“So this is Christmas, and what have you done?” John Lennon sang from my nightstand, waking me out of a deep slumber.
Bleary-eyed, I pondered his question: What have I been doing all year?
A decade ago, my conversations with my younger brother, went something like this: “Do anything but medicine for God’s sake, save your soul, man!”
He’s now an emergency room doc. …
What I learned from the next generation of doctors
There’s a lot of angst when it comes to board recertification. The general consensus is that doctors find the requirements onerous, while a more cynical segment calls the whole process a money-making operation for our professional societies and those that profit from recertification courses and materials.
Cardiologist Wes Fisher has articulated the many criticisms against board recertification: “Does board recertification …
How to fix maintenance of certification: Here’s what I’d do
I had just started the sexual health clinic at Massachusetts General Hospital (MGH) when I was approached to meet with a group of prostate cancer survivors. I was hesitant at first — my interests were in female cancer survivors who had experienced sexual dysfunction. This was partly because I had assumed men had an easier time accessing information on …
After prostate cancer treatment: What about intimacy for men?
I think I will become a neurosurgeon. Tomorrow.
It shouldn’t be too hard, right? I’m a breast cancer surgeon, and that is kind of like being a neurosurgeon, isn’t it? I wear scrubs and know how to tie knots really well. OK, maybe I don’t know much about the brain, and the last time I was on a neurosurgical team was during …
Why hospitals have to dramatically change their missions
Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death.
Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. …
How to introduce palliative care to patients
Mr. B shook my hand as the paramedics got the stretcher ready to send him to a nursing home. His firm grip punctuated the end of a long hospitalization, which had been characterized by several decisions to leave the hospital against medical advice into extremely unsafe situations, leading into complex capacity evaluation decisions.
It was a pleasure to take care of you, I told him. He smirked back at me and …
The conflicting feelings a new intern has for a patient
She arrived by ambulance in the middle of the night, awake, alert, and bleeding like crazy. We’d gotten a call earlier in the evening that she was on her way from a small hospital about forty miles to the north. We were the big city hospital, and an attending physician had agreed to have her transferred for a life-saving procedure, in this case a shunt that might stop her bleeding.
People …
Witness to a patient, losing her life in front of us
Since starting a direct primary care (DPC) practice nearly three years ago, I’ve become accustomed to skepticism and even the occasional criticism. Given the status quo, I understand it’s difficult for some to envision a model that could be better for family physicians and our patients than traditional fee-for-service practice.
Two common concerns about DPC have emerged during my conversations with fellow …
Direct primary care: Setting the record straight
“My wife died uncomfortable and alone. She died thirsty!”
The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to …
She died thirsty! Ice chips matter when it comes to patient satisfaction.
Most of us reject the rational argument that better medical quality costs more money. Conversely, I have argued that spending less money could improve medical outcomes. Developing incentives to reduce unnecessary medical tests and treatments should be our fundamental strategy. Not a day passes that I don’t confront excessive and unnecessary medical care — some of it mine — being foisted on patients.
At one point in my career, I would …
Should doctors consider costs when making medical decisions?
I keep six honest serving-men
(They taught me all I knew);
Their names are What and Why and When
And How and Where and Who.
– Rudyard Kipling
Medicine has become a very complex, multifaceted science, ranging from pharmacogenetics to psychoneurobiology. Doctoring, however, is increasingly viewed as so simple that you don’t actually have to be a doctor to know how it should be done.
What else could explain why IT people tell doctors what “workflows” …
Medicine is complex, but doctoring is viewed as being simple
It started with a mild case of nausea and got progressively worse. I became dizzy and shaky, but tried to ignore it. There was work to be done that afternoon. We were moving boxes into storage at my in-laws’ house in Michigan, and I needed to be strong. I carried boxes on unsteady feet, catching myself before bumping into walls. By early evening my legs were wobbly, and I felt …
A costly anomaly on a brain MRI
A common complaint regarding the use of electronic medical records (EMRs) is that physicians spend the majority of their time with a patient “tinkering” on a computer rather than interacting with the patient.
Use of EMRs is now mandatory in the U.S., creating many advantages: Patient information can be more easily shared in a secure environment, there are no lost files or …
Medical scribes are a solution to click overload
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Are millennial doctors well trained for the 21st century? That was the question posed in NPR’s Millennial Doctors May Be More Tech-Savvy, But Is That Better? I believe how millennial doctors are educated may make them less adequately prepared than previous generations. This isn’t a reflection of medical education, but of education in general.
Are millennial doctors ready for 21st century medicine?
Dr. Kenneth Azar, a mentor of mine at the old Georgia Regional Psychiatric Hospital in Augusta, Georgia, told me something once that has always stuck with me.
He told me that in the early years of his practice, when he was living and working out in Idaho, that he was one of a very small handful of psychiatrists who served the whole state. If an adult with psychosis needed to be …
A child psychiatrist: Whether I choose to be one or not
No one wants a hospital-acquired infection — a wound infection, a central line infection, or any other kind. But today, the level of concern in American hospitals about infection rates has reached a new peak — better termed paranoia than legitimate concern.
The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies. As far as I can tell, …
The paranoia surrounding hospital infection rates
The holiday season is well underway. This is the time of year for celebrating with family and close friends and reflecting on what is truly important to us. It can also be a time of significant stress, inevitable over-eating and deviation from our usual routines. Essentially, the holidays can be hazardous to your health and this is particularly true when it comes to your gastrointestinal (GI) system. So what can …
Say happy holidays to your GI tract
A guest column by the American College of Physicians, exclusive to KevinMD.com.
One of the American College of Physicians’ priority areas for the current fiscal year is to “Help ACP members experience more joy in their professional lives.” This includes decreasing what is known as the “hassle factor” that …
Ways to reduce administrative burdens on physicians
An excerpt from The Myths of Modern Medicine: The Alarming Truth about American Health Care (Rowman & Littlefield).
Myth 1: “The United States boasts the best health care in the world.”
Betsy Lehman trusted her life to the American health care system. An award-winning journalist, Lehman was a rising star at the Boston Globe, where she wrote extensively about health care issues. So when the mother of two was …
Physicians must be the architects of health care change
This is an open love letter about my left leg.
I broke it at a roller derby scrimmage in Detroit on September 6. It was my third time representing the Glass City Rollers on the road and the beginning of a long ordeal that has given me plenty of opportunity to reflect on my body and my wellness goals.
Before this injury, my …
An open love letter to my broken leg
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