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Someone said she was at Mount Sinai in NYC. I don't know if that's true.
America's leading voice for ideal medical care
America's leading voice for ideal medical care
I am incredibly sensitive to the burnout in physician circles and mental healthcare in general. But, that site (and authors) tends to exaggerate and mislead more than advocate.
I am incredibly sensitive to the burnout in physician circles and mental healthcare in general. But, that site (and authors) tends to exaggerate and mislead more than advocate.
From what I can tell, that building is operated by Mt Sinai and there was a death there in March 2016. Mt. Sinai also had a suicide in August 2016 which inspired the NEJM article, "Kathryn." Is this #3?
I am incredibly sensitive to the burnout in physician circles and mental healthcare in general. But, that site (and authors) tends to exaggerate and mislead more than advocate.
From what I can tell, that building is operated by Mt Sinai and there was a death there in March 2016. Mt. Sinai also had a suicide in August 2016 which inspired the NEJM article, "Kathryn." Is this #3?
Screaming is easy. Workable solutions are hard.
More in NYC or more at Mount Sinai? I mean, damn. Just what the hell is going on up there?
Why is Dr. Wible the only one keeping track of these suicides? Should we doing a root cause analysis whenever it happens?
Yeesh. Don't do residency in NYC, kiddos. I've heard it's hell on earth.
Who told you that
Every physician suicide deserves an M&M.
Was it on Pamela Wible's website that someone had written that they researched that you had to jump from the 6th floor or higher to ensure death? Thank heavens that didn't occur!jumped from the 8th floor
conducted by whom?
Doctors from another hospital. There should be investigations into these things, especially when it happens more than once at the same hospital.
Doctors from another hospital. There should be investigations into these things, especially when it happens more than once at the same hospital.
More in NYC or more at Mount Sinai? I mean, damn. Just what the hell is going on up there?
Why is Dr. Wible the only one keeping track of these suicides? Should we doing a root cause analysis whenever it happens?
Like, actual trained auditors or what? You'd still have to attempt to do such a thing while the medical and psychiatric records of the victim remain confidential. Good luck making anything useful from it.
If we're making a list of suggestions, I'd add this: confidential mental health support provided by a peer institution in the same locale. I know physicians who have avoided their home institution's support systems, because they don't want a record of mental health visits to appear their EMR.
Just to clarify, none of the resident suicides were from Sinai hospital. They were from st lukes, an affiliate. Either way, it's a tragic story.
I know it says you're an attending, but I have to ask. You have attended an M&M in the past, right??? Because if so, then the answer to your question and your concern should be pretty obvious if you understand the basis of an M&M, what it's for, what it does, and the level of confidentiality involved.
How does that change what I said?
In every way imaginable. Only someone who's never participated in an M&M would ask those questions.
Go on, smart guy...
Sorry, but if you're implying the victim's treating providers should M&M the case, absolutely. The program and victim's employer (what I'm assuming was asked about here)? They can absolutely review any of their own documentation and interactions with the employee but if can't just pull PHI if the resident was not a patient there.
They don't need to pull her private records. No one said that. But many of these physician suicide cases are directly related to their work environment and the culture of medicine and THAT'S what deserves the M&M.
That's perfectly fair, but I also think those are ultimately aren't going to be super useful, and possibly harmfully speculative.
We have reasonably good data on the major causes of burnout. That's what's most likely to come out during these M&M sessions you want.I disagree. I think some introspection and accountability is necessary.
We have reasonably good data on the major causes of burnout. That's what's most likely to come out during these M&M sessions you want.
Once that information is more widely known among Hospital leadership, exactly what outcome do you expect to get from this?
Hospitals are not going to get rid of their terrible Mrs. They're not going to let us work less without a significant cut in pay. They don't have the power to decrease our paperwork burden unless they hire staff to do it all for us, and that's not going to happen.
So seriously, how do you think this is going to improve things?
First of all, I don't think this is all about just burnout. That's a catch-phrase these days but it minimizes the serious systematic problems within medical training, specifically, to the extreme. I mention training because those in training are most vulnerable to the affects of an abusive/malignant environment. There are many other contributors that actually can be directly traced back to how things are run. For instance, residents working beyond the 80-hour work week and being highly encouraged to lie, being yelled at, humiliated, and even physically assaulted by senior residents/attendings, etc. When a doctor commits suicide, I think everything in his/her professional life needs to be examined.
Ah, OK so you're going after suicides among residents/fellows. That does change things a bit.First of all, I don't think this is all about just burnout. That's a catch-phrase these days but it minimizes the serious systematic problems within medical training, specifically, to the extreme. I mention training because those in training are most vulnerable to the affects of an abusive/malignant environment. There are many other contributors that actually can be directly traced back to how things are run. For instance, residents working beyond the 80-hour work week and being highly encouraged to lie, being yelled at, humiliated, and even physically assaulted by senior residents/attendings, etc. When a doctor commits suicide, I think everything in his/her professional life needs to be examined.
Ah, OK so you're going after suicides among residents/fellows. That does change things a bit.
An internal investigation is absolutely warranted, but a format resembling an M&M would be grossly inappropriate.
An internal investigation is absolutely warranted, but a format resembling an M&M would be grossly inappropriate, even questionably legal.
Agreed. I don't think if a colleague died from suicide that a Powerpoint presentation should be made about him or her and he or she should be presented in front of the group that he or she left behind. It would be grotesque and wrong.
Did 3rd and 4th year of med school in Queens. First day of IM 3rd year, the intern I was paired with looked at me and said "This place is jungle!" The IM residents there were worked like rented mules.
1st day trauma surgery rotation. "Trauma team to the emergency room" over the intercom. My very first trauma experience was the chief resident of IM had jumped from the 8th floor of the hospital parking deck. Had Ortho, Neuro and gen surg all operating on him at the same time. Miraculously, he survived but finished the job about a year later after he was allowed to return to the program.
We have reasonably good data on the major causes of burnout. That's what's most likely to come out during these M&M sessions you want.
Once that information is more widely known among Hospital leadership, exactly what outcome do you expect to get from this?
Hospitals are not going to get rid of their terrible Mrs. They're not going to let us work less without a significant cut in pay. They don't have the power to decrease our paperwork burden unless they hire staff to do it all for us, and that's not going to happen.
So seriously, how do you think this is going to improve things?
Yes that's exactly what I said, do nothing. Good reading comprehension there champ.So your solution is to do nothing? Just because you can't think of anything doesn't mean that there's nothing to be done. See the article posted by APD.
Yes that's exactly what I said, do nothing. Good reading comprehension there champ.
OK so first, I didn't imply anything. You inferred. That makes you wrong since I know what I meant and your interpretation is not it.Given the context, that's exactly what your comment implies. That because you assume that hospitals won't do anything to change the current state of affairs we shouldn't study it more.
Since you asked, I'll tell you what I expect from this: I expect reform. I expect that doctors treat each other more humanly, that boards stop threatening to end a physician's career if he admits that he needs help. I expect that doctors, the public, hospitals, and the government recognize our humanity and understand that we are fallible and that we need rest.
We can't work 70-100 hours a week witnessing a world of hurt and expect that our emotions won't be affected. We can't work under the sword of Damocles, under threat of lawsuits, government intrusion, and board meddling into our affairs, and not be affected.
We are fallible and emotional human beings. When all of the parties involved in health care accept this (including ourselves) we will start moving in the right direction.
I know it says you're an attending, but I have to ask. You have attended an M&M in the past, right???
Have you been part of an M&M?
Given the context, that's exactly what your comment implies. That because you assume that hospitals won't do anything to change the current state of affairs we shouldn't study it more.
Perhaps instead of acting like a dick about your proposal, you could discuss this like a grownup and actually lay out how you would handle an "M&M" for an employee suicide? Who (specifically) would conduct it, what type of information would be presented, what manner would it be gathered, what types of information would and wouldn't be available to be shared? Who is invited to take part?
Plenty of us in this forum are involved in MedEd, and actually want to hear legit proposals, and I'm not sure how this would be difficult for you to specify; however, since it's clear that none of us here are at the level of your brilliance and expertise, please remember to speak slowly and use small words.
M&Ms vary quite dramatically. In my residency and fellowship all M&Ms involved a power point presentation on the medical history and course of the patient in question. So if you are proposing something other than a powerpoint presentation that goes over the deceased medical history, psych history and the details of what happened it isn't going to look like much like a lot of M&Ms I have been to. Hence some more details about what you are suggesting might help other people picture the type of presentation you are thinking about. Then if we are all thinking about the same thing we can talk about how it would help.Asking someone who comments about M&Ms if they've ever actually attended one is not a "dick" question. It's a legitimate one. Maybe if you stopped being so defensive about your lack of knowledge about M&Ms, you'd realize I answered the questions. I'm not making a proposal to you. I'm making suggestions in the course of conversation. My suggestion would be an M&M-like analysis of what went wrong. Period, end of story. You can feel free to expand that or not, but just because I don't have all the answers doesn't mean the proposal itself is worthless or that I deserve your condescending, patronizing, defensive retorts, especially when you refuse to answer a very straight-forward fact-based question.
M&Ms vary quite dramatically. In my residency and fellowship all M&Ms involved a power point presentation on the medical history and course of the patient in question. So if you are proposing something other than a powerpoint presentation that goes over the deceased medical history, psych history and the details of what happened it isn't going to look like much like a lot of M&Ms I have been to. Hence some more details about what you are suggesting might help other people picture the type of presentation you are thinking about. Then if we are all thinking about the same thing we can talk about how it would help.
Stop calling it an M&M then. That's a loaded phrase in this world, and you should know that. The point of an M&M is never to actually figure out what went wrong and fix a systemic error so that it doesn't happen again. It's to make sure somebody publicly takes the blame for what happened and everybody can move on.Actually, the point of the M&M is what I've been referring to and have referenced multiple times. Getting hung up on the logistics is neither helpful nor productive in moving the discussion forward. The point of an M&M is analysis of what went wrong and why in regards to hospital/department involvement. It doesn't need to involve the resident's personal history or life, as I said above already, but rather the professional contributions to the ultimate death. This is what I am suggesting. You don't need to call it an M&M. You can call it whatever you want. You don't need a powerpoint. You can use whatever presentation modality you want. The point -- as I said -- is introspection, which will do most of us some good.
Stop calling it an M&M then. That's a loaded phrase in this world, and you should know that. The point of an M&M is never to actually figure out what went wrong and fix a systemic error so that it doesn't happen again. It's to make sure somebody publicly takes the blame for what happened and everybody can move on.
As much as I hate to bust out the douche-y management speak, what you seem to want (and it's not unreasonable...although you started this thread without a clue of the details and the information you did have turns out to have been incorrect) is a root cause analysis, or a kaizen.