Just had this published in the BMJ
15 Apr, 15 | by BMJ
Until recently I thought I knew the meaning of the term “pimp” or “pimping.” But a couple of weeks ago a friend who is a student in a physician assistant program at a major medical school gave me new insight into the word when she told me how stressed she was because she was being “pimped out” by so many attending physicians during her training rotations. “Pimping out,” I asked her, what is that? Surprised that someone who’s written about medicine didn’t know the term, she explained that “pimping” occurs when attending physicians deliberately ask trainees questions that the senior physician knows the trainees cannot possibly answer. When, as expected, trainees couldn’t answer the unanswerable, they would be deliberately humiliated. “It’s horrible,” she said. “They roll their eyes, look at you like you’re an idiot, and, make you feel like a piece of dirt. When this goes on during a procedure, it makes … Continue reading
Several weeks ago, I was talking to a colleague who is a hospitalist at a community hospital. She was picking my brain about teamwork, wondering what kind of in-service she could provide to help physicians, nurses and others in her hospital better communicate. The woman is very well-intentioned and really wants things to improve. But she is stymied by several fundamental problems. One is the way the whole issue of team communication is often framed.
When this physician called me about her desire to re-form communication between doctors and nurses, she framed her concerns in terms of niceness. We, as physicians, need to be nicer to nurses. This is a common formulation of the problem. Nurses will often say that nurses need to be nicer to each other. Or they believe that nurses need to be nicer to aides, and so on. And everyone should be nicer to the housekeeper or janitor or electrician. I have nothing against niceness or being nice. The problem is that the issue here isn’t niceness. It’s all about Team Intelligence which is all about patient and staff safety. Physicians (or nurses or whomever) need … Continue reading
When I was a kid, the doctor came to you when you were sick. The idea of taking a sick child to a physician’s office was unheard of. It was considered semi-barbaric to force someone who was sick to leave the comfort of home and trek to a doctor. Plus, you were endangering other people by bringing a sick patient into a waiting room where they could infect others. In America, with some notable exceptions, the house call is a thing of the past, even for children.
Over the past several months, I have been thinking a lot about the crisis of primary care in this country. That crisis has become very vivid as I have watched medical residents who have not chosen to become PCPs go through primary care rotations where they learn skills — like feedback, shared decision-making, and motivational interviewing — they have not been taught to value much throughout their medical training.
Nancy is one of those residents. A tall thin young woman with striking red hair, she is rotating through a primary care practice. As she tries to put into practice the patient centered care skills she is learning, she does so grudgingly. She is practicing patient centered care, role playing primary care, but you can tell from the tension on her face as she talks to patients that she does not find it either fulfilling or particularly convincing. What she wants are certainties, to order a test or procedure that will produce numbers that she can analyze, dissect, and then use to determine some kind of certainty (i.e treatment) that will deliver something concrete – something she can feel good about — no matter how fleeting.
… Continue reading
This past week, I spent two and a half days at a conference put on by the Lown Institute on Right Care in healthcare. The Lown Institute was started by cardiologist Bernard Lown who has done critical research on sudden cardiac death, developed the direct current defibrillator for use in resuscitation when there is a cardiac arrest, and pioneered other critical cardiac treatments. In 1962 Lown founded Physicians for Social Responsibility and in 1980, with Russian physician Evgeni Chazov, Lown founded International Physicians for the Prevention of Nuclear War. In 1985, the two were awarded the Nobel Peace Prize. I had the privilege of working with Bernard Lown as well as other physicians like David Himmelstein and Steffie Woolhandler of Physicians for a National Health Program, (PNHP in the mid 1990’s when they created a group of physicians and nurses who launched a protest against Managed Care. This Ad Hoc Committee to Defend Health Care created a movement of some of the most prominent physicians and nurses in Massachusetts who encouraged their colleagues to sign a letter — For Our Patients, Not for Profits: a Call to Action … Continue reading