Pauline W. Chen: A Surgeon's Reflections

How Connected Are You to Your Doctor?

How connected are you to your doctor?

In this week's "Doctor and Patient" column, I write about a recent study in The Annals of Internal Medicine. Researchers from the Massachusetts General Hospital in Boston looked at "connectedness" -- a measure of the relationship between patients and their primary care physicians. While roughly 60 percent of patients were "connected" with a specific doctor, a sizable minority of patients were "connected" to a practice but not to a single physician; and just over 5 percent were not "connected" at all.

Not surprisingly, those patients "connected" to a specific doctor were more likely to receive recommended preventive care.

I understood these study results both instinctively and from my experiences as a doctor and a patient. But the findings led me to wonder how we might improve patient-doctor "connectedness."

What are you thoughts on "connectedness" between patients and doctors? How "connected" are you to your doctors? And are your doctors connected to you?

Please feel free to leave your comments below or on Tara Parker-Pope's "Well" blog.

A Medical Student's Rite of Passage

Today is Match Day, and as has been the case every third Thursday in March for over 50 years, at noon EST senior medical students across the country open the envelopes, or access the password-protected Websites, that will determine their careers and their life. Like a dart thrown on a map, the envelopes hold the name of a single residency program somewhere in the country.

Every doctor can recall his or her Match Day. While many of us remember only our emotions upon opening the envelope, the process of matching is much more than receiving your residency assignment. It is a powerful early lesson about the system in which we learn medicine: as exciting and fulfilling and personal as our work can be, it has the potential to control our lives and the lives of those we love.

This week I was reminded of that lesson as I read the book, Match Day (St. Martin's Press, 2009), by journalist Brian Eule. Mr. Eule follows three young women for a year, from a few months before their Match Day through the spring of their internship. While the book ostensibly focuses on the match, it is really about the impact of the medical system on the lives of the youngest doctors.

I write about Match Day in this week's "Doctor and Patient" column. As always, I'd appreciate learning about your thoughts either below or on Tara Parker-Pope's "Well" blog.

When Patients Feel Abandoned by Doctors

Do doctors abandon their dying patients at the end of life, even when they don't mean to?

This week the Archives of Internal Medicine published a study from the University of Washington and the Fred Hutchinson Cancer Research Center in Seattle that followed 55 terminal patients over the year prior to death, as well as the dozens of family caregivers, nurses, and doctors who cared for them. The findings were particularly poignant.  While most doctors were aware of patients' abandonment fears and consciously tried to address them, patients and their caregivers still ended up feeling abandoned by their doctors around the time of death.

According to the study investigators, this sense of abandonment could be mitigated if physicians did a better job giving patients and their families a sense of closure at the end of life.

I had a chance to speak with the study's lead author, Dr. Anthony L. Back, about his study's findings, difficult conversations, and his own experiences giving patients and their families closure. I also had a chance, I hope, to bring long overdue closure to a family I cared for several years ago.

You can read more in this week's "Doctor and Patient" column. And please leave your thoughts and comments below or on Tara Parker-Pope's "Well" blog.

On Young Doctors and Long Workdays

Last month, the Accreditation Council for Graduate Medical Education issued an open letter outlining its plans to review, revise and enforce the duty hours of residents, young doctors recently graduated from medical school. The council came under criticism this past December in a report by the Institute of Medicine. The report charged that despite mandating an 80-hour-per-week cap in 2003, the council failed to address duty hour violations that were “substantial and underreported.”

This week in "Doctor and Patient," I speak to Dr. Thomas Nasca, the chief executive officer of the ACGME. Dr. Nasca talks about resident duty hours, patient safety in teaching hospitals, and the realities of medical practice today.

What do you think about the 80-hour-per-workweek mandate and how should the ACGME proceed?