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"I wouldn't do it twice, but I would not 'not' do it once."

- ZDoggMD

Entries in Medical Careers (6)

Thursday
Nov222012

5 Must Watch TED Talks For Any Medical Visionary

Visionary people face the same problems everyone else faces; but rather than get paralyzed by their problems, visionaries immediately commit themselves to finding a solution.    -Bill Hybels

Ok, I'm sure you are all familar with TED.com, basically it's is like crack for those who thrive on big ideas. I must admit, TED is a bit of an addiction for me. So if you have a bit of extra time this weekend; here is my must watch list for anyone who wants to do big things with their medical career.

 

1. The Wireless Future of Medicine

Eric Topol says we'll soon use our smartphones to monitor our vital signs and chronic conditions. At TEDMED, he highlights several of the most important wireless devices in medicine's future -- all helping to keep more of us out of hospital beds.

Eric Topol is a leading cardiologist who has embraced the study of genomics and the latest advances in technology to treat chronic disease.

 

2. Medicine's future? There's An App for That

Daniel Kraft offers a fast-paced look at the next few years of innovations in medicine, powered by new tools, tests and apps that bring diagnostic information right to the patient's bedside.

Daniel Kraft is a physician-scientist, inventor and innovator. He chairs the FutureMed program at Singularity University, exploring the impact and potential of rapidly developing technologies as applied to health and medicine.

 

3. Robert Fischell on Medical Inventing

Accepting his 2005 TED Prize, inventor Robert Fischell makes three wishes: redesigning a portable device that treats migraines, finding new cures for clinical depression and reforming the medical malpractice system.

Robert Fischell invented the rechargeable pacemaker, the implantable insulin pump, and devices that warn of epileptic seizures and heart attacks. Yet it's not just his inventive genius that makes him fascinating, but his determination to make the world a better place.

 

4. How Do We Heal Medicine?

Our medical systems are broken. Doctors are capable of extraordinary (and expensive) treatments, but they are losing their core focus: actually treating people. Doctor and writer Atul Gawande suggests we take a step back and look at new ways to do medicine -- with fewer cowboys and more pit crews.

Surgeon by day and public health journalist by night, Atul Gawande explores how doctors can dramatically improve their practice using something as simple as a checklist.

 

5. Where Good Ideas Come From

People often credit their ideas to individual "Eureka!" moments. But Steven Johnson shows how history tells a different story. His fascinating tour takes us from the "liquid networks" of London's coffee houses to Charles Darwin's long, slow hunch to today's high-velocity web.

Steven Berlin Johnson is the best-selling author of six books on the intersection of science, technology and personal experience. His forthcoming book examines "Where Good Ideas Come From."

Wednesday
Oct312012

Be The Doctor Who Thinks Differently

I can summarize the most successful people I’ve ever known with one trait: the willingness to challenge mainstream ideas.

An Uncommon Guest Post by Leo Babauta

This has been the key to everything good in my life too:

I changed my health and drastically reduced my carbon footprint when I stopped eating like everyone else around me and became vegetarian (and eventually vegan).

I simplified my life when I stopped believing what the majority of people believe, that buying stuff makes you happier, more secure, look better in the eyes of others, etc.

I improved my health and reduced our carbon footprint when I went car-free.

I changed my career by blogging differently than others (on simplifying rather than doing more) when I started Zen Habits.

And there are many more examples, but you get the point. This isn’t a post to brag about all of that — it’s to share what I believe is a real key to life: the willingness to think differently than most people. It means you have to be willing to question what most people do and what the majority will tell you. It means you have to have the courage to try something different. It means you have to be brave enough to stand out from the crowd and not take the safe route.

The Safe Route

Most people take the safe route, because they’re afraid of being different and failing. If you do nothing amazing but you go with the crowd, then you don’t look stupid. But then you miss out on the amazing. If you never stand out from the crowd, you will always be average. True being an average physican is no small achievement but that's not the right way of looking at it. The question should be are you living your dreams are you passionate about your day to day activites? 

The people who stand out are the ones who make a mark, who innovate and discover, who learn the freedom of exploration and invention. If you stand out when you apply for residency or a job, you’ll be more likely to be noticed. If you don’t, and you play it safe, then they’ll likely ignore you. If you stand out when you start a business, people will be curious and check you out. If you’re just one of many businesses doing the same thing, why should others care about you? Why should they choose you?

And yet, most people play it safe:

Most people go to school and then college then because that’s what everyone else does. They don’t know what they really want to do, so why not take the traditional route? And that’s fine, but it’s good to look into other options. Most people get a job and stick to it because that’s the traditional way to make a living. Others might be a solo entrepreneur or start a small business and dare to create something new and live a life they’re passionate about.

Most people eat meat and dairy and eggs because that’s how they were brought up, and eating differently is weird and unthinkable. “I love my ribs too much!” But then you miss out on a whole world of healthy, delicious food, and the opportunity to change the planet and your own health. 

Most people drive a car, because that’s what everyone else does — and changing it is too difficult. And yet, cars pollute and cost a lot and make us less healthy and make the streets less safe for our communities and take up most of our public spaces.

These are just some examples in my life, however the need to play it safe turns up in every part of our lives.

Learning to Think Differently

When you hear an idea that’s different than what you’re used to, pause. Instead of rejecting it outright, consider it — is there some merit? What are the arguments, the evidence? Let go of the emotions that come up, the defensiveness. Many people, when presented with ideas conterary to their belief feel they must lash out and attack. And yet, if you set aside those emotions, and look at the arguments, you might learn to think differently — and that applies to all ideas. Looking at the world, and especially your career as a physican, through these lenses can radically change your outlook.

When you are told that this is the way to do things, take a second look. Is this really the best way? Are there other possibilities? If no one has thought of them, can you? Just because an idea is different, don’t just accept it. Look at the bulk of the evidence, and learn to spot flaws in reasoning.

Test out different ideas.

Just because most people don’t do it, doesn’t mean it’s wrong. They might all be wrong, and this might be better. No better way to find out than to test it. If it’s not a good idea, drop it and move on. Learn to be proud of your ability to test things that people traditionally believe in, and not to worry so much if you stand out. In fact, learn to see standing out as good — not just to stand out, but to forge new ground, to challenge ideas, to express your individual voice rather than blending in.

 ____________________________

Become a writer on Uncommon Student MD: Submit a Guest Post.

Monday
Apr092012

The Battlefield Mentality Of Medicine

 

 The Physician Casualties of Medical Tragedies

 

A Guest Post by Dike Drummond, a family doctor who specializes in physician burnout prevention and treatment at his website, The Happy MD.

 

The mother of the dead baby sat in her husband's arms and simply asked "why?" over and over through the Vietnamese interpreter. I had no way to answer the question. I didn't know why. There was nothing to point to. No defect in the child or mother or the actions taken in L&D.

All I could do was say "I am so sorry" ... for your baby, for you ... for everyone involved.

It was a nightmare, losing a baby during childbirth in my family practice residency. It was THE thing each of us dreaded the most. What happened afterwards was even more devastating in the long run. What happened was ... nothing.

It had been a normal evening on call. The family practice residents ran our community hospital. I would end up delivering over 250 babies in my two years here. It was just before midnight, three women in labor, I had just changed out of my clothes into green scrubs and the typical long white jacket.

As I walked past the first labor room on the left I heard an obvious deceleration on the external monitor. HR dropped from 140 to less than 60 for almost a full minute with what looked like a late pattern. The mother was a Hmong woman who did not speak English. This was her third child. No previous problems in childbirth.

She was doing just fine. Dad was standing by the bed in the half light of the labor room. Everything was quiet - that’s how I had heard the deceleration. The night shift had just come on. A calm scene really, except for the yellow light of my nerves jangling from the deceleration.

Exam showed her to be 7 cm dilated, head well applied, normal contraction pattern. The decelerations continued. Protocol called me to rupture the membranes and apply a scalp electrode. I opened the amnion hook, had the nurse stabilize the external monitor puck and apply some fundal pressure. The father held the mother’s hand as they spoke quietly to each other in a language I couldn’t understand.

I ruptured the membranes but only a small amount of clear fluid came out. The heart rate dropped immediately to zero as if it had tipped off the edge of a table and fallen to the floor. 140 - 60 - 20 - nothing. Vaginal exam showed no prolapsed cord, no bleeding or any other abnormality. I was the only doctor in the hospital. The OB attending was 15 minutes away. This baby needed to be out right now.

With much shouting to push, my fingers completing the dilation of the cervix and good cooperation from the mom ... we had the baby out within three contractions.

No nuchal cord, no abruption, no blood anywhere ... the child was normal ... except it had been without a heartbeat for almost 5 minutes at this point. Full resuscitation. Epi down the tube. Chest compressions. Nothing. [Heart breaking. Are we getting anywhere? I do not want to call the code and give up.] Suddenly, five minutes of chest compressions and two doses of Epi in ... we have a heartbeat at 160. [Hallelujah] Stop the chest compressions. Let's tape the tube and call the NICU in the big city down south.

As the nurse and I begin to breathe again ... I feel a gentle tap on my shoulder. The father is standing next to me and points at my left hand. I notice that this whole time - as I stabilize the ET tube and the child’s head - the tip of my left pinky has been touching the baby's open eye. I thank the father, change my grip and close the upper lid. I begin to realize this heartbreak of the last 20 minutes is only the beginning.

We got the call three days later. The child showed no signs of brain activity and the ventilator had been turned off. I released the breath I had been holding since that night in this moment of final recognition. The baby was dead. That is NOT supposed to happen to anyone ... ever. Not to the baby, not to the family and not to any Resident.

The director of the residency program and the OB staff held a case review. No "fault" was found. Procedure had been followed. The baby's post mortem was normal. All actions were deemed "appropriate". I was not to blame. That was very little consolation. The baby was dead. My mind ran over and over the events like a gerbil on a wheel.

A little piece of me died that day. Deliveries were never the same joyful wonder they had been before ... they were bullets to be dodged. For years and another 300 deliveries I would occasionally be jolted awake at night by a vision of an amnion hook with a trigger on it.

In the days and weeks afterwards ... it gradually dawned on me that something I had always taken for granted ... was NOT happening. We were a small residency ... only 8 of us running our community hospital. It felt like a family. I had always assumed any tragedy would be met by a rallying around the unfortunate resident.

Here was our collective worst nightmare ... and ... nothing happened. Nothing except the case review and my meeting with the family - both agonizing experiences where I was by myself. I felt tainted, like a failure, an outcast in the wilderness.

I don't blame anyone. I am certain the first reaction among my colleagues was ... "OMG it happened". Followed by, "thank GOD it didn't happen to ME."

It’s the same thought process as a soldier in battle when his best friend goes down as they storm the beach. I don’t know if I would have thought the same things if it had happened to another resident. I don’t know if that fear would have stopped me from reaching out to them. Here’s what I do know...

Most of the physicians I have worked with have their own version of this story; something bad that happened followed by complete isolation. It has hurt us all. Let’s vow to end this compounding of the natural tragedies that occur in our profession. Losing a baby is bad enough. Coming away from the experience feeling that no one really cares and we are all on our own in the end ... is a wound on a wound. This does not have to continue. We do not have to let our own fear stop us from supporting our colleagues in their hour of greatest need.

If you are still reading this article, I want you to know something with crystal clarity. Your Physician Colleague who suffers a bad outcome wants you to come and talk with them. Sit and have coffee, put a hand on their shoulder. Make them a “hot dish” so they don’t have to cook for a couple days. (I am from the upper Midwest ... that’s just what we do) Do it again and again until they say, "enough already".

There are some stories even our significant other and parents can never understand ... only another doctor can fathom the feelings. The next time tragedy strikes in your medical community, reach out to your sisters and brothers. PLEASE don't run from them because of your own discomfort. They are not contagious, nothing is going to rub off on you.

Don't let the natural "battlefield mentality" win out. Notice it and act in spite of it. It will make a huge difference to your friend. I promise.

This is the time when you can step up and pay it forward. Just be there ... when it counts the most. You never know when you will desperately want them to do the same.

-Dike Drummon M.D. The Happy MD

Friday
Dec302011

Physicians & Lifestyle Design

By Greg Bledsoe MD MPH

Over on Freelance MD, I've posted a couple of articles about taking responsibility for yourself and "building your own ship" , and we've also gone through a few common reasons why physicians aren't the best at career modification.

In this post, I'd like to spend a little time introducing you to the idea of "lifestyle design," something that has become a bit of a buzz-phrase in the business world but as far as I can tell hasn't penetrated the world of medicine just yet (for a lot of reasons).

I'll begin with a personal story...

When I jumped off the academic track in 2006, I wasn't exactly sure what I wanted to do as a career but I knew I wanted something unique.  My idea was to design a career that was flexible, fun, adventurous, and meaningful, all the while paying my bills and being a responsible spouse and parent.  Simple, huh?

I spent months thinking about how to do this as a physician.  I searched websites and blogs.  I spoke with mentors and colleagues.  I read the literature, all to no avail.  There seemed to be no conversation about a career like this in medicine.  I mean, there were a few articles about volunteer opportunities or non-traditional careers, but nothing really like what I was trying to create.  

What I found, though, was that while the medical community was silent about how to develop a very non-traditional and interesting career, the business world had already awakened to the idea.  Within the world of business, the idea of becoming a "free agent" and overhauling your career through "lifestyle design" was beginning to pick up steam. 

Around this time I picked up a copy of the book Free Agent Nation by Daniel Pink.  I'm not sure how I found this book, but it became a sort of manifesto for me.  In this book, Dan explains how more and more individuals were escaping their cubicles to become independent free-lancers and living their lives with increasing flexibility and empowerment.  It was a great read and it hit me at a very important time.  Through this book I realized that I was not alone in my desire for more autonomy, and that a lot of workers who had already yanked themselves off the grid were thriving.  I was hooked.

The second book I read was a book that has become a bit of a cult classic already, Timothy Ferriss' text, The 4-Hour Workweek .  This book is a basic introduction to how Tim built a stream of residual income and then used his extra time and money to explore his interests and live a more interesting life.  It was Tim's book that introduced me to the term "lifestyle design," and while the phrase might seem a bit hokey, it's a very powerful concept.  Basically, what Tim discusses in his book is the idea that it is possible to live an incredible life if you prioritize correctly, live frugally, and develop your entrepreneurial side.  Some have criticized the book recently, explaining that no productive person-- not even Tim Ferriss himself-- really only works four hours a week-- but I would argue that that's not really the point.  The catchy title sells books, but it's the mindset Tim describes that is the reason why the book is an important introduction for individuals who feel helplessly caught in a hamster wheel at work.  Tim's point is that you can-- through ingenuity and hard work-- leap off the hamster wheel and into something much better.

So how does all this apply to physicians?

Well, when you have a career discussion with most physicians, it often boils down to whether or not that individual wants to continue practicing clinical medicine or go into a nonclinical job.  There's nothing wrong with either, mind you, and I have friends who have great careers in each; however, for me and for many other physicians, I suspect, this approach is just too simplistic.

The fact is, I like clinical medicine.  I've spent a of of time getting good at what I do and I'd like to continue to be able to help people by providing good clinical care to patients who need it.  I also like many aspects of the nonclinical opportunities available to physicians-- things like consulting, writing, medical device development, and many other niches really appeal to me.

My main question is not whether I want to practice clinical medicine or jump into a nonclinical career, it's how do I design my life to be able to practice medicine, participate in the nonclinical activities I enjoy, and still have the flexibility to pursue life outside of medicine?  Discussions about clinical versus nonclinical are at their core too reductionistic for most modern physicians.  What most modern physicians really need to be having are overarching discussions about how to design a lifestyle that incorporates the multiple facets of their career interests and also does not overlook the ultimate (and most likely unspoken) goals they have for their lives. This is a much deeper conversation, but one that is desperately needed today in this time of significant upheaval in our healthcare system.

So where do you begin if you're a physician and you are interested in exploring this idea of "lifestyle design?"

Well, don't go to the career advice section of your specialty journal and certainly don't go to the HR person at your hospital or academic institution.  

In my opinion, you should begin by checking out the conversations going on in other fields.  There are some incredible websites built around some really creative and interesting people who are living fascinating lives and teaching others how to do the same.  Check out the following as a starting point:

Once you immerse yourself in this culture you begin to see possibilities that you never would have realized before.  What's more, as a physician there are even more possibilities available to you than for the typical person, if only you'll step out and take a little risk.

Over the last few years this idea of lifestyle design has been a focal point of my thinking when it comes to career moves and ultimate goals.  I've invested a lot of time, cash, and sweat into learning how to build a unique career, and my hope with ExpedMed is that we can use this website as a vehicle to help other physicians, just like you, succeed in designing a lifestyle and career they truly enjoy. 

As a medical school student, you can begin by using Uncommon Student MD to become familiar with all of the ways that you can leverage your medical degree and choose a lifestyle as a physician that you find most rewarding.

About: Dr. Greg Bledsoe is has founded a number of startups including ExpedMed, the Medical Fusion Conference and Freelance MD.

Sunday
Dec112011

Radiologists Putting Surgeons Out Of Business?

Looks like the scalpel might be getting replaced by a keyboard and mouse

I recently watched a video where patients underwent surgery without a single cut. It's pretty unbelievable! For the past 13 years, Yoav Medan has been working as a pioneer in MR guided Focused Ultrasound Surgery. As I watched this clip,  I had visions of my future self telling my grandchildren (in a crotchety old man voice) about the good ol' days when we used to get to cut our patients open and slosh through their insides during surgery....those where the days.  I guess surgeons will have to start being a little nicer to the radiologists. They may need a job from them someday.

 

Tuesday
Nov012011

Is Medicine Destroying Young Doctors?

By Greg Bledsoe MD

I came across a blog post not long ago that's a great read. The title of the blog is the Traveling Medicine Show and the specific post is entitled, What Could Possibly Go Wrong?Leaving Medicine the First Time.

This post is a very interesting and humorous story about how the author—a first-year Neurology resident at the time—decides to leave his residency on an impulse after a spontaneous marriage to his girlfriend.  The story is well-written and quite funny, and it's easy to identify with the author who is so frustrated with medicine but can't seem to quite find a life outside of medicine either.  Here's how it begins:

After the third month of my neurology residency in Chicago, I took a trip out to New Mexico and never came back.

No one leaves medicine. It’s just not done. Or rarely. There was the guy in my medical school who was so twisted, that even after repeated reprimands for being inappropriate with female patients and colleagues, he couldn’t get it together. Though not by choice, he left. Or the anesthesiology resident found dead of an overdose in his call room, a surreptitious IV catheter still taped to his ankle. He left. These were the role models.

I had fantasized about leaving medicine for years. By my second year of med school, I had the feeling that I had boarded the wrong train, but I kept on clunking down the wrong track, hoping things would improve as I passed into each new stage of training. Things would be better when I was in the clinical years. Clunk. Clunk. When I get to my internship. Clunk Clunk. I couldn’t find the strength to leave something that seemed so successful, even noble. Anyway, the ticket had been so exorbitant, and soon so many miles had flown by that getting off was simply not an option.

I won't ruin the story and tell you how it all ends, but suffice it to say that it is worth reading.  I know many physicians who have felt, and still feel, like this author but only discuss these feelings behind closed doors to their closest confidants, if at all.

What's particularly poignant about this post, however, are the comments at the end.  The post was written in 2007, but the comments have been building since then and emote a sense of desperation amongst the writers. "Glad to know I'm not the only one who feels this way," reads one comment.  "I wish I had never done [medical school]—just look what they make you give," reads another. 

The comments continue: "I just left residency after two years of medicine...," and "I'm in my first semester of med school and I hate it," and "I’m a family doc, have been practicing for eight years. Recently hit with two meritless, frivolous, ridiculous lawsuits… both still pending, one I’ve fought for two years now... I'm getting out."

There are more comments, but you get the point.

What most disturbs me about these comments is that they are all from individuals at the beginning of their careers in medicine. It's one thing to have a cohort of physicians towards the end of their careers, complaining about changes in medicine and longing for "the good old days." But these writers are all young, early in their careers—and desperate to get out.

Our colleague Dr. Ryan Flesher produced an entire documentary film on this subject entitled The Vanishing Oath.  Ryan's film sheds light on the problem of early burnout in young physicians, and after watching his film, it caused me to be seriously concerned whether there would be anyone left in medicine to care for my family and me when we're older.

When I read comments like the ones mentioned earlier, or see a film like The Vanishing Oath, or speak to colleagues who are overwhelmed by their careers and stressed to the hilt, it makes me even more committed to what we're doing here at Freelance MD.  

You see, I come from a family of medical people. Between the stories I've personally heard and the stories told to me by other family members, I have had a growing concern that the practice of medicine is becoming increasingly toxic to those who practice it. Medicine is devouring its young.

This unfortunate truth is why Freelance MD and the Medical Fusion Conference were developed—to help physicians navigate the now treacherous waters of modern medicine.  

We'll be discussing physician burnout and other indicators of the problems in medicine in more depth, but our hope is that the discussion won't simply digress into a complaint session. We've created this site as a place not to simply document the obvious problems in medicine, but to offer direction for those who are struggling and connect them to leaders who can help them progress into a career that is fulfilling.

So take advantage of the resources here at Freelance MD and begin building towards a better career.  

We need you in medicine.

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