Doctors

The Ultimate Patient Advocate

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Posting my piece written for Sermo, as a guest blogger on the Sermo Blog, April 13, 2015. Click on the link here (The Ultimate Patient Advocate)to see the original post. 

Adding the quotes to set the tone, though, as I usually do. The graphic is also my own photography, as with all of the pictures on this blog. Enjoy!

“Only one rule in medical ethics need concern you — that action on your part which best conserves the interests of your patient.” – Dr. Martin H. Fischer, German-American Physician and Author

“A physician shall, while caring for a patient, regard responsibility to the patient as paramount.” – Principles of Medical Ethics, American Medical Association

“I pledge to pursue the practice of surgery with honesty and to place the welfare and the rights of my patient above all else.” – Fellowship Pledge, The American College of Surgeons

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Laurel, North Andover, MA

Advocating for patients is a core value in medicine, in patient care. Our legacy as patient advocates dates back to Hippocrates in 500 B.C.E., codified in the oath and teachings that have provided the moral and ethical foundation on which the profession has been built. Even the Code of Conduct for the American College of Surgeons includes as its first principle, “Serve as effective advocates of our patients’ needs.”

Physicians fundamentally care for patients, their families, our communities. We advocate on the small, individual scale for each patient, and we advocate on the large scale for the entire population of patients and society.

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A Different Kind of Mentor

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This is my “mentor piece” that was written for the Association of Women Surgeons, and published on their blog April 22. 2015. Click here to link to the original post. The quotes and picture on this version are my own addition, like I always do. Enjoy!

“The greatest good you can do for another is not just to share your riches but to reveal to him his own.” –Benjamin Disraeli

“Have a little faith in me…” – John Hiatt

“If you’re lucky enough to do well, it’s your responsibility to send the elevator back down” – Kevin Spacey

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Swans, Rockport, MA

Mentorship in medicine and surgery was not always formally acknowledged and promoted. Today not only is it acknowledged and promoted, but also the importance of mentorship for professional development through the arc of a career is stressed. However, for many women, the one-to-one relationship of the classic mentor-protégé remains elusive, complicated by gender and generational differences. This has been especially true for the groundbreaking women before me, and for some remains true even today.

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Muted

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Smitty greets Sully as they meet to head to work, “Hey there, Sully! How’s your wife?” Sully answers, “Oh, geez. She’s up in bed with laryngitis.” Then Smitty says, “Laryngitis?! That damned Greek!”

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First cone of the season, West Boxford, MA

As you may have guessed, I am nursing a case of laryngitis, my voice muted and strained. This time, it has not stopped me from attending to my work responsibilities or other activities. It has required some adjustments though, as I squeak and growl and cough and sputter, my voice robbed of inflection and tone, and even volume control. It is an irony to have to strain my voice to repeat myself because of my strained voice.

I have had more severe laryngitis twice, one time a couple of months ago, another time several years ago. These were so bad, my voice so completely silenced, that I had to change both my operative and office schedules, not just to recover, but because it made my job impossible. We wear masks in the operating room which obscure our expressions and hide our mouths, muffling our voices just a bit; it can be difficult to hear and be heard even with functioning vocal cords. It is impossible if you can’t even manage a whisper.

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A Matter of Faith

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“Have a little Faith in Me” – Have a Little Faith in Me, John Hiatt

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Russian painted wooden Easter eggs

Spring ushers in major holidays in many faiths and religions. Western Easter has just passed, we are in the midst of Passover, and coming to the close of Holy Week with Good Friday for Eastern Orthodox Christians, making final preparations for their own Easter celebration.

The rites of spring and the vernal equinox, new life and rebirth are springtime themes and touchstones across many cultures. Faith is important to many people and across many cultures and religions. I would assert faith is even important to atheists and agnostics, and those without a formal religious tradition.

Faith is important in medicine, too. Continue reading →

Thoughts on Doctor’s Day

“Clowns to the left of me, jokers to the right. Here I am, stuck in the middle with you!” – Stuck in the Middle with You, Steeler’s Wheel

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Daffodil between the rocks, Spring 2014, North Andover, MA

Today is Doctor’s Day, established to take a moment to recognize and honor the work and contributions of doctors.

The first thing I read today was a message from current Massachusetts Medical Society President, Dr. Richard Pieters, who in speaking about Doctor’s Day reminds us all that the focus of the day is not just physicians, but the physician-patient relationship. The physicians of the Massachusetts Medical Society have declared that this Doctor’s Day we recognize “the basic principles that the doctor-patient relationship is confidential and sacrosanct.”

In his piece, which discusses this in the context of gag laws preventing physicians from asking about gun ownership and gun safety in the home, he emphasizes the efforts of physicians to focus on the patients and have unencumbered and protected conversations. It is impotent to protect both directions of these conversations—patient to physician as well as physician to patient. He further stresses the importance, and danger, of government laws, rules, and regulations that would insert themselves between physician and patient, silencing physicians or compelling them to include specific proscribed content.

I could not agree more. I would in fact go even further. Continue reading →

Friday Afternoon Rituals—Here Comes the Weekend!

“Party Weekend” – Joe “King” Carrasco

“Fight for Your Right (To Party)!” – Beastie Boys

“We Just Wanna Dance” – The Flirts

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Mom & Dad’s dog Sophia, too pooped to party…

My favorite radio station, WHFS, had a ritual every Friday afternoon to start off the weekend, back in the day. DJs Weasel and Bob Here would exchange pleasantries as they exchanged shifts, and would launch in to the same set of songs at the same time every Friday (with occasional additions). The songs above, as a matter of fact. These were selected to get your spirits up and blood pumping as the work week morphed into the weekend. It was a ritual which became a tradition for ‘HFS and loyal listeners, fondly recalled to this day, even though the radio station itself is long gone and the DJs dispersed. Every Friday I seemed to be in my car at just the right time, cranking up the volume, celebrating the end of my week and the coming weekend.

Doctors also prepare for Friday afternoons, bracing for a ritual of sorts. Any time after 3:00 it starts, lasting until well after the offices close and the weekday schedule transitions to the after-hours weekend routine. It is observed by most physicians, regardless of specialty, whether they practice in the hospital or in an outpatient office.

Suddenly on Friday afternoons, it occurs to people that the weekend will be starting, and the availability of the doctors and their offices, labs, imaging, testing and what-have-you will be limited. So all of the problems languishing in and out of the hospital take on a renewed sense of urgency, and must be taken care of Right Now, before the weekend hits. Nothing can wait another hour or day, and certainly not until Next Week (Monday)! Continue reading →

The Convert: The Doctor Embraces Social Media

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“Waaaah-Hoo!!” – Slim Pickins as Maj. ‘King’ Kong, riding the bomb in “Dr. Strangelove”

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St. Louis Cathedral, Jackson Square, New Orleans

I am converted. Like many doctors, I was very leary of social media, wary about using it, skeptical of its professional value. Especially Twitter, but really all of the platforms. No longer: I have embraced social media, and it has embraced me.

I feel a little bit like Dr. Strangelove, only the subtitle is now “How I Learned To  Stop Worrying and Love Social Media.”

Like most converts, I find myself an enthusiastic proselyte, spreading the good word to friends and colleagues, regaling them with my new-found experiences using Twitter, Facebook, LinkedIn and the like. Discovering more sites and platforms, like Sermo, Doximity, Docphin, and Medstro, to name a few. (Disclosure: I have no financial or other arrangement with any of these, but have written for both Sermo and Medstro, and am a discussion panelist later this month on Medstro). The list goes on and on, and keeps growing. Websites and apps abound; they all go mobile, so much content to explore. So much time to waste!

“Waste of time” is the most common and scathing criticism leveled at social media by my physician friends and colleagues who have not yet seen the light. Continue reading →

The Paradox of Physician Communication

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“Communication Breakdown, It’s always the same, I’m having a nervous breakdown, Drive me insane!” – Communication Breakdown, Led Zeppelin

“Oh why can’t we talk again? Don’t leave me hanging on the telephone!”  – Hanging on the Telephone, Blondie

Carriage line, Jackson Square, New Orleans, LA

Carriage line, Jackson Square, New Orleans, LA

I honestly don’t know how they did it, how doctors practiced and communicated effectively in the days before our modern technology, with computers, pagers, and cell phones (not to mention laptops, iPads and tablets, and smart phones), but they did.  All of these have been a ubiquitous presence my entire practice career; each has insinuated itself rapidly and completely into the lives and practices of physicians.  I think most physicians would feel lost or disoriented trying to practice without all of this technology today (well, maybe not pagers, which are phasing out rapidly as cell phones and smart phones leave fewer gaps in coverage).

There are so many ways to be in touch and in communication today, making us available at any time, in any place, limited only by the reach of our devices.

It certainly feels as if physicians live their lives constantly plugged in and available, all of our devices turned on even if we are off. We feel as if no time or place is sacred or spared, and must make it clear to others and arrange those times when we must be free from interruption. Even then, there is a barrage of communication that awaits us when we plug back in. There is an expectation of constant and uninterrupted availability. There is anxiety when the communication fails — a dead battery, or poor signal when we thought we were in a place with coverage — only alleviated when we are once more connected.

So with all of this ability to communicate, all of this technology, our electronic leashes keeping us tethered, why aren’t we communicating with each other? Why is our communication so ineffective? Continue reading →

Is There a Provider in the House?

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“I said Doctor, Doctor, Mr. M.D. – Can you tell me what’s ailing me?” – Good Lovin’, The Grateful Dead

“I’m a doctor, not a mechanic.” – Dr. Leonard “Bones” McCoy, “Star Trek”

“I’m not a doctor, but I play one on TV. ” – Chris Robinson/Dr. Rick Webber of  “General Hospital”

 

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Ceiling, Bellagio Hotel Lobby

I enjoyed an email exchange with a couple of long-distance friends the other day, Gina (an author and journalist) and Eric (a computer/IT professional), prompted by the follow-up questionnaire Gina received after her recent doctor visit and procedure. Throughout the form, it asked her to evaluate the various aspects of her interaction with her provider. 

This struck her as odd and funny, and we engaged in a generally humorous exchange. A couple of really serious points were made as well.

First, though, it made me think of a new game, playing around with words. Take any fictional character from books, film, television; any famous poetry, literary passage, or song lyric; any famous person or historical figure that contains or references the title “doctor” or “physician”, and substitute “practitioner” or “provider.” Dr. Who, Dr. Strangelove, Dr. Zhivago. Christ the Physician. Dr. Spock (both of them), Dr. Koop. Dr. Gawande. “Doctor, my eyes…”, “Doctor, Doctor, tell me the news…” , “Is there a doctor in the house?” You get the idea. Stilted, clumsy, and the result is often strange if not creepy. We can play the same game with references to the word “patient”, substituting “customer” or “client”.

But wait, we already play that game, it is a daily interaction, and we are getting shockingly accustomed to it. Continue reading →

Running Late: Confessions of the Late Doctor

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“I’m late! I’m late! For a very important date! No time to say hello, goodbye! I’m late! I’m late! I’m late!” – The White Rabbit, Disney’s Alice in Wonderland 

“Oh dear! Oh dear! I shall be too late!” – The White Rabbit, Lewis Carroll’s Alice in Wonderland

“Which form of proverb do you prefer Better late than never, or Better never than late?” – Lewis Carroll

“And it’s too late, baby, now it’s too late, though we really did try to make it.” – Carol King, It’s Too Late, Tapestry

Clock Tower, Mary Lyon Hall Mount Holyoke College, South Hadley, MA

Clock Tower, Mary Lyon Hall
Mount Holyoke College, South Hadley, MA

It is in the very words, running late. It is not walking late, or strolling late, or even meandering late. It is always running late, the phrase itself active, implying urgency and speed, rush and anxiety. The distress, just like the White Rabbit. The dash to the next appointment in a crammed tight, overfilled schedule.

Running late. It is the bane of doctors everywhere. I can’t stand it, I don’t think any doctor is happy when it happens. It is distressing, and feels unavoidable. I feel as if I can’t stop it, can’t prevent it.

It is almost to the point that I am amazed if I am ever actually on time. Office schedules overbooked to compensate for no-shows and to accommodate urgent patients, and operations are scheduled with an optimistic slant on the time needed. All of it collapsing with the first surprise, the extra problem, the emergency. The schedule so carefully crafted, like a house of cards, and just as vulnerable to come crashing down at the slightest perturbation, the tiniest shift. These shifts and adjustments snowball throughout the rest of the day, bigger and bigger, later and later, sweeping me along the avalanche path.

Run, run, run. Rush, rush, rush. Office to hospital, hospital to office. Continue reading →