Thursday, November 30, 2017

Where do you get your ideas?

Readers always ask where I get my ideas.

With my latest book, The Burnout Cure, I didn’t have far to look. While Wolf, Lily, and the characters who inhabit their world are fictional, the issues of physician burnout, depression, and suicide are very real—as are the sobering statistics that Lily quotes about how many physicians are affected.

The first seeds of this story were planted back when I was a young doctor-in-training. As Lily, the heroine of The Burnout Cure describes in the book, the hours and work conditions during internship and residency were brutal. I lucked out with a program that provided wonderful role models and great institutional support. Unlike many of my peers, I didn’t have to race from one hospital room to another throughout the night, drawing blood and starting IV’s—our main teaching hospital had in-house phlebotomists and a great nursing staff who were paid to do that.

But there were still entire months when I never saw the sun because I was pre-rounding on patients at 4:30 a.m., spending the day in the O.R., doing evening rounds on post-op patients in the SICU (surgical intensive care unit), and then signing out to the night team at 9 or 10 p.m.—when I wasn’t on call myself.

Speaking of call, I lucked out there too. I was never on call more often than every third night, and my longest stretch of working straight through without sleep was forty-two hours. I had friends, though, who suffered through training programs like Nick’s. They took call every other night, worked a hundred-plus hours each week, and lied to Joint Commission inspectors to keep their programs—and ultimately themselves—out of regulatory hot water for flouting the rules.

Fast forward ten years to another milestone event, when three excellent, successful, well-respected physicians in our community committed suicide within months of each other. Our local medical society held a dinner to honor their memory, and the keynote speaker talked about physician burnout.

I’d never heard about burnout prior to that night. But before long, the term seemed to be on everyone’s lips. As Wolf notes in the opening chapter: 

"Whenever he opened a medical journal, or stepped into the doctors’ lounge, or went to the ER to admit a patient, there was always someone talking about wellness, burnout, or both." 

Practically overnight, it seemed that physician burnout burgeoned to epidemic proportions, and even the popular press started quoting the grim statistics that those of us in the trenches lived with every day.

A few years ago, I came across a TEDMED talk by Pamela Wible, a family physician from Eugene, Oregon. She talks about “Why Doctors Kill Themselves”—and she doesn’t mince words. She describes a broken system that dehumanizes aspiring physicians and perpetuates abuses in medical education and practice. 

Dr. Wible’s passion about the topic got me thinking.

What if a woman who is smart, mouthy, and willing to challenge the establishment decides to turn her personal tragedy into a cautionary lesson for other physicians? What if the one man who can help her spread the message is an irreverent, unapologetic chauvinist who doesn’t believe in burnout? And what if they strike sparks off each other, hot enough to burn up the sheets?

And so, The Burnout Cure was born.

watch the book trailer:

Thursday, July 27, 2017

#RealLife - a doctor's story

Hello, lovely readers!

I haven't blogged in a while. Because, well...real life. Kids: three. Husband: one. Day job: ah, the day job. That's where things got tricky.

I started my medical career in private practice. Over the past decade or so, changes in the medical marketplace have forced more and more physicians to joined larger organizations in order to stay afloat. Our group joined a large academic center, and for a while things were good.

But bureaucracy is like a huge boa constrictor. It squeezes tighter and tighter. First you can't move. Then you can't breathe. Then you're done. Buh-bye.

We became cogs in a big system, forced to check "meaningful use" boxes that had nothing to do with patient care. When we went the extra mile to help our patients, we'd get reprimanded for not following the rules. It was all about the system. The liability. The bottom line.

This year, we decided: enough. 

We left Big Medicine and went back to private practice. A smaller, leaner group for sure. Age, illness, and the desire for a steady paycheck whittled down our numbers. Some doctors retired. Others decided to remain in the university hospital setting. The rest of us embarked on an exciting new venture, hoping to rediscover the joys of practicing medicine.

Are we there yet? No. 

I'm working harder than ever, trying to organize everything while still seeing patients. There are new offices to set up, new staff to train, new workflows to design, new computer systems, new equipment, new...well, you get the picture. It's a process, with a steep learning curve.

But those patients who followed us on this grand adventure already appreciate the difference. More personalized care. Smiling, friendly staff. Doctors who can and do go that extra mile.

Which brings me back to where I started: real life has a way of messing with the best intentions. My New Year's resolution to write more (or at least more regularly) gave way to other priorities. I'm getting back on track now, and hope to finish my next book soon.

Thanks for sticking with me, and stay tuned for The Burnout Cure. Art imitating life, but with a happy ending. Guaranteed.