Category: Physician Blog

Develop Resiliency: A How-to Guide

Develop Resiliency: A How-to Guide

What is resiliency?

Medical schools say they desire this in candidates and in response applicants strive to demonstrate this quality in their written application, as well as interviews. Easy enough, just talk about how you recovered from a significant setback, whether it be in your personal life or career. The more important question though, is not how we portray this quality, but instead how we develop it. Some may say it is inherent and fixed, but that could not be further from the truth. I believe it can be refined and needs to be refined to prepare you for the challenges ahead. What follows is how to develop resiliency.

 

Past Achievements

Doubt is an interesting phenomenon in that it can creep into everyone’s mind, even the most elite. Given the humbling nature of medicine, its breadth and lack of mercy in presentation, I assure you that even the most badass physician has had to stare it down. When this happens, look to your past achievements. In my mind, past success is the greatest predictor of future success. If you are a premed, you have likely begun the process of crafting your resume, including research, volunteering, shadowing, work experience, etc. There are definitely notable achievements buried in here. If you are a medical student, don’t forget that your body of work earned you matriculation over literally thousands of qualified candidates. The point is, in times of uncertainty, lean on your past. I guarantee it significantly outweighs a single poor event and should illustrate your ability to triumphantly bounce back.

 

Fake it Until You Make It

This mantra permeates all aspects of life. There is a reason though, it’s true. Faking it until you make it is all about projecting positively. In clinic, given my limited knowledge base thus far, I feel like an imposter. I wander around in my short white coat, take histories and examine patients, and then present to my preceptor. To put it bluntly, my presentations are horrible. However, if I focused on all that I did not know and all that I was doing wrong, it would weight me down. Instead, I zero in on what I do know. This allows me to calmly connect the dots and recognize the strides I have made. I know that this attitude will serve me well going forward because I won’t have “made it,” being defined as a competent physician, for at least a decade.

 

Faith

This is not faith in any sort of a religious sense, but rather a deep seeded belief that everything is going to work out. That is different for everyone. For some, it may encompass balancing competing demands in your personal life and work. For others, it may focus more so on matching in a specific specialty. Faking it until you make it plays into this some, in that you may not have an organic belief that everything will be okay. No matter, saying it to yourself enough times will cement it as a natural response. Ultimately, this takes a tremendous amount of pressure off of yourself because you focus on the things inside of your control, rather than those outside of it.

 

Life, especially within medicine, is a roller coaster. Therefore, you will need to rely on these tactics time and time again. I alluded to the badass physician who still combats insecurity. Writing this has been therapeutic for me too, normalizing my intermittent feelings of doubt and reminding myself of the tools to squash it!

By Bryan Miles

How To Do Well In Medical School – 3 Reasons Why You Need A Daily Task List

How To Do Well In Medical School – 3 Reasons Why You Need A Daily Task List

Medical school is chaotic. You are balancing school itself, the extracurriculars helping to propel you towards a residency, maintaining the relationships that comprise your support network, and not to mention basic human necessities like eating, exercising, and showering. Just reading this sentence can cause your mind to swirl. So, here are three reasons you need to make a daily task list and start your own medical school organization.

 

1. It Reduces Anxiety

As I alluded to above, medical school is anxiety provoking. I would argue that daily task lists actually reduce this anxiety and should be utilized by everyone for optimal medical school organization and performance. You take a mess of tasks and neatly organize them into discrete, digestible components. Moreover, once your list is made, there is nothing to worry about. It is time to buckle down and start crossing things off.

Side Note-A Running List Furthers Anxiety Reduction

Continuing on the above thoughts, additional tasks will undoubtedly come to mind while diligently working through your list. No problem, have a running to do list next to your daily tasks. This is simply a place to write down thoughts as they organically present themselves. For instance, if you suddenly remember that you need to call your mom or complete a pre-class quiz, just jot that down on your running list. Now your mind is not distracted with thoughts of that and you are able to better focus on whatever task may be at hand. Note, this is to be utilized for short-term things you intend to complete that day!

 

2. It Increases Productivity

I honestly believe organization increases productivity. You have complete control over your daily task list. Therefore, you can set your priorities and create a roadmap for the day reflecting this. In our Finding Your Focal Point piece, we discussed the value of goal setting. This holds true here as well. You are essentially setting goals for the day, rather than haphazardly accomplishing tasks. While the later may seem just as efficient, I assure you that long-term, meticulously charting out your path to success is more optimizing.

3. It Provides a Sense of Accomplishment

Unlike undergrad, which is generally filled with endless tasks, such as assignments and papers, medical school is just the opposite. Most semesters consist of a few rounds of tests or a mid-term and a final. That only equates to a few boxes to check off. In the interim, you are persevering through vast amounts of material with no defined starting or stopping points (other than the exams of course). This can weight on your psyche. To combat this, I started creating more boxes to check. For instance, my daily task list includes things like watch Microbiome lecture or review sexually transmitted infections lecture. I don’t know why it is so satisfying, but I absolutely love crossing things a to do list!

Your turn:

Daily Task List

  1. Read: How To Do Well In Medical School – 3 Reasons You Need A Daily Task List
  2. Starting making Daily Task Lists

 

Why Most Medical Students and Doctors are Hypocrites (And How We Can Change)

Why Most Medical Students and Doctors are Hypocrites (And How We Can Change)

Social Histories

If you were to sit in on any routine doctor’s visit, you are bound to hear a few common questions. “Do you smoke? How much alcohol do you drink, if any? What is your diet like? How much exercise do you get weekly?” These are questions we are trained to ask as early as the first week of medical school. We are taught to treat not just the conditions a patient presents with, but also inquire about their overall health and instruct them on ways to improve it.

Addressing negative social habits that can impact patient’s health is a recurring theme throughout medical school.

My classmates and I have learned how to recognize drug addiction and drug-seeking behavior, how to determine if our patients were alcoholics, and effective ways to counsel people on healthier diets. As much as we future doctors know what qualifies as “good” health, and how to attain it, I wonder how closely we follow our own advice.

Medical students work incredibly hard, studying for hours on end for very difficult exams, as well as spending long days in the hospital without pay. With this amount of dedication, certain things are almost automatically erased from our lives. Sleep deprivation is the first thing that comes to mind, and I am constantly aware that this will only get worse when I start residency. Though the field of medicine has made great strides in ensuring that residents have work hour limitations, and the days of sleeping in the hospital all weekend are largely behind us, the amount of work still leaves many constantly fatigued. We counsel our patients to have good sleep hygiene, and often attribute lack of sleep to problems with mood, concentration, and general quality of life. But what about us? We set ourselves up for failure in these areas when six hours of sleep is a good night’s rest.

Doctor Non-Compliance

This lack of good sleep directly leads to an increase in the amount of stress we put on our bodies and minds as students and physicians. Let’s face it: medical school is stressful. This is a point that needs no clarification. Passing exams, getting honors on clerkships, and resting all of our hopes on a few board exams is pressure nobody enjoys. The stresses that come along with a career in medicine are certainly matched in other fields, but most other professionals do not spend their days advising their clients to avoid stress. How ironic is that? I have seen the effects stress can have on people, including my classmates: dissolution of relationships, family strife, and depression, to name a few. While we tell our patients to go easy on themselves when they are having trouble in their personal life or at work, we do not afford ourselves the same luxury.

The last, and possibly most important, area that I notice physicians and other healthcare professionals not taking their own advice is in our indulgences.

Long hours, high student debt, and a relatively low salary can restrict medical students and residents from having the healthiest habits in terms of diet and exercise. When you have to round quickly on patients and get to the OR by 7 am, it is not uncommon that all you have the chance to eat is a light snack or coffee. Throughout the day the demands of the patient wards may prevent you from having a real meal, and the vending machine seems like it may as well be a Michelin star restaurant. In spite of this, I am constantly impressed by a small subset of my peers who manage to make exercise a focal point of their day, whether it be at 5 in the morning or 10 at night. Many of us—and our patients—do not have this will power or motivation, and will collapse into our beds the second we have a minute to do so.

Other indulgences include drugs and alcohol, the unspoken hidden addictions many doctors struggle to control. The House of God provides anecdotal evidence:

“the classic novel where residents take swigs out of a flask at work and aim to be inebriated as often as possible when off the clock. This is a work of fiction, but it is based in reality.”

Physicians are often incredibly vulnerable to addiction when it comes to alcohol and drugs. It may be because we self-medicate, thinking we can recognize a problem more easily since that is what we were trained to do. Hence, we quickly and easily enter the world of self-denial. It is not uncommon to hear stories of physicians overdosing on prescription drugs or attending AA meetings. This is nothing to be ashamed of, and it is always good to get help when it is needed. However, the pressure placed on us not to have such problems—and to hide them if we do—makes it harder to identify and treat addictions when they do exist.

Some Of Our Own Medicine

We should strive to be the best versions of ourselves always, but also recognize that we are not above the maladies that may afflict our patients. If a patient states they are struggling with work and feel they need to drink more lately, it is okay to recognize that you as a doctor have experienced that problem too. When you advise your patient to cut back on the booze, take a day off work, and get better, remember that can be an option for you as well. The next time you ask your patient if they are downplaying a problem, ask yourself the same question. It is just as important to care for yourself as it is to care for others. Remember, just because there’s no lecture on it in med school, doesn’t make the problem any less real.

 

Jessica Celine Morgan
MD Candidate  |  Class of 2017
New York University School of Medicine
Medical School Side Hustles: Are You Up for the Challenge?

Medical School Side Hustles: Are You Up for the Challenge?

Medical School Side Hustles: Are You Up for the Challenge?

Medical school is crazy expensive. Obviously, your first priority should be doing well in school school and building your resume. This should be combined with a healthy balance of quality time spent with family, friends, not to mention focusing on your own personal well-being. If, and only if, all of that is in order, then perhaps you may be interested in one of the following medical school side hustles. However, working during medical school doesn’t have to be a giant commitment either – here are some of the ideas that fellow med students have tried to make some extra money…

Leverage a Talent

You will have to define your talent, but it could be something along the lines of an athletic or musical aptitude. At the very least, your status as a medical student should earn you tutoring gigs, if not for your medical school itself. Basically, if you are a master at something, or at least well beyond average, then you can likely charge for your services. For instance, I teach tennis part time and garner $20+/hour after the facilities cut. I have also tutored intermittently, landing $20/hour there as well. Now it is your turn, dig deep and find your inner medical school side hustles!

Earn $20+/hour Working for Motivate MD

This flexible opportunity fits perfectly with a med student’s busy schedule!  Motivate MD is currently seeking talented medical students for:

  • MCAT Tutor 
  • Pre-Med Online Mentoring 
  • Blog Content Writing
  • Sharing Motivate MD’s Pre-Med App and Services

If you’re interested in using your talents and past experiences to help pre-meds achieve their dreams, and desire the flexibility to fit into your busy med school schedule, this might be the job for you!  Take 5-10 min to fill out our simple job application here.

Donate Plasma

This one is not for the faint of heart, aka those with a crippling fear of needles. You are going into medicine though, so I will assume this applies to the minority. I have donated at BioLife Plasma, which pays $20 for your first visit each week, with another $50 if you come a second time that week. You can only donate twice in a calendar week and each donation must be at least a day apart. The sessions generally last only an hour. The best part is that BioLife has free Wifi, so studying is an easy possibility. I usually crush Anki decks while donating!

Uber or Lyft

I read online that you could net $25/hour and was obviously skeptical. “Why not try it out,” I said to myself. I was pleasantly surprised and did in fact net $25/hour. Surge definitely helps (elevated fairs based on consumer demand), but even without it I would have done well. Moreover, the passengers were all kind and chatty (one simply handed me a $20 for the tip), instead of drunken and belligerent, as I had imagined. The one downside is that your car can take on a lot of extra miles with this, so I would recommend doing it sparingly, but if you have got some time and a ride, give it a shot as one of your medical school side hustles! You can apply to Uber or  Lyft here.

Overnight Sleeping Shifts

These are absolute hidden gems. What is better than getting paid to sleep? Again, I figured this was too good to be true, but am thrilled with the results. Forty hours a week I sleep at a group home. I am actually only awake and doing things, like making breakfast or packing lunches, for 4 hours each week. The remaining time I truly sleep, or study. Facilities like this need round the clock supervision and odds are there will be one and demand near you if you reside in a big city. You will need to feel out the group home residents though. If they are runners, good luck getting sleep. Simply explain the situation to the interviewer and say that you are paying your way through school and actually need to sleep during the shift. They are understanding, as everyone else picks the job to sleep!

Landlording

I wish I could have made this one happen, but it wasn’t meant to be. If you think you have the chops to find an ideal property, location being key, then perhaps you should pursue this. The idea is that you have your tenants, hopefully other medical students, pay your mortgage. Then, long-term you can continue renting to medical students and have created your first rental property, voila! Make sure you have the nerve to handle any hiccups and headaches that may come along though.

Thank you for reading, and best of luck throughout your journey to becoming a doctor!

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7 Key Factors for Choosing the RIGHT Location for Your Medical Practice

7 Key Factors for Choosing the RIGHT Location for Your Medical Practice

 

Becoming a physician is a long, arduous journey. After many years of hard work, you finally reach the point of completion and begin your career as a physician. As you embark on the next steps of your vocation, one important factor must be determined… Where to locate your practice?

Choosing your location is an important decision and one that should not be made solely based on the clinical nature of the job. Due to my years of experience, both working directly for hospitals and as a third-party physician recruiter, I would suggest the following factors to consider:

1) Geographic Location

When choosing to relocate, there are many geographical factors that can sway your decision such as optimal climate and desirable neighbourhoods. It’s important to keep in mind that although these factors can be very tempting, there are future life changes that may also be important to consider such as career opportunities for your spouse, proximity to desirable schools and the growing needs of a family that may come your way.

2) Clinical

When considering the clinical aspect of the role, you need to take into account the following:
Are there enough patients to ensure both clinical competency as well as financial goals?

Is the patient population a group that would consistently need the clinical services you provide? Has the hospital invested in the needed equipment and budget for continued investments over time?

Have they completed a resources plan for the department in order to forecast future hiring and investment?

3) Relationship with Administration

What is the relationship like with the hospital or clinic administration? Given the interdependency with other healthcare providers and administration, these relationships will have a great impact on the environment you work in. The better the relationship the better the environment.

4) Market Share

The hospital or clinics reputation in the region and their market share is important and can potentially impact the clinical volumes and access to resources in the area.

5) Academic

Depending on personal preference, you will want to explore what opportunities exist for continued training as well as leadership development. Look into what affiliations they have with external academic organizations and teaching prospects.

6) Compensation

Compensation can be a key factor, however if you don’t have favourable responses to items 1 to 5, no amount of money will make it a great place to work. Keep in mind that a relocation allowance is not an incentive or bonus, but rather a resource that will make the process of relocation less daunting to tackle.

7) Recruiting Process

Lastly, I believe that the relationship you build during the recruitment process will be a good indication of the brand and culture of the organization and how helpful they will be as you go through the licensing and credentialing process.

Thankfully the process usually transpires over several months and thus allows the time to ask these questions and examine the fit. Physicians don’t move frequently so ensuring a thorough decision process at the start gives the best chance of a long-standing mutually beneficial environment.

Guest Post by:  Kevin Kirkpatrick, Managing Director of TMA Executive Search has worked recruiting physicians and planning for physician staffing for the last 12 years in Canada and the United States. He has worked with academic, urban and rural communities to recruit physicians.
Debunking the ‘Doctor Type’

Debunking the ‘Doctor Type’

 

Sometimes, your greatest obstacles can be in your own head.

Take resident physician Kyle Evers, MD. Throughout high school, he had a strong interest in the sciences and a natural desire to help people. Yet when thinking about his future career, medicine barely crossed his mind as a possibility.

Why? He didn’t fit his own notion of “the doctor type.”

“In my mind, doctors were people who never had to study—those kids who got straight A’s without even trying,” Dr. Evers explains. “That wasn’t me. So I didn’t really consider myself a future doctor.”

Today, Dr. Evers is a third-year resident in internal medicine at Memorial University Medical Center in Savannah, Georgia. It’s safe to say his views on who can be a doctor have expanded—along with his confidence in himself.

Discovering His Passion

When I ask Dr. Evers why he chose internal medicine, he says he loves the diversity of it—and begins ticking off all the different specialties he enjoys. Rheumatology. Nephrology. Gastroenterology. Cardiology. Endocrinology.

“My intern friends would joke that I wanted to specialize in everything, because when starting each new rotation, I would change my mind and decide that one was my favorite,” Dr. Evers says with a laugh. “I just wanted to do everything.”

It might seem hard to believe that someone with such an obvious affinity for medicine could have ever doubted his potential in the field. But Dr. Evers had discounted medicine since his teenage years, and it wouldn’t resurface until he was majoring in biology at LaGrange College. Recognizing his talent, a few of his professors encouraged him to reconsider the career he had long since dismissed.

“I kind of laughed it off at first, but then it became this recurring idea,” says Dr. Evers.

So he did an internship with a general surgeon in his college town. Then, he got a job as an orderly in the operating room, where he worked during his last year and a half at college. “That sealed it,” says Dr. Evers. “I knew I wanted to be a doctor.”

A Diverse Perspective

Dr. Evers decided to attend Ross University School of Medicine in the West Indies for a few reasons, including residency placement rates and overall reputation. In addition, he was intrigued by the option to choose either a single location for his clinical clerkships or experience multiple hospitals throughout the country.

“I love to travel and being able to experience new cultures, so being able to do that while getting a medical degree was a no-brainer,” says Dr. Evers.

Sure enough, during his clinical year, Dr. Evers took advantage of the option—getting a taste for medicine in Miami, New York, Cape Cod, Connecticut and Michigan.

His favorite? Miami. (“I love the culture and the bilingual nature of everything—and there’s amazing food.”)

“You can learn medicine anywhere if you’re willing to study. The real difference is the environment and the experiences,” says Dr. Evers. “That was the key benefit for me. If you work at only one place, you may think every hospital operates like that, but if you move around, you quickly realize how different hospital systems are. And each system has its strengths.”

Making a Home

His rich background across many hospitals helps him appreciate his residency hospital, Memorial Health, that much more.

In particular, Dr. Evers was struck by the “family atmosphere” he sensed at Memorial. During his interview, he was impressed by the interaction between residents and attending physicians. Not only did they stay after meetings to chat, they clearly made an effort to get together outside of work as well.

“It was very comfortable, very warm,” he says. “It’s a very personal environment.”

That environment is good not only for having friends outside of work—it’s also a key factor in helping the hospital run smoothly. Dr. Evers credits the friendly atmosphere with fostering open communication that’s led to great relationships across residency lines.

“Here, the staff is dedicated to patient care and diligent in their jobs,” says Dr. Evers. “It takes a lot of pressure off residents.”

And it’s clear that the feeling goes both ways.

“Dr. Evers is one of our most exceptional residents,” says Dr. Timothy Connelly, associate residency program director at Memorial Health. “I’m grateful for his awesome contributions to our program.”

The Real Doctor Type

Today, that high school student who thought he wasn’t the “doctor type” seems a world away from this dedicated physician who’s enamored with his work and singularly focused on patients.

Dr. Evers says he can’t imagine himself doing anything else.

“Even if I had a billion dollars and didn’t have to work, I’d still want to do this job. I can’t think of anything more perfect for me,” he says.

In fact, while some of his medical school classmates are earning their MBAs or have an eye towards management in the future, Dr. Evers couldn’t be happier exactly where he is.

“I don’t have administrative aspirations,” he says. “I just like taking care of people.”

Guest Post By Kristin Baresich – [email protected]

 

 

Top Medical Innovations – December

Top Medical Innovations – December

The series “Top Medical Innovations”, will select a company, an invention, or breakthrough research that we feel can change the landscape of medicine for the better. Hope you enjoy…

Motivate MD’s pick for the top medical innovation of the month is the company EvidenceCare.  I feel that this new free decision support tool has the potential to revolutionize the access to high-quality, clinically-relevant information in an efficient manner.  Now this is not to be exclusively used by practicing docs.  As a med student, I find myself going through the clinical scenarios to solidify the material I am currently learning.  I also feel like pre-meds can also benefit from this by following the clinical scenarios and developing valuable critical thinking skills that will help them become a great doctor.  But enough of my take, let’s hear their story…

 

[flat_button text=”Check out EvidenceCARE” title=”Check out EvidenceCARE” url=”https://evidence.care/?utm_source=motivatemd&utm_campaign=motivatemd_blog&utm_medium=blog%20/t%20_blank” padding=”10px 20px” bg_color=”#FF5C00″ border_color=”#FF5C00″ border_width=”1px” text_color=”#FFFFFF” text_size=”14px” align=”left” target=”_blank”]

 

“The concept of EvidenceCare evolved as a result of a void experienced by founder, Dr. Brian Fengler. As an emergency room physician, Dr. Fengler is constantly faced with challenging situations. It’s simply the nature of the business.
During his residency at The University of Virginia, Fengler took extensive interest in the management of patients with pulmonary embolisms (blood clots in the lungs), even authoring a protocol that was published in the Emergency Medicine Literature.

(Dr. Fengler, Founder of EvidenceCare)

The genesis of EvidenceCare came when he was working in the ER and found himself faced with a situation that challenged his expertise…a 36-week pregnant woman with a massive pulmonary embolism. He knew how to treat the mother, but wasn’t clear on what the impact of those treatment options would be to the baby. As 86% of providers do, Fengler turned to the internet and spent precious time trying to find data to allow him to make the right decision and be able to convey treatment options to the patient.

As healthcare providers are acutely aware, he was unable to find the information he needed in a timely manner. Fortunately, he had enough knowledge and clinical experience to make a decision that he felt was best for the patient and her baby, and both went on to do well, but the experience left Fengler acutely aware of a gap in decision support for healthcare providers.

Dr. Fengler embarked on the creation of a decision support tool that would fill this gap:

  • The data, evidence, and recommendations would be gathered, evaluated, and edited by leading experts.
  • The information would be patient-focused, allowing the provider to access data specific to each patient’s condition
  • The tool would be easily accessible, a delight to use, and actually enhance provider workflow.
  • The results would be graphic in nature and easy to share with the patient and the patient’s family…to achieve the very best patient experience.
  • The information would be available to EVERY doctor, mid-level or nurse. For FREE.

 

 

EvidenceCare is the first, and only, decision support tool that addresses each of these imperatives, and is doing so with rave reviews.”

[flat_button text=”Check out EvidenceCARE” title=”Check out EvidenceCARE” url=”https://evidence.care/?utm_source=motivatemd&utm_campaign=motivatemd_blog&utm_medium=blog%20/t%20_blank” padding=”10px 20px” bg_color=”#FF5C00″ border_color=”#FF5C00″ border_width=”1px” text_color=”#FFFFFF” text_size=”14px” align=”left” target=”_blank”]

 

 

It’s companies like EvidenceCare that get us med students excited about the future of medicine instead of the focusing on the crazy burnout rates and shortages! So check them out and sign up for the free service here. Stay tuned for next month’s medical innovation…

By Drew Porter
2nd Year Med Student, Founder of Motivate MD

Surviving a Brain Hemorrhage: An Excerpt from “I’m Never Ill”

Surviving a Brain Hemorrhage: An Excerpt from “I’m Never Ill”

I awoke from a coma on Good Friday 2009. I’d love to say that I arose on Easter Sunday, but I’d be lying. I knew exactly why I was there. I remembered the events leading up to eventually slipping into unconsciousness; the pain in my head during the very early hours of the morning, the journey to the hospital, my girlfriend Sarah coming to visit me there with the news that her divorce had just become final and the later news that I’d suffered a small brain hemorrhage, but that there was nothing to worry about. We call the 8th April our divorci-versary/brain-iversary.  We joke that I’d tried to escape by slipping into a coma, but when I woke up a few days later she was still there!

Although the hemorrhage was small, the blood that escaped into the fluid around my brain clotted, blocking the channel at the base of the skull where the fluid drains into the spine. This caused the build-up of pressure in my head, known as hydrocephalus. It was this that sent me into a coma. I was then rushed to a neighbouring hospital where they drilled a hole in my head to drain the fluid.
“Will he be brain-damaged?” Sarah asked the doctor?
“Let’s just see if he makes it through the night,” was the reply.A small blister-like aneurysm was the cause of the bleed. Without further treatment, I was now a ticking time bomb. Aneurysms are usually treated by either clipping them from the outside after first removing a piece of skull (a craniotomy), or by blocking them from the inside by inserting platinum coils into them, via a catheter through the femoral artery in the groin. However, my aneurysm was too small for either of these methods, so the doctors decided to block the blood flow to the vulnerable area with a balloon, using the catheter method. I was awake during the operation, which had to be abandoned when the balloon pressed against a nerve, causing excruciating pain and complete double vision. Two days later, they tried a different method, blocking the area by strategically placing nine or ten platinum coils (I forgot to ask how many they’d settled for afterwards) into the vascular system in my head. This was successful.Although at this point we had separate homes, I spent my recuperation at Sarah’s house and never really moved back out. I spent much of my recovery time playing my classical guitar. During this period I composed a piece of music that Sarah really liked. She would ask me to play it over and over again. I never found a title for it, but it became “our” piece of music. I had no significant disabilities other than the fact that my memory was not what it used to be in the early stages of recovery. I’m not sure whether or not it has returned back to normal because it’s impossible to quantify, but it functions well enough now.

Against all odds, I returned to work just three months after my brain hemorrhage. A year later I proposed to Sarah. To set the tone for the marriage, she said, “Yes – but there are terms and conditions!” When I asked what the conditions were, she said that she would only marry me if she could walk down the aisle to our piece of music that I’d composed during my recuperation. On the 9th April 2011 (the day after our second brain-iversary/divorci-versary) we tied the knot, after I’d dutifully recorded our piece of music for her to walk down the aisle to meet me.
Towards the end of 2012, I began writing a book about my experiences. In March 2013, Sarah and I moved to our dream house in an idyllic rural location in Wales, teeming with wildlife and close to some lovely countryside walks. Things couldn’t really have turned out much better. However, things could become worse…

Three months later, Sarah was diagnosed with breast cancer.

I sometimes tell her that she did it as a response to my brain hemorrhage. She had always joked that when we first met, suffering a brain hemorrhage wasn’t in the contract. I certainly don’t remember breast cancer, a lumpectomy, removal of the lymph nodes under the left arm, six doses of chemotherapy and three weeks of radiotherapy being a part of any contract either! The whole cancer journey from diagnosis to finishing the treatment took around eight months, but the recovery from the chemotherapy took much longer. We spoke openly about the cancer, even nicknaming the lump “Clarence”! We encouraged people to talk to us about it, and we were proud to announce to everyone that Clarence was sent packing with a one-way ticket to an unknown destination.
People are often surprised, and sometimes even shocked by our flippant, dismissive attitude towards such grave issues. But it’s how we deal with it. We have now beaten our illnesses and turned our lives around. They are actually among the best things ever to have happened to us, forcing us to change our outlooks and to live more for the “here and now”. Whenever I tell people our story, I’m quick to assert the fact that we are fine now and that there is no need for sympathetic eyes or concern. All is well.

But here is the important bit. My brain hemorrhage survival with no significant disabilities was nothing more than sheer luck. However, Sarah’s triumph over cancer was not. As soon as she found the lump she went straight to the doctor. The removal of the lump was done within two weeks, and with “clear margins”, indicating that they were satisfied that there was no more cancer in the breast. After further investigation, they found a microscopic trace of cancer in the lymph node closest to the breast. This indicated that it had gone no further than this point. Effectively, Sarah’s cancer had walked down the garden path and was in the process of opening the gate. If she had not sought medical advice immediately, it would have opened the gate and begun walking down the main road and into whichever side roads it chose.

Six months after Sarah’s treatment ended, in the summer of 2014, we embarked on the trip of a lifetime. We flew from London to Chicago and then drove to Los Angeles along Route 66. It was more than a holiday. It was a complete adventure that had us absorbed from beginning to end. Sarah has just one heartthrob (apart from me, of course) – Pierce Brosnan. Coincidentally, on the last day of the journey while walking along Hollywood Boulevard, he turned up at the same place for the premier of his movie, November Man. We both stood within two metres from him while he was signing autographs. Bizarrely, during our three-week journey, Sarah told me that it was worth having cancer for! That is a colossal statement, but one that needs to be understood in context. It wasn’t just about Cancer v Route 66. It was about the way our attitudes towards life have changed as a result of our illnesses. We are two of the luckiest people alive, and this has made us appreciate everything that we have, which, by default, makes us happier people. Not only that, with all the platinum inside it, the scrap value of my head is worth more than the actual value of both of our cars together – enough to pay for my funeral and a damned good knees up for everyone who attends.
After our road trip across the USA, we decided to continue in the same vein. We began taking lindy hop and swing dancing classes. We go dancing two or three times per week, and in December 2015 we celebrated Sarah’s 50th birthday with a spectacular dancing party.

​-Mark D. Pritchard (Guest Post)  – ​ www.markdpritchard.co.uk 
Better to Burnout than Fade Away?

Better to Burnout than Fade Away?

Physician burnout is a hot topic lately.  The trade magazines, e-mails, and even popular media have been featuring stories on physician burnout.
In case you haven’t been paying attention, here are 10 links from a quick google search:

§  New York Times
§  Physicians Weekly
§  Medscape
§  Consumer Affairs
§  Americain Medical Association
§  Huffington Post
§  Washington Post
§  Chicago Tribune
§  Hospitals & Health Networks

What is burnout?

How is burnout defined?  In this context, it is described as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.  In another context, it might be the guy who started smoking weed in 7th grade and now hands you the stub from your movie ticket, keeping the other half for his employer.
Of course, in this post, we’re talking about physician burnout brought on by increasing bureaucracy, increasing hours and expectations, decreasing time with patients, pay for performance, unfair ratings systems, etc…  It wouldn’t be tough to come up with a list of 101 ways a physician’s life can be made more stressful.

Why Does Burnout Matter?

Why should we care?  On a personal level, burnout is not a good feeling.  A burned out physician may not be able to give every patient the level of care they’re expecting.  A burned out physician may be more likely to make a mistake.  A burned out physician may not be at his or her best at home, leading to marital conflict, decreased life satisfaction, making work even more difficult to stomach every day.  It’s easy to envision a cycle that repeats itself, becoming a downward spiral that can’t possibly end well.
The repercussions are not good for patients.  Would you want to be seen by a physician who dreads coming to work each day?  A physician who is more likely to abuse alcohol or other substances?  One who is more likely to contemplate suicide?  The stakes are that high.

The Prevalence of Burnout

How common is burnout?  Quite common and increasing.  A recent article published in the Mayo Clinic Proceedings showed at least 1 symptom of burnout in 54.4% of physicians in 2014, up from 45.5% 3 years earlier.  Satisfaction with work-life balance decreased from 48.5% to 40.9% over that time.  A 2012 articlepublished in JAMA showed 45.8% of physicians exhibiting at least 1 sign of burnout, and physicians having an overall burnout rate about 10% higher than the non-physician worker.  Dissatisfaction with work-life balance was about double when compared to the non-physician.
What can be done?  There are big, system-wide answers and there are tiny, change-your-routine answers.  I won’t pretend to have them all, but I can at least tell you what others have done or suggested.  Stanford is rewarding emergency physicians with its time banking program, offering “meals, housecleaning and a host of other services — babysitting, elder care, movie tickets, grant writing help, handyman services, dry cleaning pickup, speech training, Web support and more.”
A recent newspaper editorial suggests the public needs to rally around its doctors like it has its teachers, who have been subject to the myriad of metrics in the recent past.  The AMA has released its STEPS Forwardprogram to help physicians gain control of their professional lives.
Common recommendations to relieve burnout are the usual suggestions to relieve stress:  eat better, take time for yourself, exercise… I’m just not sure how many of us can yoga our way out of professional misery.

My answer to physician burnout

What do you suppose I would suggest to help prevent or alleviate symptoms of burnout? Can you read the words at the top of the page, you know, that whole FIRE acronym?  I believe working toward a goal of Financial Independence, and seeing real progress toward that goal, can do wonders for the psyche.  If you are experiencing burnout, but can see a sliver of light at the end of that career tunnel, and you can watch that sliver expand and shine brighter, your outlook on your career and life might start to glow brighter as well.
When you are saving like Dr. Anderson, you know that you won’t be stuck in this position forever.  Starting from scratch, you could achieve Financial Independence within about 10 years.  That may seem like a long time depending on the stage of your career, but it’s less than the combined years you put in to college, medical school, and residency.
Once you have achieved FI, you’ll have options to lighten the load you’re carrying.  You can work fewer days or hours if your position allows.  You may be able to drop the worst part of your job, while maintaining the part you enjoy.  For example, The White Coat Investor is dropping his overnight E.D. shifts now that he’s got a sizeable nest egg.
You will be empowered to enact the changes you need.  If the only appealing option is to be done entirely and stop working, you can do that too.  And let every day be a Saturday.
Personally, I would rather remain gainfully employed than walk away at the age of 40.  I haven’t taken a formal survey or questionnaire, but I would guess my burnout score would be pretty low.  Some workdays are tougher than others, but I don’t dread them or end them feeling overwhelmed and exhausted.

Burnout varies by specialty

I may be in a specialty that is somewhat shielded from the bureacratic nightmares that plague primary care. The term “prior authorization” does not factor into my workday; I don’t have to worry about dotting enough i’s and crossing enough t’s to magically transform a clinic visit into a Level 3.
The 2015 Medscape Lifestyle Report show anesthesiology having a burnout rate of 43%.  That’s not as low as the dermatologists, reporting a survey-low 37% burnout rate, but quite a bit better than the 50% to 53% seen in emergency, internal, and family medicine, general surgery, and infectious disease.
In My My, Hey Hey, Neil Young tells us that it’s better to burnout than fade away (a worldview repeated by Def Leppard in Rock Of Ages).  I think I’ll ignore their collective wisdom, and do my best to fade away when I’m ready for my career to wind down.  From what I’ve read, burnout can be downright ugly.
What do you think?  Feeling burned out?  Why or why not?  Would progress towards or achievement of Financial Independence change anything for you?  Sound off in the comments below.

By Physician on Fire