Two physicians, through dialogue and interviews, take a critical look at medical training and the culture of medicine and explore how interpersonal boundary clarity and the capacity to fully engage are essential to effective medical practice, mentoring, medical education, and a nourishing career. This podcast builds on Dr. Weiner’s book, On Becoming a Healer: The Journey from Patient Care to Caring about Your Patients (Johns Hopkins University Press, 2020). Hosted by Saul J. Weiner MD, and Stefan Kertesz MD MSc
Medical Student Mistreatment: A Wicked Problem
43:08How is it that a healing profession -- medicine -- has such a deeply ingrained culture of harming its own? And what can we do about it? In this first of two back-to-back episodes on medical student mistreatment we consider the scope of the problem and attempts to confront it. We hear from one medical school that, with external funding, developed a program with online resources available to any school that are designed to foster discussion and self-reflection among all stakeholders: attendings, residents, students, and other health care professionals in the ecosystem. We share here links to resources and papers discussed in the episode: #MDsToo: A student mistreatment prevention curriculum for faculty members and residents - PubMed (nih.gov) To access the UC Irvine video series JAMA IM paper Eradicating medical student mistreatment: a longitudinal study of one institution's efforts - PubMed (nih.gov)
Uncommon wisdom from a family physician and medical educator
33:00Simon Auster, MD, was a family physician, psychiatrist, and medical educator who had extraordinary insight about practicing medicine but absolutely zero interest in drawing attention to himself. His students and patients had the good fortune of having him as their teacher or doctor but far too few have benefited from his wisdom. Today we discuss some of Simon's saying's -- "Simonisms" -- that are remarkable because they are not the usual cliches one hears. Some challenge us to reconsider our assumptions. We share and discuss them because we believe they can help many doctors, those in training, and those who train them find more joy and meaning in their work. You can learn about Simon in an online (open access) essay about his life, published in The Pharos, the journal of the AOA medical honor society.
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Challenging Questions to Help Physicians Reflect, Grow, and Find More Joy Practicing Medicine
43:27Medical training and practice habituates physicians to a culture that narrows the possibilities we see for finding joy and meaning in our work. We often become efficient task completers, stuck in routines, and prone to burnout. Saul and Stefan discuss a set of questions that challenge physicians to look at their work and themselves in fresh ways, can be used for mentoring or teaching purposes, as prompts for reflective writing exercises, or to engage thoughtful colleagues (perhaps over a beer). 10 Questions (selected from On Becoming a Healer: The Journey from Patient Care to Caring about Your Patients) Think about a brief account of a patient interaction you recently had in which you think you functioned as a healer rather than just a task completer – meaning that you were able to help the patient beyond the narrowly biomedical aspects of care? Was there something you learned from this visit that you could apply more broadly? Think of interactions with patients that are rewarding and meaningful? Are they rare or common? Can you think of a specific one? Was there something you did differently that made the encounter memorable? If so, can you think of ways you could modify how you practice and interact with other patients so that more of your interactions are as satisfying? Do you see yourself as someone friends turn to when they are in distress or need guidance? If so, what is it that you offer them that enables you to be such a valuable resource? Is that part of you accessible to your patients during medical encounters? Can you think of an example? If not, why do you think that is? If you couldn’t be a physician, what would you most want to do instead? How would it be similar or different from what you have sought in a medical career? Can you draw connections between your second choice and medicine to gain perspective on what you most love to do? Assuming you stay in medicine, how can you be sure you are most likely to find it? What’s happened to your curiosity during medical training? What are you more curious about? What are you less curious about? Specifically, what questions do you find yourself asking or wanting to ask as you go through the day? How do you think your curiosity or lack of curiosity affects how you relate to and care for your patients and how you feel about your work? Do you feel your patients are benefiting from the distinct qualities that make you the unique person you are, or is that uniqueness not really a part of the way you relate to them? Do you feel you are interacting with patients in a manner that gives you a window into what makes each of them unique? Are many of your interactions rewarding? If so, in what ways? Are there certain types of patients who “get under your skin,” making you cringe when you see their names on your appointment calendar? Consider what might be going on during your interactions with them, utilizing the framework described in this chapter. Is it that you can’t engage with them? Do you struggle with maintaining boundaries when they make incessant demands? How might you alter your behavior so that these encounters become opportunities to model healthy interaction and to provide them a brief respite from the chaos that is likely present in their other relationships? Have you ever felt resentment that a patient didn’t show appreciation after you significantly helped them? If so, why do you think their show of gratitude is important to you? Does the doctor-patient relationship include an expectation that patients make their doctors feel good too? Could their indifference reduce your investment in their care? What if you learned from a patient’s family member that the person actually does appreciate you but just isn’t able to show it? Given what you know now, do you think you can have a career in medicine in which you find patient interaction rewarding and meaningful much of the time? If yes, are you on course to experience those rewards, or do you need to make some changes? If the latter, what are you going to do to make those changes? Are you going to live with low expectations or look for something more rewarding? Many, if not most, work environments have a fair amount of hassle, meaning you spend a good deal of time doing nuisance work and coping with difficult colleagues and bosses. These are manageable challenges, and they even provide an opportunity to learn to negotiate and adapt. Sometimes, however, workplaces become too dysfunctional to do your job effectively or facilitate meaningful change. They are beyond repair. How would you know when that line has been crossed? Have you experienced either or both of these situations? How did you respond? What did you learn? Saul J. Weiner, MD; [email protected]
Organic Chemistry and the Questionable Ways We Select and Train Physicians
30:03In October, the New York Times published the first of several articles about an eminent professor at NYU who was dismissed after his students complained that his organic chemistry class, essential to medical school admission, was too hard. Thousands of comments were unsympathetic saying, essentially, that students who couldn't hack it shouldn't be doctors. But is that really true? Saul and Stefan debate not only whether organic chemistry should be a gateway into medicine, but what else is questionable in how we train physicians -- and why it matters. Are medical students spending massive amounts of time jumping through hoops when they could be acquiring vital skills? What are some indicators that medical education needs substantial redesign?
Contextualizing Care in a Nutshell (and a New Study)
27:29Today, Stefan talks with Saul about his favorite topic (and life's work), contextualizing care. We're re-releasing this conversation (from January of last year) because Saul's research team has just published a new study -- an RCT, titled "Effect of Electronic Health Record Clinical Decision Support on Contextualization of Care: A Randomized Clinical Trial," which is open access, so you can read it by clicking on the link. This episode provides a brief "one-stop-shop" for anyone who wants to understand what it means to contextualize care and why it matters.
Medical Gaslighting: Why Are We A--holes?
35:29Recent articles in mainstream media about "medical gaslighting" have struck a nerve with thousands of comments on social media platforms. People are complaining about how their doctors are treating them, with women and underrepresented minorities disproportionately telling some of the worst stories. Meanwhile physicians are responding, mostly on the defensive. They're saying their jobs are too tough and patients are unreasonable. We explore what's going on.
Urine Drug Screening: How it can traumatize patients and undermine the physician-patient relationship without helping anyone
38:02Urine drug screening (UDS) is used in the care of patients with opioid use disorder, and for patients receiving opioids for chronic pain. There's no strong evidence that testing helps patients, however, and no consensus on what to do with the results anyway. These tests, often mandated, may cause serious harm when physicians don't realize how often there are false positives or react punitively by cutting off treatment. Testing can resemble a criminal justice encounter, where failing could result in jail time. In a conversation with an expert, we reflect on how urine tests can be helpful, but only if we understand what our role as a physician is in caring for vulnerable, marginalized, and traumatized patients who desperately need us to care about them.
Pursuing a Medical Career While Black: What it Takes and Why it Matters
55:43Making it into and through medical school is tough even for those who have all the advantages: excellent schools starting at a young age, well-educated parents who may be doctors themselves, lots of role models and…white skin. In this episode we hear from two pre-meds and one newly minted physician, all Black, about their journeys with few of these advantages. Despite their remarkable optimism, their burdens are evident, and many do seem tied to race, as it is understood in the US. The extreme underrepresentation of Blacks in medicine should be a source of deep concern for the profession and for society, as a matter of social justice as well as patient care. The passion of these young men and woman is inspiring, and the mentorship opportunities provided by pipeline programs like the I Am Abel Foundation which has been central to their lives, offers hope. To learn more about I Am Abel, check out "Season 1, Episode 6: Hope and Healing for Those Who Follow" of our podcast. To support the Foundation’s commitment to mentoring talented students see: https://www.iamabel.org/donate Guests: Korinne Carr, Josh Leake, Eseosa (“Sosa”) Aiwerioghene
Rescuing medical professionalism: Could “cup-of-coffee conversations” do more good than committees and letters-to-the-file?
42:06Medical students may be subject to professionalism review by committees, most commonly for “unreliability” such as not responding to emails, falling behind on compliance requirements, showing up late for assignments and so on. Then they hit the wards, and frequently experience mistreatment by residents and attendings (many of whom also don’t answer their emails etc…), most commonly in the form of public humiliation. This seems like a recipe for cynicism and burnout, rather than growth as a professional. In this episode we talk with our guests, experts in a more nurturing approach, about alternatives. We hear about “cup-of-coffee conversations” and other relationship building approaches to cultivating civility, collegiality, and professionalism.
Why Residents Unionize
36:35Many residents are not doing well, psychologically, and sometimes physically -- and with good reason. High levels of mistreatment and harassment, patient care that some experience as moral injury, and a lack of voice in the workplace, contribute to burnout and can adversely affect the kind of physicians people become. A growing path to empowerment is unionization. What are resident and fellow unions doing to create healthier training environments? Today we hear from a recent residency program graduate who served as president of a resident union at a large academic medical center.