resident.”
A quiet, frail, emaciated gentleman in his 60s who was dying of cancer. What made him different was that he was shackled to the bed, one arm and one leg bound to the bed of a barren room, lit only by the pale blue light from the window that cast the silhouette of bars on the floor. This was the prison unit.
In order for the country to make meaningful progress in tackling the opioid epidemic, we need a cultural shift in the way patients and providers think about pain.
Pharmaceutical companies and physicians are being demonized for their manufacturing and dispensing of opioid analgesics. Money-hungry executives from Big Pharma caused the crisis by brainwashing doctors to prescribe these medications left and right. Greedy doctors want patients dependent upon them for years, ensuring a steady stream of paying patients in their waiting room. Drugs drive the market. Drugs lead to big profits for everyone involved. The more drugs, the better.
For most of our childhoods growing up in the Midwest, the Iowa we called home was a swing state proud of its investments in education, was welcoming to refugees from around the world, and was the third US state to legalize marriage equality.
Physician burnout has emerged as an increasingly concerning phenomenon in medicine. As high as 51% of physicians in a Medscape survey report symptoms of burnout. Doctors face higher demands with less time and support. Academic medical centers, which historically have been insulated from outside forces, are now seeing larger patient censuses, leaving less time for physicians to work through each patient’s case carefully.
“Locker room culture” is a common trope that has been used to describe medical community of the recent past. Current practitioners will say that culture is, unfortunately, still prevalent.
Just like many Americans, Teresa is a busy mother-of-two with a lot on her plate. When her four-year-old daughter fell ill with the flu, she was grateful that the Child Health Insurance Coverage (CHIP) their family relies on was recently reauthorized in January after four months of funding limbo.
It seems that each week we learn of a new mass shooting. Gunfire from a legally-purchased AR-15 assault rifle hits innocent high school students, nightclub patrons, and mall-goers. A politician reassures the nation that our brave first responders are bringing the victims to a nearby hospital. The media’s report to the public generally ends, but when I hear “trauma team to ED STAT,” my work only just begins.
Every job is different, but my experiences so far have drawn a very stark contrast to life as a resident. Now imagine, if you can: you stroll into work at whatever time you want. You round on your patients, write notes and leave. The rest of the day you give verbal orders over the phone while you hang out at the beach.
On night shift as an OB/GYN resident, you are not the same person you are when you’re among the living. It might be the long hours, the lack of sleep, or the darkness creeping in from the windows, but your temper is shorter, a pager sounding sends you over the edge, and simple nursing requests leave you sour.
I’d like to share a true story of my experience with the on-call surgery resident shortly after my first breast cancer surgery.
“How are you doing this morning, Mr. Tracy? Sorry we’re running late. You’ve been waiting an hour.”