Applying to Residency: Tips for Medical Students (from MS1 to MS4)

Applying for a residency starts with choosing your specialty.  The application for residency includes personal statements, curriculum vitae, letters of recommendation, transcripts and all the other components required by ERAS.  This application is then used by the NRMP to match medical students to their residencies.  It’s a fairly complex process on a relatively short timeline.

Photo Credit (You Tube video)

The prezi below was put together to walk medical students through the process – from picking a specialty to matching in the specialty and program which is the best fit for you.

 

I’d love feedback from anyone if I’ve missed something or could explain this in a better way – please comment below!

Best of luck to the students who are starting this process to match next spring – and thanks to all the faculty, administrator and deans who help them along the way!

Photo credit

 

Top Ten Tips on Starting Medical School

Starting medical school is one of the most exciting moments in a physicians career… but it can be a little daunting!  This talk is one I gave recently to the college students in the Baylor College of Medicine Summer Surgery Program.  In addition to talking about how medical school is different from college, I also included my top 10 tips for successfully making this important transition.

Photo Credit

[embeddoc url=”https://wellnessrounds.org/wp-content/uploads/2017/06/Transition-to-medical-school-compressed.ppt” download=”all” viewer=”microsoft”]

Why is there a battle going on about MOC … and why should you care?

Everyone hates exams.  Most of us hate regulations.  But, exams and regulations in medicine came about because of abuses in the past that led to the public distrusting doctors.  It’s a fascinating, and somewhat terrifying history that starts with changing “medical schools” from for profit (and horrible!) businesses into what we know today.  As general doctors started doing ophthalmology, surgery, or obstetrics full time, it was became clear that defining what constituted a specialty, and demonstrating that practitioners were competent was important.

Photo credit

What does it mean to be “board certified”?

Being “board certified” means that one of the 24 specialty boards in the United States attests that you have met all the requirements and have passed rigorous exams to show that you are qualified to practice in that specialty.

Does the board certification last forever?

Short answer, no. Family Medicine was the first specialty (in 1970) to realize that initial certification was not enough.  As the public continued to ask for evidence that physicians remained up to date, Surgery (1976), Emergency Medicine (1980) and Ob/Gyn (1986) added a recertification examination.  As of 1990, the remaining boards became “time-limited” which means board certification expires after 6-10 years, unless physicians take and pass the recertification examination. So, many internists who are now in their 60s and 70s didn’t have to do anything other than pass the initial examinations.  (This is referred to as being “grandfathered”).

 

Who makes up “the board” for the specialties?

The members of most boards are volunteer physicians in the specialty.  In surgery, which I know the best, the board members are called “directors”.  There are 41 directors of the American Board of Surgery who represent a variety of organizations and specialties in surgery.  These volunteer surgeons spend 20+ days a year away from their practices with no pay (although their expenses are paid) to give the oral examinations in surgery, and to design and validate the written examinations. They also have a variety of committees and projects which focused on one critical question: “What do we need to do to make sure we maintain the public trust in surgeons?”

Photo Credit

How do the specialty boards decide if specialists are up to date?

Since 1990, boards have to be “maintained”.  If you don’t maintain your board, you lose it.  Hence the term, Maintenance of Certification (MOC).  So what do you have to do for “MOC”?  In addition to having a license, most boards have requirements to document hospital privileges and provide letters of reference.  Here’s a summary of the other requirements for four of the largest boards:

 

Continuing Medical Education (CME) Recertification examination Practice Assessment Cost
Internal Medicine Must do some CME every 2 years.

Must get 100 MOC points every 5 yrs. (roughly 20-25 hrs/yr)

Recertification examination every 10 years (counts as 20 hrs MOC points) Nothing required.

Can earn MOC points by QI or by teaching.

$1940 ($194/yr) for General Medicine.

$2560 ($256/yr) for specialties.

Ob/Gyn Read at least 30 of the 45 articles provided by the board annually  and answer four questions/article (=25hrs CME credit) Exam every 6 years but may be exempt if excellence demonstrated by answers to articles. (pilot program) Completion of ABOG practice improvement modules

QI projects

Presentations/publications

$265/year.

Additional fee of $175 if exam is required.

Pediatrics 100 MOC points/5yrs. At least 40 in CME, 40 in practice assessment

“Question of the week” delivered by email.  20 questions = 10 MOC pts.

Recertification examination every 10 years (counts as 60 hrs of CME) Institutional or practice QI projects $1300/5yrs ($260/yr)
Surgery 90 hrs in 3 yrs. (30 hrs/yr) of CME (lectures or online)

60 hrs (20/yr) have to be Level 1(test questions involved)

Recertification examination every 10 years (counts as 60 hrs of CME) Participation in an outcome or quality improvement program $1600 ($160/yr)

 

What happens if doctors decide to not do MOC?

Being board certified is voluntary and so is maintaining a board.  But, if doctors choose not to do MOC, they will lose their board certification.

Here’s some of the possible implications if a doctor loses board certification:

  1. Hospital bylaws almost universally require staff members to be board certified. These bylaws will have to be rewritten for doctors who have lost their boards in order for them to work in these institutions.
  2. The ACGME requires that faculty that teach residents are board certified.
  3. The American College of Surgeons requires that all doctors are board certified who work in ACS accredited Trauma Centers or Children’s Surgery Centers. .
  4. The American Academy of Pediatrics requires that all doctors in the NICU are board certified in order for the NICU to be verified prior to accreditation.

My bottom line on MOC

Since the new MOC requirements went into place I have increased both the quantity and quality of the materials I use to stay up to date, which I strongly feel has made me a better surgeon.  I still don’t like taking exams, but every time I do (I have three boards, so I take a lot of them!) I learn so much that I find the experience invaluable. (Yes, that’s after the exam, not before or during… that hasn’t changed since medical school.)

MOC isn’t perfect, but it’s evolving, and the reason it exists is a good one.  Passing laws state by state to make MOC “optional” has the risk of hurting the public’s trust in physicians – and the risk of creating quite a bit of chaos for hospitals, training programs, and others. For what?  Saving $200 a year?  Not having to take the test every 10 years? Not having to log the CME that is required by almost all state medical boards?

Photo credit

“Here’s what’s at stake: we physicians are granted an extraordinary amount of autonomy by the public and the government. We ask people to disrobe in our presence; we prescribe medications that can kill; we perform procedures that would be labeled as assault if done by the non-credentialed. If we prove ourselves incapable of self-governance, we are violating this trust, and society will – and should – step into the breach with standards and regulations that will be more onerous, more politically driven, and less informed by science. That is the road we may be headed down. It is why this fight matters.” Robert Wachter, MD

 

 

 

 

 

 

 

Rethinking Institutional Metrics of Success

Recently, I was talking to a superstar surgeon who had travelled to Africa for two weeks to operate and teach. Lives were saved, a gift was given, but when he returned he was told that the two weeks he had spent in Africa resulted in not meeting his RVU target for the month…which he now had to “make up.”

Are you kidding? I can’t think of any physician that would think this is ok….

Photo credit

I have held leadership roles and I am not naïve. “No margin, no mission” is a universal truth. Financial accountability and stability are necessary for us to heal patients, teach and change the future through research.   But, if we only measure and report productivity it will be the only metric that is perceived to matter…. and that’s not ok.

Financial and productivity metrics are critically important in any business. Healthcare is a very complicated business. But for physicians, medicine is a profession, not a business. This distinction explains why the standard business metrics of productivity don’t sit well with most physicians.

A stethoscope is on a balance sheet. Health care costs

Photo credit

I’m becoming more and more convinced that we need to rethink how we define “success” for the physicians (professionals) who work in a business (healthcare). If we don’t, I’m afraid we will lose our way…. and potentially a generation of physicians.   So, as a starting point…. what if we thought about the following as potential new metrics of institutional “success”?

RVUs of the group, not the individual

It is human nature that what is counted is assumed to “count” the most. In addition to my friend who was almost despondent over having to “pay back” a mission trip that was part of his original contract, I have watched bright and hard-working physicians choose to stay to do one more little case or see two more consults instead of going home to their children because of this RVU pressure. By the way, these events were when a partner was on call and in the hospital, available and willing to take on this work.

Physicians are a competitive lot. If you give them a target to meet, they will do everything necessary to meet it. But the RVUs for an individual physician vary over time and with circumstances. Because medicine is a profession and not a “job”, there are very few physicians who are “slackers”.   Reporting the RVUs for individual physicians has the risk of hurting the morale of the physicians that are working hard, and rarely motivates people that don’t want to work hard. Besides, do we really want to send a report that monthly RVUs didn’t meet target to a physician who took time off to care for their own hospitalized child? (Yes, it happens.)

Let’s commit to a new institutional paradigm. Set RVU goals for the group. Trust the chiefs and chairs to be responsible for monitoring productivity. Let them take into account the normal ebbs and flows of work as a physican. Trust them to call in the few physicians who are consistently below expectations.

Turnover of physicians in the group

In an academic practice, it’s a good sign if strong, mid-level faculty members are recruited away to other institutions. In all groups there will be physicians who leave for family reasons or because a spouse has been recruited. But keeping track of physicians who leave for other reasons may be a metric that can reveal a bigger problem. Given the extraordinary cost of replacing physicians, isn’t this a metric that should be followed?

Burnout

Burnout is reported in 50% of physicians and costs institutions money. I strongly believe that every physician should have an assessment for burnout as part of their annual evaluation. Physicians that score high on the burnout scale need help – for their sake and the sake of the institution. The cost to the institution in decreased patient satisfaction and increased liability should be enough, but burnout is a life limiting or even life threatening condition. Let’s protect our most precious resource in medicine by paying attention to this epidemic. Why not reward divisions and/or groups that consistently demonstrate low levels of burnout? Why not use what they have learned to coach other groups who need help?

Support staff to physician ratio

I am quite certain that most people have no idea the amount of clerical work that physicians do today. For institutions, it’s a waste of extraordinarily profitable physician time and a major contributor to physician distress. No one knows what the ideal ratio of support staff to physicians should be, which support staff are more important, or what the differences should be between specialties.   So lets measure it, report this metric and compare between groups in our own hospitals and between institutions.  Let’s also make sure we understand how the ratio of support staff to physicians impacts burnout and physician turnover.

Teaching, research and innovation

Professionals work to make a difference but sometimes are not recognized for their successes. Even grown ups love a gold star.  Let’s make a big deal about teaching local physicians, publishing new research, receiving “Doc of the month” awards and building new programs. Celebrate successes – of all kinds – publically and sincerely.

Gifts of time

Likewise, let’s call out and celebrate the physicians who serve on boards of charitable organizations, who travel to treat patients and teach in underdeveloped areas, who sponsor student groups or who otherwise donate their time and expertise to make the world a better place.

Pay equity

I understand that salaries are “complex” in medicine, but it’s time to realize that they can be extremely unfair. When new physicians are hired at a higher salary than extremely successful physicians who have been there for 20 years, something is very wrong. When women and minorities consistently make less, something is very wrong.

There is no way that budgets can suddenly be changed to make pay equity a reality, but its time for all of us to make a commitment that pay equity will happen. Decide how long it will take … 5 years? 10 years? Once you have decided, let your physicians know you will commit to this change. To be transparent, report an annual metric of the percentage of physicians that meet the goal of pay equity. Make these changes. It’s the right thing to do.

Photo credit

 

 

 

How to Ace the NBME Shelf Exams, In-Training Exams and Your Boards.

Ok, now that I have your attention, let me share something with you. I’m going to show you how to maximize what you learn from the “school” we call rotations in medical school and residency so you can be an awesome master clinician. And, yes, it’s going to help you with your exams, so stay with me.

Clinical rotations are a strange blend of learning and work. You learn from the work, but we all forget that the work is not the purpose of these clinical experiences. The purpose of rotations is to be able to “practice” medicine (as a student) and then master the art of your specialty (as a resident.)

There are six basic principles to learn medicine, and then learn your specialty …and on the way ace the exams:

  1. Remember it’s school.
  2. At the beginning of each rotation, decide what topics you need to learn during the rotation and make a list.
  3. Take notes. All the time.
  4. Figure out how you will store your notes so you can find them quickly and organize them for review.
  5. Go through the notes you make every day to review them and then store them in your system.
  6. You can’t learn medicine from a review book (yes, including UWorld)

Somewhere around the beginning of my third year of residency, I was sitting in the “dome” (the chief resident’s “office” above OR 1 in our County Hospital) when Fred, one of my fellow 3rd years, walked in. He sat down and started to look through a stack of 3×5 cards so I asked him what he was doing. We all knew that he had scored the highest in our class on the ABSITE (the surgery in-service exam) and I was about to find out why.

REMEMBER IT’S SCHOOL

Fred figured out from day one that there was no way he was going to be able to study like he did in college and during basic sciences. Instead of hours to sit and read, it had to be flexible “on the job” learning.

This mindset is probably the single more important thing to cultivate. It’s the thing that drives you to constantly ask questions about why things are done the way they are and then go look up the answers.

Photo credit

 

AT THE BEGINNING OF EACH ROTATION, DECIDE WHAT TOPICS YOU NEED TO LEARN DURING THE ROTATION AND MAKE A LIST. 

Your list can be pretty simple, or more complex, but it needs to be enough.

First hint – There is a curriculum that has been defined for your rotations. Everything your professors have decided should be taught should absolutely be on your list.   (By the way….If it’s in the curriculum, it has to be part of an objective. If there is an objective, it has to be linked to a test question)

Second hint – There is no way in medical school that “surgery” (or any specialty) can be covered in 8-12 lectures. The same is true for your rotations in residency. You have to do more.

This is one time that an example may be better than a formula. Let’s say I’m a brand new clinical student on my core surgery rotation….

Photo credit 

 Step 1. Find a textbook of Surgery and make a list of the topics from the chapters. A spreadsheet may be best for this, but any kind of list will do. 

For example, our library has Sabiston’s Textbook of Surgery (20th edition, 2017) on line:

 

 Step 2. Breathe deeply. There are 72 chapters and no, you are not going to read all these pages.

Man carrying books

 Photo credit 

Step 3. Create a schedule to SKIM every chapter during the rotation. Look only at the “big picture” i.e. headings, section titles, diagrams, tables. Your schedule should leave the last week or two free. So, for example, if your rotation is 2 months long, plan to SKIM 12 chapters a week to get them done in 6 weeks.

 Photo credit 

 Step 4 – Now we get to the real deal (remember, this is graduate school and/or specialty training).

List the sections on your spreadsheet.

As a student, you won’t read every section – unless they are very general (Acute Abdomen, for example) or if you have a patient with that particular problem. Here’s what it might look like:

 

TAKE NOTES. ALL THE TIME.

After I learned Fred’s system, I always kept a stack of blank 3×5 cards in my pocket. Like him, for the last 3 years of my residency, I made notes ALL the time.  Here’s the kind of notes we are talking about:

  1. Reading textbooks or other curricular readings. Take the time to make the notes and make them well so you never have to go back to the chapter to review it.
  2. On rounds when someone teaches an important point (e.g. the 7 things that keep a fistula from closing)
  3. During Grand Rounds
  4. During conferences
  5. When you look up a paper to read about a patient
  6. And – most important – what you learn from specific patients. Do NOT put the name of the patient or their MRN (HIPPA). But, do put specifics that help you remember the patient (e.g. pt that always wore a red baseball cap and had a tattoo of a dragon)

As you can imagine, once I started this system, I was making 10-20 notes a day. It is remarkable how much you learn in a given day… and how it’s almost instantly gone if you don’t write it down.  In three years I filled up two boxes with cards. These cards were the only thing I reviewed for my Board exams.

 

FIGURE OUT HOW YOU WILL STORE YOUR NOTES SO YOU CAN FIND THEM QUICKLY AND ORGANIZE THEM FOR REVIEW

This is why using a notebook isn’t the best way to keep notes on rotations. You’ll take them chronologically and, unless you have an amazing index at the back with all the key words and pages listed, you’ll never be able to find a specific note.

The key is being able to “file” the notes so you can find them.  For the 3×5 system, leave a blank square at the top to put the topic you’ll use to file them.

I used anatomy as the basis for my filing system. So I would use a pencil (so I could change it later if I needed to) to put the topic in the box.  For example

Pancreas, pancreatitis

Appendix, neoplasms, carcinoid

This is very old-fashioned (but very effective) system.. I personally think there are better ways to do this now using scanning, cloud storage, key words and tags.  For some ideas, check out this post.

What doesn’t work well is to try to type notes on your phone.  What REALLY doesn’t work is to make notes and then decide to copy them, type them or somehow redo them later. (It never happens).

 

GO THROUGH THE NOTES YOU MAKE EVERY DAY TO REVIEW THEM AND THEN STORE THEM IN YOUR SYSTEM

The key to learning (as opposed to memorizing for a test) is review. Simply filing the cards means you are reviewing them. Plan to pull them out to look at them (and all the work you accomplished!) every week or two.

More importantly, when you see a patient with pancreatitis 5 months from now on a different rotation, pull the cards you made on this rotation. You’ll find you have 20 or so cards (or card equivalents) on pancreatitis … a review of the Surgery textbook, notes from Grand Rounds, the 3 patients you saw with pancreatitis that taught you about the disease and a few pearls you learned on rounds from your chief resident.

 

YOU CAN’T LEARN MEDICINE FROM A REVIEW BOOK (YES, INCLUDING UWORLD) 

I’m really serious. Not only will you suffer when you are taking care of patients, you won’t do as well on the tests (despite what the upper level students or residents tell you).

Remember the last two weeks of the rotation that you saved?  Now’s the time to pull out the review books.  It’s a wonderful way to review what you have learned from your skimming and patient oriented reading.  It’s also a great way to identify gaps and look up information.

p.s. Take more notes while you are doing this.

p.p.s Review all your notes, including the ones you make from the review books.

p.p.p.s Review them again.

Link to the Wikipedia article about the forgetting curve

We All Need a Compass

I was delighted to be asked to be the AOA visiting professor at the University of Miami Miller School of Medicine this week.  The following is the speech I gave at the induction banquet.  For those who are not in medicine, Alpha Omega Alpha is the “Phi Beta Kappa” of medical school, an honor society that recognizes students who are at the top of their class… but who have also demonstrated service, leadership and professionalism. 

 

What an honor that I have been asked to be here tonight for this celebration!  I am in the company of superstars and great friends, both new and old … what could be better?

I want to start by congratulating the junior AOA, resident and faculty inductees.  For the junior AOA inductees, you are clearly on a strong path to excellence which will serve you well.  Although I’m going to address my remarks to the graduating seniors, please know that I haven’t forgotten you or what it took for you to be here tonight.  For the resident and faculty inductees, you have been singled out for this very particular honor because you are amazing clinicians, educators and role models.  Thank you for what you do.

I thought I’d start with a short description of what it means to be inducted into AOA from the AOA website.

“Election to Alpha Omega Alpha is an honor signifying a lasting commitment to scholarship, leadership, professionalism, and service. A lifelong honor, membership in the society confers recognition for a physician’s dedication to the profession and art of healing.”

Induction into AOA is a major milestone in your career and, based on your predecessors in the organization, it also represents the beginning of a remarkable journey.  It’s a journey that you won’t take alone.  If history is a guide, you represent the future leaders of medicine, which means you’ll be guiding others on this journey as well.

That’s the reason I decided I should talk about how to use a compass.

 

Photo credit

I suspect that you have all used a compass before but, like me, you probably haven’t given it much thought.  A traditional compass works by aligning a needle to the magnetic pulls of the north and south poles.  Although we really could use either north or south as a reference point, by convention we use north. I’m not going to get into the differences between true north and magnetic north*… suffice it to say that because a compass lets us know where north is, we can calculate the difference between “true north” and where we are heading, which in nautical terms, is called our “absolute bearing”.

So where am I going with this?  Why is it important to have a point of reference, a “true north”, as you start your journey through residency into the practice of medicine?

I know you’ve already been on services where the focus seemed to be more on checking the boxes on the scut list than on caring for the patients… and you had the feeling that there was something missing.

That’s why you need a “true north”.

You’ve also been on committees or in organizations that seemed to worry more about policies and procedures than how to use those policies and procedures for the better good.

That’s why you need a “true north.”

And I know that you have experienced days where you manifested one or more of the three cardinal symptoms of burnout, days when you lost enthusiasm for your work, felt that patients were objects rather than people and/or decided everyone around you could do a better job than you could.

That’s why you need a “true north”.

Unless you know where your “true north” is, you can’t navigate… you can’t make the adjustments that keep you on course.

Photo credit

The single most important piece of advice I can give you as you start on this journey is to make sure you know where “true north” is for you.  As each of you define your own personal “true north”, you will share things in common.  For example, loving your family and friends, being kind, and trying to make a difference.  But even though there will be common themes, “true north” will be a little different for each of you.  This is not as abstract a concept as you might think. It is not only possible to articulate your goals, what gives you meaning and how you define your own integrity, it’s important to do so. And, yes, I mean write them down, think about them, and revise them when necessary.  When you hit the inevitable days of stormy weather, having a compass that it true is critically important.

Photo credit

In reading about compasses, I also learned that the traditional compass has to be held level to work.  I learned that “when the compass is held level, the needle turns until, after a few seconds to allow oscillation to die out, it settles into its equilibrium orientation.”

What a great image.  You have to be still to let the compass equilibrate.  You have to be mindful to look at the needle to calculate your absolute bearing.  And then you have to take that information and apply it to correct your course.  And to do so, you have to hold the compass level, which I think is a great metaphor for taking care of yourself – physically, emotionally and spiritually.

Photo credit

There is not a lot in the day to day life of an intern, resident or practicing physician that teaches us the skill of focusing on that still point, on getting our bearings to make sure we don’t veer off course.

It’s not a trivial problem.  Veering off course can result in doing something we don’t want to do or, more importantly, becoming someone we don’t want to be.  More importantly for those of you just starting on this journey, a small error in navigation at the beginning of a journey results in a very large error when you arrive.  That’s why, as you start this journey, it’s so important to know what “true north” is for you.

As you articulate what your “true north” is, I would also urge you to translate it into something that is easy to remember for those times that you are making a decision in a difficult moment.   For me, my “true north” as a physician has been distilled into three rules that I try to follow and that I teach my trainees.

Rule 1:  Do what’s right for the patient.

Rule 2:  Look cool doing it.

Rule 3:  Don’t hurt anything that has a name.

Let me expand just a little…

Rule 1 means always do what’s right for the patient.  Even if you are tired, even if others disagree, even if you don’t get paid, even if it’s not technically “your” patient – do what’s right.  It also means developing an life-long method to deliberately read and study so you know the right thing to do.  And it means doing all of this with compassion and integrity.

Rule 2, “Look cool doing it”, means practicing your art until you look cool.  If you are surgeon, make sure your movements look like Tai Chi and that you have no wasted motion.  If you are a pathologist, learn all the variations on the themes that cells can create. No matter what your specialty, read about each of your patients, prepare for all cases, procedures and conferences deliberately and diligently. “Look cool doing it” also means don’t lose your cool.  Be professional, which at its core is just another way of saying kindness and integrity matter.

Rule 3, “Don’t hurt anything that has a name”, certainly means don’t cut the ureter if you are doing a colectomy, but it means more than that because…

You have a name.

Your significant other has a name.

Your institution, your friends, your family all have names.

You are about to embark on the amazing and challenging journey of residency… I know you have a sense of trepidation and also a sense of incredible excitement.  Everyone in this room who has been there remembers and, to be honest, is probably a little jealous. What an amazing time to start a career in medicine.

Congratulations on all you have accomplished so far. I wish you smooth sailing and a compass that is true.

 

Photo credit

*Because I am using “true north” as a metaphor, the scientists will have to forgive me.  There is a difference between “true north”, which is the actual north pole and “magnetic north” which is what a compass shows.  Here’s a great link that explains this further:  Magnetic North vs Geographic (True) North Pole

 

 

 

Sometimes it hurts…

A few years after I started as an attending in pediatric surgery, I was called to see a little girl who had been with her father at a construction site. For whatever reason, a wall under construction had fallen and she was caught under it. Her injuries were severe, with massive blood loss from a crushed liver. We opened her chest, packed the liver, transfused her massively but to no avail…

I vividly remember what happened next. Instead of the usual quiet moment of reflection, the team started talking about our week, carrying on a conversation as though this was just one more event in a busy day. It hit me how unusual this was as I was driving home. It was the middle of the night and, as I drove into my neighborhood, I noticed that I wasn’t feeling anything, that the sadness and other emotions I usually felt when I lost a patient weren’t there.

A cat darted in front of my car. I got out of the car, looked at the cat and burst into sobs… which continued for a good 30-40 minutes.

The loss of a patient, the loss of a pet, or even the loss of a dream related to your career leads to grief. Granted, the depth of grief may be, and should be, less than the loss of a family member, but it is grief nonetheless.   Because these losses are often viewed as “less serious”, people may feel that it’s somehow “not normal” to feel true grief when they occur. This is particularly true for physicians, who often have to suppress these feelings to be able to treat the next patient.

o-doctor-loses-patient-570

Photo credit

Here’s the single most important message…It’s ok to feel the loss.

The ability to cry over a tragic injury or loss of a patient is the sign of a compassionate physician or provider, not a sign of weakness.   For all of us who experience these losses, It is important to allow ourselves to grieve, if that is what we are feeling. Although this will mean different things for different people, here are a few ways that might help…

Share your thoughts with someone you trust. Talk to your friends and, in particular, senior colleagues.   It is important for your future patients that you are allowed the space to grieve. It is also normal to worry about returning to work if you’ve experienced a particularly traumatic loss.  If you have a colleague who has lost a patient, let them know in direct or indirect ways that you are there for them if they need to talk.

If you are the team leader, talk to your team. It’s important to debrief with your team (and anyone else who was there) immediately afterwards and a few days later.   Make sure you acknowledge how hard this is and ask if people are ok. Remember for many of your learners, this may be their first time to experience the loss of a patient… how you respond will be remembered as their example for the future.

“Good models teach us to handle the experiences that change us.” Thomas J. Krizek.

 Communicate with the family. Immediately afterwards, just be with them. It is human nature to avoid “bothering them” in their time of grief but try to go. Bearing witness to their grief by sitting silently with them is a powerful way to help. Write a condolence letter. Call, email or write a note 3-6 months later to let them know you are thinking of them and to ask if they have any lingering questions. Offer to meet with them if they would like.

Go to the visitation and/or the funeral. Even after a hard journey together, even if you question if you could have done something different, go to the funeral if it feels like you should. Not just for the family, who will be very appreciative – but for you. There is closure in ceremony for everyone.

Take care of yourself. Focus on self-care by being with family and friends, eating good food, exercising, sleeping and doing the things you love.   It is both the burden and privilege of our profession that we experience these moments of intense and tender transitions…. but sometimes it hurts.

md-listening-to-heart

Photo credit