On Becoming a Healer

Today, Stefan talks with Saul about his favorite topic (and life's work), contextualizing care. We're re-releasing this conversation (from January of last year) because Saul's research team has just published a new study -- an RCT, titled "Effect of Electronic Health Record Clinical Decision Support on Contextualization of Care: A Randomized Clinical Trial," which is open access, so you can read it by clicking on the link. This episode provides a brief "one-stop-shop" for anyone who wants to understand what it means to contextualize care and why it matters.

Recent articles in mainstream media about "medical gaslighting" have struck a nerve with thousands of comments on social media platforms. People are complaining about how their doctors are treating them, with women and underrepresented minorities disproportionately telling some of the worst stories. Meanwhile physicians are responding, mostly on the defensive. They're saying their jobs are too tough and patients are unreasonable. We explore what's going on.

Urine drug screening (UDS) is used in the care of patients with opioid use disorder, and for patients receiving opioids for chronic pain. There's no strong evidence that testing helps patients, however, and no consensus on what to do with the results anyway. These tests, often mandated, may cause serious harm when physicians don't realize how often there are false positives or react punitively by cutting off treatment. Testing can resemble a criminal justice encounter, where failing could result in jail time. In a conversation with an expert, we reflect on how urine tests can be helpful, but only if we understand what our role as a physician is in caring for vulnerable, marginalized, and traumatized patients who desperately need us to care about them.

Making it into and through medical school is tough even for those who have all the advantages: excellent schools starting at a young age, well-educated parents who may be doctors themselves, lots of role models and…white skin.

In this episode we hear from two pre-meds and one newly minted physician, all Black, about their journeys with few of these advantages. Despite their remarkable optimism, their burdens are evident, and many do seem tied to race, as it is understood in the US.

The extreme underrepresentation of Blacks in medicine should be a source of deep concern for the profession and for society, as a matter of social justice as well as patient care. The passion of these young men and woman is inspiring, and the mentorship opportunities provided by pipeline programs like the I Am Abel Foundation which has been central to their lives, offers hope. To learn more about I Am Abel, check out "Season 1, Episode 6: Hope and Healing for Those Who Follow" of our podcast. To support the Foundation's commitment to mentoring talented students see: https://www.iamabel.org/donate

Guests: Korinne Carr, Josh Leake, Eseosa ("Sosa") Aiwerioghene

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.