culture · fellowship

Physician suicide

This week, the New England Journal published two articles on physician well-being, or the rather, the lack thereof. One, Kathryn, is the story of a fourth-year medical student who jumped out of her apartment window last August. The other, Breaking the Stigma, is about how the culture of medicine is one of ritual shaming, particularly when it comes to mental illness. [I think both are open access, but please let me know if they are paywalled.]

Tragic stories, both of them, and sadly common. There were no suicides in my medical school, but there was at least one almost. I’m glad that there is growing awareness — at least among medical educators, hopefully among the wider public too — of how severely we are failing each other. When one in ten medical students contemplate suicide, we are failing each other; we are failing our future.


Sunday rant

“Can I ask you a personal question?”

hate when people say this. Because you know what’s coming — a socially inappropriate, irrelevant question about your age, your income, your marital status, your ethnicity, or your personal appearance — and the question-asker knows this, and is basically asking your permission to be let off the hook for their rudeness.

It’s also a question without a free choice, because either you say “yes” (and validate the inappropriate follow-up question) or you say “no” (and then YOU become the impolite one.)

So there’s a weird awkward pause while you try to figure out how to respond, and then you finally give up and say “…sure” because it seems easier, and then you have to deal with several layers of increasingly inappropriate follow-up questions.

Next time someone asks me “Can I ask you a personal question?” I’m just going to say, “Only if I can ask you one too.”


Know thy audience

What’s dystonia?

It’s the sustained co-contraction of agonist/antagonist muscles.


[I found out later that the reason he was so far behind with the previous patient was that when the patient asked “What causes Parkinson disease?” he drew the direct and indirect pathways. For a demented patient with a 10th grade education.]

Greater than 50% of this visit was spent in counseling and coordination of care.


Bad Leadership

I’m not sure I know how to be a great leader, but I can tell you how to be a terrible one:

When your state has declared a disaster emergency for snow, you should tell your subordinates that they better come to work tomorrow for their routine clinic patients (who may or may not show up), and declare that you’re going to be home playing in the snow with your kids. And when your staff expresses doubts about the feasibility of making it to work in 2 feet of snow and 60 mph winds, tell them they are not team players.

And then leave an hour early, to get a head start on those snowmen.

[Bonus points for blaming a staff member for poor documentation in a note that was written more than two years before she started working there.]