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It’s Not Too Late, from page 13 MDs to stay informed and updated on appropriate standards, be they about life-or-death choices, financial conflicts of interest, or other issues.

Resources AMA Council on Ethical and Judicial Affairs: go/ceja “Clinical Bioethics: A Practical Approach to Ethical Decisions in Clinical Medicine,” by Albert Jonsen, Mark Siegler, and William Winslade. w w w. m hprofe s siona l .c om /pro duc t .php?s e a rc h _ crawl=true&isbn=0071491538


The media confirm that we live in a violent world. Anyone who has spent time in an emergency department knows that, but much (or arguably most) violence is concealed. “Domestic” (partner, elder, child) violence is endemic. Like addiction, it often goes unrecognized, untreated, and unreported, although it impacts a patient’s health as much or more than any other factor in life. Physicians need to learn methods of identifying and treating or referring issues revolving around domestic abuse, including hospital protocols, patient counseling, and resources available to patients. (Gun control and community violence are unfortunately beyond our scope here.)

Resources “Domestic Violence: A Practical Approach for Clinicians.” San Francisco Medical Society: “Simplifying Physicians’ Response to Domestic Violence.” www.

Environmental health

No man or woman is an island. Our environment affects our health in more ways than we usually imagine. So where and how a patient lives and what they eat, drink, and breathe are all factors physicians need to know something about. Knowledge is rapidly growing about the impact of chemicals, infectious agents, irradiation, maybe even global warming on our environment, bodies, and health. An “environmental history” is part of good clinical assessment—particularly for children, who are often most severely affected. Physicians have the unique opportunity to link personal and environmental status, which can be important for prevention and for acute and chronic care.

Resources The Collaborative on Health and the Environment: Medicine and the Environment: Practice, Prevention, and Policy: Medicine&Template=/CM/HTMLDisplay.cfm&ContentID=2978

more when a respected clinician speaks and acts on behalf of policy issues and public health. This voice becomes ever more important as modern “health reform” evolves.

Resources “Understanding Health Policy: A Clinical Approach,” by Thomas S. Bodenheimer and Kevin Grumbach. UCSF Institute of Health Policy Studies: www.ihps.medschool.ucsf. edu/

The business and organization of medicine

Physicians have rarely been taught much about how to run a medical practice or manage finances. Thus, the old stereotype about physicians being brilliant at medicine, but ignorant about money, is often not too far from the truth. Depending on what type of practice environment a doctor works in, this is more or less important. But everyone should know, for example, about health insurance, managed care, electronic health records, and other information technology, down to negotiating rent and personnel issues. How to work effectively as a care team is crucial as well. This arena, too, is ever more important with evolving “health reform.” And knowing about how pharmaceutical industry money has intruded on medical practice (and education) is important, too.

Resources Contact your local medical society for educational opportunities on practice management, electronic health records, and so on. Marketing of Medicines: An online CME course from UCSF: w w aspx?coursenumber=MED11006

Your own well-being

Anyone who has read this far might have a sense of being overwhelmed by all there is to know and do. It’s a common feeling among physicians (and medical students); it may be one reason for the tragic fact that physicians are at elevated risk for depression, substance abuse, and suicide. Frustration in meeting expectations both external and internal, stress from all sources, and the challenge of leading a balanced life are common problems. Many physicians may also struggle with feeling they have an unrewarding life and career. Physicians need to be aware of resources available to address their needs, able to define and maintain priorities, and recognize the numerous daily rewards that are unique to the medical profession. Doing so can help one retain the idealism that so often motivates the career choice of medicine in the first place.

Resources RENEW: “The Heart of Medicine”:

Health policy

Many clinicians may believe, or wish, that their practices exist in social vacuums, but that is untrue. Priorities and decisions made—or not made—in legislative arenas affect what kinds of clinical problems come in your door and what you can do about them. Public health— epidemiology, prevention, and so on—have long been neglected factors in medical education and practice. Yet physicians have high credibility among the public and legislators, and that prestige is heightened even 14 | THE BULLETIN | MARCH / APRIL 2011

Dr. Philip Lee is chancellor emeritus of UCSF, former United States assistant secretary of health, and professor emeritus at Stanford University’s program in Human Biology and in the Department of Medicine at UCSF. Steve Heilig is director of public health and education for the San Francisco Medical Society and the Collaborative on Health and the Environment and coeditor of the Cambridge Quarterly of Healthcare Ethics.

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