Residency - Dr. Mursi, MD

Delivering Bad News As a Physician

During my hospice rotation in residency, Dr. B, the hospice director, asked me questions that really caught me off guard. The rhetorical questions went like this: “Are you uncomfortable delivering bad news to patients because you are projecting your feelings? Are you uncomfortable with death, and therefore, you have a hard time talking about it?”

During this time, my mom was still battling breast cancer. When Dr. B posed these questions to me, I was taken aback. I looked him straight in the eyes, and as I repeated his questions in my head, I began to feel a sense of confusion. Am I uncomfortable talking about death because I am uncomfortable with the idea of death? Am I afraid of my mom dying because I don’t want to feel the pain of her loss? Am I afraid of dying? Am I projecting my fear onto my mom?

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When caring for someone kind and loving, you want to ensure they feel your love and joy in return. You want them to have everything they could ever want. How do you give them everything when you don’t have the most important thing to offer, time? When I posed this question to Dr. B, he reminded me that projecting my own emotions onto my mom was not helpful. Those are your emotions; you may be projecting pain onto her when she just needs your presence of joy and love. Your mother likely has her own fears and anxieties, and projecting your own onto her would only make things worse.

As physicians, we have many responsibilities, including delivering bad news. Instead of learning how to deliver news, we should learn how to manage our own emotions to deliver news more effectively.

Death is a complex topic that affects everyone. It is an inevitable part of life that we all have to face. From the moment we are born, we carry a proverbial ticking bomb inside us that will eventually go off, whether it is in two years or over a hundred. It doesn’t matter what our personal preferences are; death comes for us all and maybe there is beauty in that.

Medicine Life/

The Struggle: Doctoring by Day, Studying by Night

Being a doctor is a noble and rewarding profession, but it has its own challenges. One of the things that people need to realize is how tired doctors get after caring for patients all day. Also, doctors must keep learning and studying to keep up with new research and treatments. This can be tough when they’re already tired. In this article, we’ll talk about how doctors deal with this struggle and how we can balance our work and studies.

The Exhaustion: A Doctor’s Daily Dose

As doctors, we must make crucial decisions, work long hours, and care for our patients’ emotional wellbeing. This can take a toll on our mental and physical energy. After a long day at work, even the most resilient doctors can feel drained, exhausted, and emotionally spent.

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The Challenge of Continued Learning

Doctors must keep learning new things about medicine, from new treatments to research. We have to keep up with the latest developments in our field, which means studying on our own time outside of work.

The Struggle to Study: A Balancing Act

With our busy lifestyle, it takes work to balance our medical career and our studies. Even though we are already tired, we must read textbooks, research papers, and medical literature to stay current. This can mean giving up our free time and resting hours.

Coping Strategies for Physician Scholars

Create a Structured Schedule:
Make a study schedule that fits in with work commitments. Set specific time slots for study sessions, and make sure they’re manageable and manageable.
Prioritize Self-Care:
Taking care of oneself is crucial for wellbeing. Good sleep, healthy food, and regular exercise help maintain the energy levels required for both work and study.
Utilize Breaks Effectively:
Use work breaks to study a little. Studying a bit during the day is better than cramming it all in at night.
Seek Support and Connection:
Make friends with colleagues who understand the challenges. Share experiences, tips, and resources to make the burden bearable. Check out the 5 study tips I wish I listened to on YouTube
Set Realistic Goals:
Set achievable short-term and long-term goals for studying. This will help manage expectations and give a sense of accomplishment. Click here to listen to study tips for students from doctors

The Shared Journey
As doctors, we have the power to change people’s lives for the better. While it can be challenging to balance work and studies, always remember that your health is just as important. By prioritizing self-care and setting healthy boundaries, we can avoid burnout and continue providing our patients with the best care possible. Keep pushing forward, and always remember our positive impact on the world.

I hope this was helpful! Follow me on Instagram, TikTok, Threads, and subscribe to my YouTube Channel!

Medicine Life/

How to Establish and Communicate Boundaries Effectively

Medical School/

My ADHD Story

I was recommended to get evaluated for ADHD by my pediatric attending during my 3rd-year clinical rotations. I did not listen to her recommendations until I started to see her reasoning as I was functionally struggling, but always in near breakdown.

I was in denial because I saw ADHD as a form of weakness and even now still struggle with this idea (I know it is silly but my truth). I finally decided to get evaluated at the end of my third year of medical school. I got diagnosed and was started on the medication, methylphenidate. I tried it for a week or two and decided it wasn’t doing anything and I just needed to change my habits and learn to control my focus.

I continued to struggle but there were also a lot of other things happening in my personal life that I continued to make excuses for my symptoms.

My excuses:

My constant inner restlessness is all from my anxiety.
my anxiety is from having generalized anxiety disorder (GAD).
My impatience and impulsivity are part of my personality
My inattentiveness is my selective hearing and daydreaming habits from my childhood
My disorganization is just my lack of good habits
My forgetfulness is from being distracted by so much work.
My distracting behavior is from having so many things on my plate.
Remarks by friends and family are just remarks and it doesn’t mean anything.

I continued to just functionally struggle. I worked really, really hard and the payoff was average. Over time, I burnt out more frequently.

My mom was diagnosed with breast cancer. I began to get moody, and easily irritable and my anxiety even worsened. I continued to work on coping mechanisms and thought I was doing okay. I thought I was handling it well. I started my intern year of family medicine residency. The stress of my mom’s cancer and the stress of residency was taking on a further toll on me with uncontrolled ADHD.

I was struggling with residency as an intern and I had mentioned a history of ADHD to one of my attendings during an evaluation. I was again recommended to discuss treatment with my PCP.

I have been on methylphenidate for over a year now and my anxiety is more controlled, and my inner restlessness, impatience, impulsivity, distractibility, and disorganization have improved. On the days I don’t take my medication there is a difference compared to when I do. Often noted by others more than myself. I am learning to accept external help for my ADHD.

I struggled for years, I mean really struggled when I could have had it a little less difficult.

This was all shared as a reminder of the various insecurities everyone deals with. truthfully, I still struggle with admitting that I have ADHD out loud as I find this a weakness like I am making an excuse for not being good enough.

As always, my posts are always a self-reminder and a reminder that you are not alone.

@Dr.Mursi.MD

Medical School/

Response to Hardship

The Process of Healing – Journal Entry 1

Through these journal entries, I hope to help myself find meaning in life again after the loss of my mom. I share such a private journey publicly in the hopes of helping someone out there who is also in a lot of pain. You are not alone in your feelings. I am here with you. This can be our healing process. To make the most of these journal entries, I encourage you to be an active participant and journal along with me. Write out your thoughts after reading each journey entry. It can be concerning the topic I talk about or just your current existing thoughts running through your head, keeping you distracted.

HOW I RESPOND TO HARDSHIP

I have always believed there are three ways that you can respond to a painful happening in your life

1. You can get stuck in the past and drown in your sorrows.
2. You can deny its existence and just go with the flow of life.
3. You can acknowledge the pain and actively work on how to grow and
improve.

My response to hardship has mostly been about the next step. What do I have to do next to survive the hardship? What I have to focus on to make the burden of the pain I feel… less. I believe I am a person who often chooses the third option, but at times I feel I do practice the second.

What do I have to focus on to make the burden of the pain I feel… less.

Medicine Life/

You Are a Warrior

⚠️ My personal self-assessment post. I share as it may help someone else.

Are you worrying about things and feeling anxious/upset/overwhelmed? Here is a self-eval task that I did right before posting this and the outcome, keep reading.

💢 I started typing out what I worry about without pausing.
💢 As I kept typing I had a realization towards the end (one I have had before but reminded again about).
💢 I read through it and realized the theme of it and possibly the root cause.
💢 I begin taking deep breaths, slow and steady. 4 counts in and 6 counts out.
💢 I type out my thoughts base on my realization
💢 Then I remind myself what if I stopped worrying and believe that it will all work out. What if it all works out?

Now you try it!

Keep reading to see my self-analysis thoughts.

My freestyle:
I am a worrier. I worry about what happens next. I worry about my goals and where I want to be. I worry about not doing enough today for tomorrow to be better. I worry about missing something today that I would regret not finding sooner. I worry things are not happening now. I worry that if it doesn’t happen soon, then it won’t happen. I especially worry about losing time. I don’t want to lose time, so I want it now so I can be in that state longer or have it for longer.

My self-analysis:
My worrying makes me pushy. I push for things now. As soon as I have decided I want it, I act on it or make it known without a second thought. This has affected my relationships because when people are not on my page, I leave them behind. I move forward on my own. My family and friends would be screaming right now in agreement. I have known this about myself for some time now and it is difficult to change a habit which has also lead me to my achievements. Today it was brought to my attention that I could lose something very special because of my worries which causes me to be very pushy.

My reminder:
Instead of worrying about what happens far in the future work on what happens today, this week, this month. Let it all work out naturally because it will all work out nicely in the end. Enjoy the moments of now instead of waiting for the moments of tomorrow. This chapter will be a chapter you will look back. If you rush through it now, you will regret rushing the opportunity of life that you were given.

I hope that made sense.
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Medical School/

Initial HPI New Born Presentation Example

Click here to go to my google drive where you can access the PDF

If you are like me, you may have a hard time with presentations. Here is my contribution to teaching what I wish I was better taught and practiced more of! There is more to come! Let me know if this is helpful and if there are any recommendations that you may have! I will be making videos eventually going through these presentations to provide better details, etc. For now, I just did not want to delay it being posted any further.

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Mental Health/

We Need Actual Therapists To See Our Hospitalized Patients. Here is why:

If you work in a hospital setting, you know that most adult patients have multiple chronic diseases. While we take care of their physical illnesses, we are neglecting their mental health.

How many times have you left a patient’s room and they were still distraught with the news you delivered, or they are sad and disheartened being in the hospital. While yes, you gave a thorough explanation, several minutes to take the information in, and gave them the appropriate time to ask questions. You even provided them a touch of human interaction by placing your hand on their shoulder but was all that enough? Not likely.

Once physicians leave the room, it isn’t clear whether the patients are mentally handling their illnesses. It isn’t clear whether they are emotionally stable. It isn’t clear whether they know coping mechanisms. In fact, you may even acknowledge that they are emotionally drained. You may even ask them if they want to talk to a pastor (likely only a pastor is an option even though there are multiple faiths in America–besides the point), or you actually ask about their mental state. Then what? Most of the time, they deny being depressed. Let’s say they actually admit to being depressed and you offer them antidepressants. Awesome, add another medication to the list! Maybe you even acknowledged that they need a therapist and you connect them with the social worker who provides them with a list of therapists. Most likely, the social worker tells the patient to look at the back of their insurance card and call the behavioral health number to see what is covered by their insurance. Do I have all the scenarios down? And how long do you think it takes for a therapist to actually see the patients as an outpatient? MONTHS and MONTHS!!!

Dealing with physical health conditions is stressful and mentally exhausting. When patients are mentally exhausted, emotionally unstable they are less likely to take care of themselves. This increases their return to the hospital as their chronic diseases worsen. If money is your motivation, this costs billions of dollars because of constant readmissions and further requirements of treatment of their progressed diseases. AND this causes further progression of their mental illness(es) which adds emotionally unstable people in a society that may have other domino effects. The point being, mental health needs to be acknowledged and better addressed.

So, what can we do? I strongly believe we need to provide actual therapists to come and see patients. Similar to how we place consults for physical therapists or case management, we would place consults for a therapist.

You might ask, well, where the hell are the psychiatrists? That is a good point. They only show up when patients are in an active state of suicide, homicide, or self-harm (or having a psychotic breakdown, etc). In terms of the hospitalists, they are seeing a number of patients and often do not have the appropriate time that the patient actually needs and deserves. Plus, not all doctors know how to or are appropriately trained to provide appropriate mental health advice. Therapists would provide patients their undivided attention also provide them with coping mechanisms and mental health goals that they can work on during the patient’s admission. Also, this increases job opportunities.

The days I have more time to talk and listen to my hospitalized patients, I see a huge difference in their spirit and mental state of mind. I can’t say enough how absolutely honored I feel knowing I have lifted their spirits. While I would always and forever make my best effort to do this more often, the reality is that there isn’t enough time every time. The reality also is that not all doctors may put that effort, therefore there isn’t consistency. While a hired therapist’s job is to be consistent. Hiring hospital therapists will provide patients with the mental health support they deserve, therefore bettering their outcomes in their physical health, etc. I can’t prove it just yet but I can just about guarantee it.

What are your thoughts? Does this make sense? Do you currently work in a hospital that provides therapists?

General Medicine/

Distrust in Medicine, an ongoing conversation

Distrust in Medical Professionals, an ongoing conversation ☝🏼

There are various working parts that contribute to this.
My intention in this post is to first and foremost remind myself to avoid these mistakes that can endanger my patient’s trust in me but to also advocate for patients and provide a reminder for physicians.

Over the past 2 years now, I have a better understanding of why there is such distrust in medical professionals, especially now as a resident while being an advocate for my mom during her hospitalizations. I believe one of the key components that play a large role in this mistrust is the lack of proper communication with patients and the lack of taking the time to understand them.

Here are some reasons that I believe play a part in the mistrust in medical professionals.

🗣 Rushing through and not providing a thorough explanation to educate/inform patients on what is going on with their health. This is especially something I take to heart because I truly believe that we can make a difference in the number of chronic disease incidence by simply taking the time to educate our patients.

🗣 Patients are left in the dark, this is especially something that occurs in the hospital setting. Patients often do not know what tests were done and why. They don’t know what the plan is or are confused because they are receiving different information from different specialists. The lack of proper updates and proper explanation of patients’ health management not only causes mistrust but also causes poor compliance and poor outcome. Often patients put their full trust in the team and believe that everything is done exactly right. And while I naively believed this to be true, it isn’t always. And this isn’t to add further mistrust, but it is to say that physicians should deliver honest and thorough information, which may decrease the chances of mistakes, but patients should learn to ask tough questions and be an active participant in their care. I think medicine is incredible, but it is flawed and the people running it are also flawed (not perfect).

🗣 When patients state their concerns and their concerns are then downplayed or dismissed altogether. This can cause a disconnect, especially when patients are made to feel like an idiot for even stating those concerns. This can lead to keeping crucial information that could help to establish the diagnosis and lead to being placed in situations, like ending in the emergency department when it could have been prevented had they felt comfortable confiding to their PCP, for example.

🗣 The use of condescending or annoyed tone when speaking to patients. This is the absolute worst. There is a difference between talking to patients in a stern and confident manner versus a demeaning and cocky manner. Similar to what was mentioned previously, patients will avoid deliverance of important information because there is that insecurity that can form in patients due to the way they were spoken to.

🗣 Physicians may see the patient’s diagnosis on a regular basis, but the patient may be learning about it for the first time. I think this can be due to becoming immune to a routine: diagnose, treat, on to the next patient, diagnose, treat, on to the next patient — which can unintentionally lead to the false belief that the patient knows more than they actually do. To run away from the room soon after delivering the news can lead to not only distrust but improper care.

This was a long post. I got really into it.
Again, my intention is to first and foremost remind myself to avoid these mistakes that can endanger my patient’s trust in me, and also to advocate for and teach patients and provide a reminder for physicians.

Residency/

My Amazon Purchases for My New Apartment!

Hi, you beautiful people!!! Welcome (welcome back) to my blog!

I am really excited to move into my own apartment and kinda “start life” as a new and upcoming resident. Who knows what the future brings and what will happen and how things will happen, but I am excited!! It is exciting to prepare for it and at the same time be in the present and enjoy the process!!! So, if you are also in the same boat and looking for similar things maybe, here is my on-going list of my AMAZON purchases for the new apartment! I will continue to update this list, so come back again in the future to this very post and you will see new added items as I purchase them!

I hope you guys find this helpful! And be sure to check back when you are looking for more items as I will update this very post as I shop for more stuff! I will have this post pinned on top of my main page when it gets updated as well! Happy shopping!

PS. check out my chit-chat YouTube video where I do my hair and talk about residency preparation, breaking cultural rules and about the #blacklivesmatter movement!

Much love,
Mursi

Category: Residency

The Exhaustion: A Doctor’s Daily Dose

The Challenge of Continued Learning

The Struggle to Study: A Balancing Act

Coping Strategies for Physician Scholars

My excuses:

I struggled for years, I mean really struggled when I could have had it a little less difficult.

The Process of Healing – Journal Entry 1

HOW I RESPOND TO HARDSHIP

Now you try it!

Bedroom

Bathroom

Living Room

Kitchen

Miscellaneous