Tag Archives: Residents

Resilient Faculty, Resilient Residents

Kathleen Rowland, MD, MS

Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.1 A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).2 The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.  

Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace.  We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.  

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Risks, Benefits, and the “Invisible Bag”

mitchell-f-richard

Richard F. Mitchell, MD, MS

“Did you discuss prostate cancer screening with your patient?”

“I did, but…”

“But what?”

“Well, it was strange, but as I was discussing the risks and benefits, the patient just looked at me and said, ‘This is confusing, can’t you just tell me what I should do? What would you do if it was you?’”

Has something like this happened to you while you were precepting residents? Has it happened to you when you were talking to your own patients? In this age of patient-centered care, we teach our residents to involve patients in shared decision making. How do you counsel a resident working with a patient who doesn’t want to buy into that program? How do you teach your residents to respond to the question, “If it was you, what would you do?”

You might find the answer in an invisible bag.

“There is an invisible bag right in front of you. Think ‘Santa Claus sack.’ Would you like to reach in and take something out?”

“Why would I do that?”

“It’s full of $100,000 bills.”

“Yes! Can I take two?”

“No. But there’s something else you should know. The bag also has blank pieces of paper that feel exactly like $100,000 bills.”

“That’s OK—can I put my hand in now?”

“One last bit of information before you do—it’s also full of razor blades.”

“…Ah.”

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A Message to Incoming Residents: Build Your Cathedral

This blog post is taken from my comments to the incoming class of residents of the St Mary’s Family Medicine Residency in Grand Junction, CO. The setting was the Devil’s Kitchen trail in the Colorado National Monument during our annual orientation hike.

Randall Reitz , PhD, LMFT

Randall Reitz
PhD, LMFT

Long ago, there was a traveler who came upon three men working with stone. Curious as to their labors, the traveler approached the first worker and asked, “What are you doing with these stones?” Without halting, the worker responded, “I am a stonecutter and I am cutting stones.”

Not satisfied with this answer, the traveler approached the second and asked, “What are you doing with these stones?” The worker paused for a moment, wiped his brow, met the traveler’s eyes, and stated “I am a stonecutter and I am making money to support my family.”

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