Faculty Bibliography

Clinical practice guidelines are a common way of summarizing the standard recommendations for medical conditions. After the research was initially published last year, I grappled with the evidence, or lack thereof, reaching a conclusion that I mainly still supported the annual visit, if only because it establishes a solid doctor-patient relationship

The bottle of Maalox sat perched on the triage desk in the emergency room. It was mint flavor, or maybe lemon -- I don't recall exactly -- but it shimmered temptingly. I had just finished with a new admission, and my stomach had been groaning ominously for hours. It was after midnight, the whole night was still ahead of me, and I was getting desperate. I scribbled the last of my medication orders and snagged the Maalox bottle, popping the top and chugging two revolting capfuls on my way to the elevator. A survey of British doctors back in the '90s found that 87 percent of G.P.'s said they would not call in sick for a severe cold (compared to 32 percent of office workers who were asked the same question). In Norway, a 2001 survey revealed that 80 percent of doctors had reported to work while sick with illnesses for which they would have advised their own patients to stay home. Two-thirds of these illnesses were considered contagious. As much as we empathize with our patients, part of protecting our inner core may require drawing an unconscious demarcation between "us" and "them." I can recall, as a resident, the palpable relief of leaving the hospital at the end of a long night, something I generally thought about in physical terms -- getting out of grubby scrubs, the promise of a hot shower and edible food. But it was more than that: There was also the awkward relief of leaving behind the graphic reminder of what could befall my own body. Somewhere, deep down, I needed to convince myself that we doctors were a different species from our patients

As doctors, they're fascinated by the relationship between physicians and patients. They're convinced that a deeper understanding of what's going on beneath the surface can benefit all parties involved. Here, Ofri shares the insider info one needs to get the best medical care--and the respect she deserves

"When we read or hear a poem that's truly effective," says [Rafael Campo], "we feel what the speaker is feeling. We experience an entire immersion of ourselves in another's consciousness." So opens Campo's prize-winning poem, "Morbidity and Mortality Rounds." It's an immersion into the maw of death. I've read textbooks and articles about facing death, but they don't capture the essence of the experience the way these few lines do. Every doctor and nurse will recognize "when I look at you, I see myself laid bare." It's the fierce existential tie between caregiver and patient. Campo's newest book of poetry, "Alternative Medicine," will be published this fall. "A good poem engulfs us," says Campo, "takes hold of us physically. Its concision and urgency demand the participation of another in order to achieve completeness, to attain full meaning. In these ways, it's not so different from providing the best, most compassionate care to our patients."

First we just had to rule out any treatable medical conditions -- get the labs, head CT scan and chest X-ray. (According to a 2006 report, medication errors alone injure an estimated 1.5 million patients a year.)

The trick to surviving was to shuttle patients to another area of the hospital as quickly as possible. This patient was a perfect candidate for the intermediate care unit, a holding station for patients with no active medical issues who were awaiting discharge. First we just had to rule out any treatable medical conditions -- get the labs, head CT scan and chest X-ray. But the docs at the intermediate ward left at 5 p.m. and it was 4:45. I quickly scanned through the labs, called the ward's doctor and ran through the case -- demented patient, still demented, return to nursing home tomorrow. I remember the doctor's voice so clearly: "You're sure the labs and everything are normal?" Yes, yes, I said, everything is fine. She hesitated, then said O.K. The intern and I high-fived each other, and bolted back to our other admissions. Much attention has been paid to reducing medical errors. Electronic prescriptions avoid penmanship mistakes. Bar codes on wristbands ensure that medications go to the right patient. Checklists and timeouts before surgeries help prevent common oversights. But we can stop only the errors we know about. There remains a black hole of near misses, of uncharted errors -- a black hole of shame that prevents caregivers from coming forward

If it's an academic institution, a bevy of medical students, interns and residents accompany an attending physician from room to room, checking up on the patient, doing a daily physical exam, reviewing the latest test results and highlighting the relevant teaching points. [...]computers handily beat out patients:

"When we read or hear a poem that's truly effective," says [Rafael Campo], "we feel what the speaker is feeling. We experience an entire immersion of ourselves in another's consciousness." 'So opens Campo's prize-winning poem, Morbidity and Mortality Rounds. It's an immersion into the maw of death. I've read textbooks and articles about facing death, but they don't capture the essence of the experience the way these few lines do. Every doctor and nurse will recognize "when I look at you, I see myself laid bare." It's the fierce existential tie between caregiver and patient. Campo's newest book of poetry, Alternative Medicine, will be published this fall. "A good poem engulfs us," says Campo, "takes hold of us physically. Its concision and urgency demand the participation of another in order to achieve completeness, to attain full meaning. In these ways, it's not so different from providing the best, most compassionate care to our patients."