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A Piece of My Mind
November 2, 2011

The Quiet Epidemic

Author Affiliations

Author Affiliations: Rehabilitation Services and Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital; Section of Rheumatology, Boston VA Healthcare System, Boston, Massachusetts (Dr Liang). Dr Chang is Contributing Editor, JAMA (tina.chang@jama-archives.org).

JAMA. 2011;306(17):1843-1844. doi:10.1001/jama.2011.1587

To sin by silence when they should protest makes cowards of men. —Abraham Lincoln

Last year a resident sent an e-mail harangue about how much time it was taking her to do the things her preceptor had asked her to do for patients. It had eaten into her “free time” to take care of these patients. Although she may have been tired at the time she wrote the e-mail, this resident is a very conscientious physician. She wanted to say that being a physician is a “job,” that she should not be spending so much of her time “following up from clinic,” and that her preceptor “has to stop doing so much for the patients,” because this was part of that clinic. She listed examples: she had answered a question from neurology about the necessity of referring a patient to neurosurgery for his debilitating back pain; she had answered a question from pharmacy about a patient's hyalgan injection (a last-ditch effort to avoid either an electric scooter or a knee-replacement surgery); she had talked to a patient who was unclear about his medication after leaving the clinic (she was the resident who saw him); she had had to clarify whether an MRI was necessary in a patient and then whether or not to use contrast; she had to call a patient at home after arranging a 23-hour observation to begin rituxan infusions to give him the date of admission. Incredulous and saddened, we felt it highlighted a generational change in what it means to be a physician and the expectations of some of its younger members.1

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