On Becoming a Healer

By Saul J. Weiner and Stefan Kertesz

Doctors and other health care professionals are too often socialized and pressured to become "efficient task completers" rather than healers, which leads to unengaged and unimaginative medical practic... more

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The podcast currently has 82 episodes available.

Best of On Becoming a Healer

The most played episodes among Podcast App listeners.

Number 1: "Dire Consequences": When students do not receive appropriate accommodations on the USMLE examinations
In last month's episode we learned that there is no evidence that time limits that impose any sort of pressure on even a small percentage of students improves test validity and that, in fact, there is ample research showing that they make tests less valid and less equitable. In this episode we discuss how, despite the data, the NBME denies accommodations on the USMLE exams to over half of medical students who have a documented learning disability and are approved for accommodations at their medical school (e.g., extra time). We talk with a leading medical educator who is co-author (along with last month's guest and co-host Saul Weiner), of a paper published last month in the journal Medical Education, titled The myth that slow test-takers are worse students: Implications for time-limited testing. The publication is Open Access, so fully accessible to everyone. In this episode, originally aired in 2023, our guest discusses a published national survey she and her colleagues conducted to assess the scope and harmful impact on medical schools and their students of current NBME policy on accommodations. We conclude with a discussion about how the NBME could make the test fair and valid for everyone by functionally eliminating time limits.
May 19, 202647min
Number 2: Caring for Patients or Policing Them? Prescription Drug Monitoring, Doctors and Opioids
Prescription Drug Monitoring Programs (PDMPs) were originally designed for law enforcement to monitor patients and physicians for criminal behavior before it became available to health care professionals. Physicians and pharmacists often find PDMPs helpful because they can verify what a patient tells them and will often decide not to prescribe or dispense opioids if they discover their patient has been going to multiple providers and pharmacies. But is that health care or policing? Who benefits and who is harmed? Those are questions we consider with our guest, Elizabeth Chiarello, PhD, sociology professor and author of Policing Patients: Treatment and Surveillance on the Frontlines of the Opioid Crisis. The themes we discuss are not unique to PDMPs. This is at least our fifth episode exploring how the criminal justice mindset has crossed into medical practice with harmful effects. Prior ones include: · Opioids and the physician-patient relationship: What are we getting wrong? March 2022 · Urine Drug Screening: How it can traumatize patients and undermine the physician-patient relationship without helping anyone August 2022 · My patient's in shackles: Can we take these off? April 2023 · Drug testing at time of birth: How physicians are co-opted into harming families while thinking they are doing the right thing. Nov 2023
March 18, 20251h 9min
Number 3: What can we learn from all those "Why I quit medicine" videos on YouTube?
There are a lot of videos on YouTube that feature typically young physicians explaining why they decided to leave the profession after years of dedication and hard work. For some it appears that they were so successful at building a social media presence and related businesses, that they quit medicine. Others seem to just want to share their experience in the hope it might help others. They describe how a sense of exhaustion, dreading work each day and discovering that it wasn't what they imagined when they dreamed of becoming a doctor drove them away. What they have to say feels quite convincing, and thousands of comments affirm them. At the same time, there is something missing. They rarely talk about their relationships with patients or how medicine, no matter how corrupted it is by profit seeking, really is a special and unique profession that is worth fighting for. We reflect on what to make of this blind spot, trying very hard not to sound preachy.
February 18, 202550min
Number 4: A Conversation with Pediatric Surgeon John Lawrence MD, Past Board President of Doctors Without Borders, USA
At a moment of increasing isolationism and xenophobia and -- for physicians – burnout, in a highly bureaucratic and profit driven health system, service in low resource high needs settings can be an antidote for what ails America and American medicine, at least for the individual clinician. John Lawrence has spent decades serving all over the globe as a pediatric surgeon, most recently in war torn Gaza and South Sudan. He explains how he headed to college with plans to become a mathematician and then got diverted from that career trajectory while teaching math to Native American youth in Montana and seeing the consequences of poor access to needed healthcare. As cliched as it may sound, physicians are supposed to serve humanity rather than just the well insured, and John exemplifies that point of view on a global scale.
December 17, 202457min
Number 5: Addressing Social Drivers of Health: What is the role of the clinician?
In can be confusing and even demoralizing for a medical student or resident to understand what's expected of them when caring for patients with social needs. They already feel overwhelmed. Are they supposed to now also screen for housing insecurity? Is it their job to intervene to address social needs? And if someone else is doing the screening, what's their role? And are they also supposed to be advocating for changes to social policies? Finally, what's special about social needs as opposed to all the other reasons that, for instance, a patient can't control their diabetes? A patient may not be able to store their insulin because they are poor. Or they may not be able to administer it because they can't read the bottle or their fingers are arthritic. Our guest, Emily Murphy MD, an academic hospitalist, provides her perspective on teaching medical students and residents about SDOH. Co-host Saul Weiner, expresses concern that messages to trainees about their roles are confusing, that the SDOH movement is just the latest buzzword in medicine, like "patient-centered care,", and that while getting a huge amount of attention the movement could ultimately have little impact on patient wellbeing. He, Dr. Murphy, and co-host Stefan Kertesz discuss these questions and concerns and consider what needs to change.
November 19, 202453min