Episodios
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Nick Andrews and Emi Okamoto, MD, talk about spending the holidays in the hospital, take a holiday quiz, and Nick reads the winning essay from the American College of Surgeons' RAS essay contest.
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Host Nick Andrews and Emi Okamoto, M.D., discuss how patients choose their doctors. Plus, Kristen Aliano Messina, a plastic surgeon in Plano, Tx., talks with Nick about resiliency among surgical residents.
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Nick Andrews and Emi Okamoto, MD, discuss the new Nike shoe for "Everyday Heroes," Google enters the EHR space (sort-of) and the American Medical Association gives 570 Hahnemann residents $125,000 for relocation and other fees such as immigration proceedings.
The guest this week is David Fajgenbaum, MD, whose book, Chasing My Cure documents his struggle with Castleman Disease as well as his fortitude to use his medical training to find a cure and unite the cause.
Links:
Nike Shoe Reddit reaction Google EHR Video Reddit reaction AMA grant for Hahnemann residents Dr. Fajgenbaum information: Academic profile Twitter New York Times profile
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Medical Muggle Nick Andrews and Emi Okamoto, MD, talk about all things Thanksgiving in this special edition of the Postcall Podcast.
We recommend saving this episode for Thanksgiving or Black Friday if you can't be with your friends/family for this holiday season.
In the episode, we talk about how sharing with patients increases trust, the best gifts for doctors, what we're thankful for, a good in-hospital, on-call workout, and codes that you may need for your Thanksgiving shift.
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Links:
Sharing stories with patients Weighing yourself every day helps with holiday poundage On-Call workout 20 Thanksgiving Codes The best gifts for doctors this seasonFor more MDedge Podcasts, go to mdedge.com/podcasts
Email the show: [email protected]
Interact with MDedge on Twitter: @MDedgeTweets
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Medical Muggle Nick Andrews and Emi Okamoto, MD, discuss how docs feel about Elizabeth Warren's plan for Medicare-for-all. They also discuss how bingeing on your favorite show affects sleep and how TV and films get medical care so wrong.
The guest this week is Ashley Alker, MD, who is a medical consultant for various TV programs and films -- she helps them get it right. The interview starts at 20:20.
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Links:
Warren's health care plan What it means for doctor pay How docs feel about it
Netflix is taking your sleep away The times TV messed up: The Blacklist The Good Doctor
The Sentinel Awards Ashley Alker, MD Website TwitterFor more MDedge Podcasts, go to mdedge.com/podcasts
Email the show: [email protected]
Interact with Nick on Twitter: @Nick_Andrews__
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Medical Muggle Nick Andrews and Emi Okamoto, MD, discuss a new survey about using the appropriate language when referring to patients. They also get into how banning sugary drinks went over at one California institution and talk about what physicians need to know about CBD.
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The interview this week is with Elisabeth Poorman, MD, MPH. Dr. Poorman is a clinical instructor of medicine at the University of Washington, Seattle.
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Timestamps:
Sugary drink ban (01:22) Cardiologists and diabetes (03:51) Calling patients by their disease (06:41) What you need to know about CBD (11:21) Interview with Dr. Poorman (18:27)***
Links:
UCSF Bans Sugary Drinks (Medscape) Cardiologists and treating diabetes (Medscape) Referring to patients by their disease (Medscape) What you need to know about CBD (MDedge) Elisabeth Poorman, MD, MPH:
Website Academic Bio Twitter MDedge Writings***
You can contact Nick and Emi by emailing [email protected] and you can follow on Twitter at @Nick_Andrews__ or on Instagram @medicalmuggle.
For more MDedge Podcasts, go to mdedge.com/podcasts.
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Medical Muggle Nick Andrews and Emi Okamoto, MD, talk about the recent research in the New England Journal of Medicine about burnout and harassment in surgical residency.
They also discuss the research in JAMA Internal Medicine about how patient behavior positively and negatively affects physicians, trainees, and medical students.
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Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019
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The interview this week is with MDedge reporter Kari Oakes on her article about addressing female physicians by their appropriate title: Doctor.
You can follow Nick on Twitter at @Nick_Andrews__ and on Instagram @medicalmuggle.
Timestamps:
Jack Strong, MD, dies (01:08) Surgical residency discrimination, abuse (01:45) Impact of patient behavior on docs (08:15) #MyFirstNameIsDoctor/Addressing female physicians appropriately (12:35) Interview with Kari Okas (12:40)Links:
Jack Strong, MD, Obit/Memoriam (Nola.com) Discrimination, abuse, harassment, and burnout in surgical residency training (N Engl J Med.) Demeaning patient behavior takes a toll (MDedge) #MyFirstNameIsDoctor (MDedge) The scene from A Few Good Men (YouTube)For more MDedge Podcasts, go to mdedge.com/podcasts
Email the show: [email protected]
Interact with us on Twitter: @MDedgeTweets
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Medical Muggle Nick Andrews and Emi Okamoto, MD, talk about football: the injuries, the NFL's Crucial Catch campaign, and what to tell patients and parents about football injuries and injuries from all sports.
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Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019
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The interview this week is with Jeff Pearson, DO, a family practice clinician practicing in Carlsbad, Calif. Dr. Pearson uses humor, magic, and general tomfoolery to forge a connection with his patients.
Timestamps:
Learn about the survey (01:00) Dogs extend life (01:30) Dogs combat burnout (03:03) NFL Crucial Catch campaign (05:15) Crucial Catch criticism (06:31) Sports injuries (09:50) Would you let your kid play football? (14:44)Relevant links:
Dogs extend life (WebMD) Dogs combat burnout (MDedge) NFL Crucial Catch campaign Crucial Catch criticism (KevinMD) NFL player Kelechi Osemele fined for getting surgery (ProFootballTalk) Football (European Soccer) Neuromuscular disorders (MDedge) Brain Injuries from sports linger for one year (MDedge) Dr. Jeff Pearson Medicine-in-MotionYou can contact Nick and Emi by emailing [email protected] and you can follow Nick on Twitter at @Nick_Andrews__ or on Instagram @medicalmuggle.
For more MDedge Podcasts, go to mdedge.com/podcasts.
Email the show: [email protected]
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Nick Andrews and Emi Okamoto, MD, talk about how to decrease the number of phone calls to your office, how more and more people view mental illness as a threat, and how to handle it when your family and friends ask for medical advice.
The interview this week is Taylor Brana, DO, the founder, producer, and host of the Happy Doc Podcast.
Timestamps:
Is mental illness threatening? (01:58) Preview gender empowerment conversation (06:08) How to decrease your office phone calls (06:58) Should you charge your friends for medical advice? (09:25) Meet the guest (14:15) Interview (18:50)Links:
People view mental illness as a threat (Medscape) #MyFirstNameIsDoctor (MDedge) Decreasing office phone calls (reddit) Charging your family and friends for medical advice? (reddit) The Happy Doc PodcastFor more MDedge Podcasts, go to mdedge.com/podcasts
Email the show: [email protected]
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In episode 51, Nick and Emi Okamoto, MD, discuss what makes a good doctor-patient relationship, how EMRs affect burnout, and when, if ever, it's okay to have had a drink before a clinical shift.
The interview portion of this episode comes from Ilana Yurkiewicz, MD, who hosts a discussion about difficult conversations that residents and fellows need to have with their patients. Dr. Yurkiewicz, along with Emily Bryer, DO, and Ronak Mistry, DO, address those times when a patient asks what you would do if the patient were your family member, and how much patients really want to know about their situation.
Dr. Yurkiewicz is a hematology/oncology fellow at Stanford (Calif.) University and the host and producer of the Clinical Correlation segment of Blood & Cancer, the official podcast of MDedge Hematology/Oncology. Dr. Bryer and Dr. Mistry are both at the University of Pennsylvania, Philadelphia.
You can contact Nick and Emi by emailing [email protected], and you can follow Nick on Twitter at @nick_andrews__ or Instagram at @medicalmuggle.
Time stamps:
Good doctor-patient relationships (01:40) Drinking before the clinic? (03:20) How EMRs affect ob.gyn. care (07:27) Hard conversations with Dr. Ilana Yurkiewicz (15:20)Links:
What Makes a Good Doctor-Patient Relationship? (Medscape) The electronic medical record's role in ObGyn burnout and patient care (MDedge/ObGyn) Downloadable PDF Having a beer before a shift (Reddit: r/medicine) Ilana Yurkiewicz, MD Academic Profile Blood & Cancer Hard Questions Column Emily Bryer, DO Ronak Mistry, DOFor more MDedge Podcasts, go to mdedge.com/podcasts
Email the show: [email protected]
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Nick and Emi Okamoto, MD, talk about the changes you'd like to see to electronic medical records systems as well as some issues with data and reporting in recent dietary studies.
The interview this week is Luke S. Johnson, MD, a dermatologist with a focus on pediatric dermatology at the University of Utah. Dr. Johnson is the founder and co-host of the brand new Dermasphere podcast.
You can contact Postcall at [email protected] and you can follow Nick Andrews on Twitter at @nick_andrews__.
Timestamps:
Transplant surgeon gets Hep C-positive heart: 01:51 Pediatric milk recommendations: 04:33 Red meat data: 07:42 What changes would you make to your EMR/EHR?: 11:50 Interview with Luke Johnson, MD: 19:00Links:
Transplant surgeon gets Hep C-positive heart Milk recommendations New Kids' Guidelines: Drink Milk, Water, Avoid Plant-Based 'Milk' New recommendations on what young children should drink
Red Meat Recommendations Red Meat OK'd in New Guideline But Critics Call Foul Panel releases guidelines for red meat, processed meat consumption
EMR/EHR changes Reddit thread Luke Johnson, MD Dermasphere Podcast Home MDedge IQ Dermatology Quizzes -
The creator of The Nocturnists podcast, Emily Silverman, MD, talks inspiration, storytelling, time management, and being a doctor. Nick and Emi Okamoto, MD, discuss the latest medical school to make their tuition free, which internal medicine subspecialties women are and aren't choosing, and more.
Links:
Weill Cornell free tuition Women residency/subspecialty choices Video games and your heart Emily Silverman, MD: Twitter (@ESilvermanMD) Website Professional Bio The Nocturnists: Website Upcoming events EpisodesContact the show at [email protected] or follow host Nick Andrews on Twitter: @Nick_Andrews__
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Nick Andrews and Emi Okamoto, MD, break down the screens and devices doctors interact with in and out of the clinic. The interview guest this week is Sarah Mojarad (@Sarah_Mojarad), who is a medical and science educator and lecturer. Ms. Mojarad gives Tweetorials about social media and medicine.
Time Stamps:
Are you still a doc with all this screen time? (01:54) How doctors get their media (06:16) Medical devices getting hacked (12:27) Interview with Sarah Mojarad (19:41)Relevant Links:
Are patients the next cyberattack targets? If you spend more than 80% of your day staring at a screen, you are no longer a doctor Time-squeezed physicians: Here's how your colleagues obtain key information Sarah Mojarad: Twitter Academic biography Personal websiteYou can contact Postcall by emailing us at [email protected].
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National Suicide Prevention Week interview with Janae Sharp of the Sharp Index, which is a resource for physician suicide awareness, prevention, and research.
Emi Okamoto, MD, and Nick have a mini journal club about the med student perspective on suicide and burnout and how Groupon can save you and/or your patients money on some medical procedures.
Time stamps:
Journal Club (01:51) Groupon saves money (02:22) Trump administration moves to ban non-tobacco flavored e-cigarettes (08:00) Med student perspective on suicide (09:47) Interview introduction (14:02) Interview with Janae Sharp (17:51)Relevant links:
Journal club articles
Groupon (Medscape) Med student perspective (Medscape) Flavored vape ban Interview: Janae Sharp LinkedIn Janae Sharp Twitter Sharp Index Questionnaire Donate ScholarshipsYou can contact Postcall by emailing Nick and/or Emi at [email protected] or finding Nick on Twitter @Nick_Andrews__
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A special lecture for suicide prevention day, week, and month from our sister podcast, the Psychcast.
Click here for more episodes of the Psychcast.
Show Notes
By Jacqueline Posada, MDIntroduction
Suicide in general population increased by 30% since 1999. The suicide rate was 14 people in every 100,000 up from 10.5 people per 100,000 in 1999. 400 physicians die per year. However, there is not great data collection about profession-specific suicide Suicide is the leading cause of death in male residents and the 2nd leading cause of death in female residents This represents a serious loss of the medical profession as well as the thousands of patients who lose their physician as wellRisks factors for physician suicide
Psychological:
Physicians tend be contentious, perfectionistic, and compulsive. They are able to cope with delayed gratification, and this may lead to a false sense of ability to cope with all obstacles, without failures. Medicine presents physicians with many obstacles such as the deaths of our patients and human frailty. Human imperfection and physician failures are juxtaposed against these traits listed aboveHistorical and genetic risk factors:
Past suicide attempt and presence of mood disorder Untreated depression is an especially high risk for physicians as they may leave their mental illness untreated due to stigma As of 2017, 32 of 48 state licensing boards continue to question doctors about their mental health history. There is increased risk of suicide with the presence of the long arm version of the serotonin transporter gene and history of childhood traumaWorkplace risk factors:
Physicians identify electronic medical records (EMR) and increased documentation demands as contributing to burnout and less job satisfaction EMR means that doctors feel like they spend more time with records than face to face with patients. With EMR there is less eye contact and direct connection with patients so itâs hard to foster relationships Physicians feel the stress of increased use of technology and connectivity via cell phones and the need to âkeep upâChange in culture
As a profession we are starting to talk about physician suicide; acknowledgment of the issue can lead to change. ACGME and other workplaces are starting to integrate physician wellness into curriculums and culture.References:
NCHS Data Brief No. 330. 2018 Nov.âSuicide mortality in the United States, 1999-2017â Yaghmour, NA et al. Acad Med. 2017 Jul. 92(7):976-83.âCauses of death of residents in ACGME-accredited programs 2000 through 2014â Implications for the learning environmentâ Babbott S et al. J Am Med Inform Assoc. 2014 Feb;21(e1):e100-61. Electronic medical records and physician stress in primary care: Results from the MEMO Studyâ Gold KJ et al.Gen Hosp Psychiatry. 2013 Jan-Feb;35(1):45-9. âDetails on suicide among U.S. physicians: Data from the National Violent Death Reporting Systemâ ACGME Symposium on Physician Well-Being -
Physician mental health policy grades for every state, microplastics in stools all around the globe, and a moving eulogy for a hospital?
After penning a eulogy for the hospital that agreed to train her as a surgical resident, Lynsey Daniels, MD, (@DanielsLynsey) joins Nick to talk about the closure, the hospital's finals days, and moving forward.
Nick and Emi Okamoto, MD, talk about microplastics in people's stools all over the world and break down how states measure up with regard to mental health policy for physicians.
Time Stamps:
Quiz (01:30) Microplastics in stools (05:55) States' grades for physician mental health (08:57) Interview with Lynsey Daniels, MD (17:15)Relevant Links:
Quiz References: Question 1 Question 2 Question 3 Question 4 Question 5 Microplastics turning up in human stool Physician-friendly states for mental health: A review of medical boards A medical resident's eulogy for Hahnemann Hospital -
New York Times contributor Danielle Ofri, MD, PhD, joins the show to talk about writing, the clinic, the system, and the Bellevue Literary Review. Emi Okamoto, MD, is back on the program.
Time Stamps:
MDedge Quiz (01:18) Checking in with Emi (08:19) The WHO and Malaria (13:19) Interview with Dr. Ofri (19:00)Relevant links:
Weekly Quiz
The following links lead to the articles that are referenced in the answers to the MDedge MD-IQ weekly quiz.
Question 1 Question 2 Question 3 Question 4 Question 5 The WHO and malaria Danielle Ofri, MD, PhD Website Biography (Wikipedia) Twitter TEDMED Buy her books New York Times op-ed -
MedTwitter stars and clinicians give their best advice for medical students as medical school resumes and @dr.skinandsmiles (Julie Amthor Croley, MD) joins Nick Andrews to talk about doctors on social media, podcasting, long-distance doctor marriages, and more.
Links:
Twitter advice for medical students thread Dr. Julie Amthor Croley Instagram Profile Resident Take Overs On social media in dermatology Being on-call as a derm resident Tips on patient communication Prescribing combined OCs Dr. Croley on MDedge MDedge Podcasts Blood & Cancer Cardiocast Daily Medical News Derm Weekly PsychcastYou can email the show at [email protected] you can email Nick at [email protected], and you can follow Nick on Twitter @tribnic
For more MDedge Podcasts, go to mdedge.com/podcasts
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Dr. Richard Balon gives a lecture on physician burnout and mandated wellness and Nick Andrews talks to Damian McNamara about the final days of Hahnemann University Hospital in Philadelphia.
Masterclass guest
Richard Balon, MD: professor of psychiatry and training director at Wayne State University, Detroit.
In March, Dr. Balon spoke at the American Academy of Clinical Psychiatrists 2019 annual meeting in Chicago, sponsored by Global Academy for Medical Education. Global Academy and this news organization are owned by the same company.
Lecture Notes
By Jacqueline Posada, MD, who is a consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Va.
Physician burnout and effective interventions
The scales (for example, the Maslach Burnout Inventory) do not necessarily represent the full extent of burnout: If physicians work 12 hours but find fulfillment in work, they will be tired but not necessarily burned out. However, if physicians work 12 hours a day feeling frustrated by the systemic problems, then burnout can ensue. Common contributors to provider burnout: Excessive workload: Pressures of working with an electronic medical record, extensive time spent on documentation; lack of work satisfaction and job control; lack of respect for the work; and student loan burden. âMoral injuryâ: The emotional burden that occurs when physicians cannot deliver ideal care/treatment to patients, especially when limited by resources (such as insurance or poverty), or other systemic health care issues. Work environment and organizational culture: These factors also contribute to physician burnout.Burnout is a problem for health care organizations as a whole
Two main ways to address burnout: physician-directed interventions (focused on individuals) and organization-directed interventions. Organization-directed burnout prevention strategies include: Reducing workload; reducing time spent on documentation, such as decreasing time spent in front of EMRs; cultivating effective teamwork; fostering a sense of job control. Organizations prefer individual-focused interventions over systemic changes: Examples include mindfulness teaching, yoga, cognitive-behavioral therapy techniques, education about burnout, and education. Individual-focused interventions are great, but they are not realistic for changing the culture that contributes to burnout.Interventions for burnout
In a systematic review and meta-analysis in JAMA Internal Medicine, Maria Panagioti, PhD, and colleagues found that:
Burnout interventions focused on individual physicians have small, significant effect on physician burnout. Organizational-directed approaches result in greater treatment effects, especially when interventions focus on promoting healthy individual/organization relationships. The impact of individual interventions can be improved when supported by organizational interventions. Interventions targeted at more experienced physicians within primary care settings show greater treatment effect than interventions targeted at less experienced physicians within secondary treatment settings.Approaches identified by staff can lead to meaningful change, as outlined by in a New England Journal of Medicine article by Melinda Ashton, MD.
A Hawaiian health care system queried individuals (physicians and mid-level and nursing staff) to identify which parts of EMR documentation were poorly designed, unnecessary, and could lead to unintended burdens contributing to burnout. This type of survey improves the efficiency of a system and illustrates that the health care organization cares about preventing clinician burnout.References
Panagioti M et al. Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Intern Med. 2017 Feb 1;777(2):195-205.
Ashton M. Getting rid of stupid stuff. N Engl J Med. 2018 Nov. 8;379(10):1789-91.
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