Many residents are not doing well, psychologically, and sometimes physically -- and with good reason. High levels of mistreatment and harassment, patient care that some experience as moral injury, and a lack of voice in the workplace, contribute to burnout and can adversely affect the kind of physicians people become.  A growing path to empowerment is unionization. What are resident and fellow unions doing to create healthier training environments? Today we hear from a recent residency program graduate who served as president of a resident union at a large academic medical center. 

The opioid crisis was precipitated by physicians overprescribing opioid pain medication, egged on by the pharmaceutical industry, contributing to suffering and death from addiction and overdose. Now, many physicians are forcibly cutting patients off of opioids and refusing to prescribe in the setting of a backlash, contributing to suffering from pain, and death from suicide. Saul and Stefan consider some of the striking similarities in how we -- the medical profession -- are getting it wrong on both sides of the crisis, why, and what we can do about it. 

The opioid crisis was precipitated by physicians overprescribing opioid pain medication, egged on by the pharmaceutical industry, contributing to suffering and death from addiction and overdose. Now, many physicians are forcibly cutting patients off of opioids and refusing to prescribe in the setting of a backlash, contributing to suffering from pain, and death from suicide. Saul and Stefan consider some of the striking similarities in how we -- the medical profession -- are getting it wrong on both sides of the crisis, why, and what we can do about it. 

On January 1st, the New York Times ran a story about prenatal genetic tests that are "usually wrong" -- but they got it wrong. These are actually just tests to tell if someone is high risk. The real story is that clinicians are not communicating with patients about what these tests mean, causing confusion and trauma. This happens across medicine and we discuss how to avoid it.

There are two qualities we may experience in others who comfort and ground us when we feel vulnerable and lost.  First that they engage with us, meaning that they are fully present with a sense of shared humanity. Second, that they respect our personal boundaries and know their own. Such boundary clarity makes them a safe sounding board. In this episode, first aired last May, we explore the interdependence of engagement and boundary clarity and their essential role in healing interactions.

Lately we've been hearing about bad behavior on airplanes. Here we discuss an incident in which a passenger unselfconsiously stepped up at an inconvenient time to assist a group of passengers in a tough spot. Saul and Stefan reflect on the qualities of people who go through life making the world a better place in small ways.  As millions travel during Thanksgiving, we thought this episode (originally released last year) might inspire  those flying the not-always friendly skies. 

Our guest, a physician a few years out of residency, describes an experience from her training when an attending yelled at her and hung up the phone when they were discussing a patient.  We talk about resident abuse, its impact on patient care, and what can be done about it. 

Our guest, a resident physician, describes her reaction and what followed, when she discovered a symbol of hate tattooed on her hospitalized patient's leg.  Most of us appreciate that as physicians we don't get to choose who are patients are, and that all deserve good care. But is there more to it than that? Can one grow as a physician and person, and even feel privileged when caring for patients who one might otherwise shun?  

Saul reached out to a former colleague whom he worked with closely so that he could apologize for something he did many years ago that he now sees as racist. Saul is a white man and his former colleague, a subordinate at the time, is a black woman. Because of his apology, along with their longstanding relationship, they are able to have an open and honest conversation about how it affected her life, why it happened and how to prevent and respond to racist behavior in the workplace. Stefan moderates the conversation. Guest: Chanel Brown