The stethoscope. Nothings says “I’m a doctor” more than the stethoscope in a pocket or draped around the neck. Forty-five years ago when I got my first one, a gift from my physician-father, the former was more common. Then we were more likely to wear coats — white coats or suit coats — and pockets were available. I had suit coats in which the lining was worn out from the …
The evolution of the stethoscope
We all know that there’s a remarkable shortage of physicians in America and that it’s growing worse. This is especially true in primary care but it’s present across all specialties. This shortage alone is a significant stress on practicing physicians. But when it is coupled with corporatization, the increasing complexity of medical care, unrelenting electronic charting requirements and the explosion of administrative tasks, physicians barely keep up each day.
This is one of the …
The risks of co-signing PA and NP charts
Back when cholesterol target numbers ruled unopposed (before 2013), we all checked fasting lipids every three months. Before 2012, we also checked liver function quarterly in hapless riders on the cholesterol pill merry-go-round. That year the FDA announced there had not been enough reports of statin-induced liver problems to recommend routine monitoring.
I have many colleagues who still do this, and who also routinely monitor routine labs quarterly …
Figuring out what’s actually true is far harder than most people realize. Our brains are both hypothesis-generating machines and incredibly credulous. As a result, most of the things we believe to be true turn out to be false. We don’t just mistakenly believe that vaccines cause autism, that the flu shot can give us the flu, and that astrology can predict our future. We also mistakenly believe that the salad …
The main difference between functional medicine and evidence-based medicine
Health care policy has been a hotly debated political topic for many years now. In recent years, new laws passed the halls of Congress while others failed to gain any traction. Despite the rules that have rolled out, health insurance companies have been in the driver’s seat for decades.
While spokespersons for the health insurance industry will tell you that they do not make medical decisions. As a doctor, I can …
How do health insurance companies harm patients?
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Those of us who provide clinical care inevitably have patients who simply don’t do what we tell them. And this isn’t limited to only primary care but is encountered in all specialties and by subspecialists and consultants alike.
Not only can this be frustrating …
Why patients don’t do what physicians tell them
This article is sponsored by Careers by KevinMD.com.
When searching for a new job, building strong relationships is an important part of the process, especially when you’re working with a physician recruiter. The relationship you create with your recruiter will set the tone for your job search and ultimately have an effect on whether or not you …
6 ways to better work with physician recruiters
I swiped this editorial cartoon by Steve Sack from the redoubtable Dr. David Gorski’s blog, who goes by the nom-de-web of Orac. Recent epidemiology shows reducing the fraction of vaccinated children in the population rather promptly leads to a resurgence of the diseases vaccines protect against. This is the concept of community or herd immunity. …
Why demanding a randomized controlled trial for vaccines is disingenuous
I remember sitting in my residency academic adviser’s office as I was discussing the plans I had designed for my community project at the end of my intern year. I can only imagine what she thought as I looked at her with a blank stare when she had suggested I should create an original research project around this. “What?” was all I had managed to mumble out of my mouth. …
5 lessons on doing research as a resident
“There will always be suffering. It flows through life like water …”
Those famous lyrics sung by Nick Cave in his Lime-Tree Arbour ring true for many of us. They take on an entirely different layer of meaning for physicians.
Even the very journey of becoming a physician is marked by suffering. While many of our classmates frequented football games, nightclubs, and social events, most of us were studying day and night …
The gift of suffering in medicine
“Passion isn’t a path in the woods. It is the woods.”
-Tom Robbins, “Half Asleep in Frog Pajamas”
I’ve met plenty of accidental physicians. These have been photographers, travel writers, artists, outdoor guides and chefs who awoke one day to find themselves doctoring. Their passions didn’t die — they were just delayed by lifestyle choices. By the time they recognized a need to follow their passion, they were at least partially through …
It’s better to not go into medicine than try to get out of it
Have you ever felt so cold? I mean bone-chilling cold. I don’t mean the same kind of cold that northern winters can leave you feeling. I am talking about working in a hospital that is climate-controlled, and you are undoubtedly shivering.
I still remember my first day on the job as a neonatology fellow. I was anxiously walking to the operating room to attend the delivery of a 25-week infant. As …
A physician loves the adrenaline surge
Sometimes things go just the way you want them to, and sometimes they don’t.
Compare and contrast the case of two different patients, and how things went trying to get them the care they needed.
The first patient, let’s call him Mr. Smith, called up one day last week with a brand-new symptom, which after a phone call was ultimately determined to be disturbing enough that he was offered a same-day appointment.
After …
When physicians order tests: a tale of 2 patients
I don’t miss making the phone calls in the middle of the night.
“Hi, this is Dr. Yang calling from the psychiatric emergency service. May I speak to Mr. or Mrs. Doe?”
“Yeah, this is Mr. Doe,” he’d reply, his voice thick and slow with sleep.
“I’m sorry to call so late. Your son is here at the hospital.” Take a breath and slow down for the next part. “He’s alive and doing OK at …
The phone calls physicians make in the middle of the night
The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20 percent for Medicare patients (higher for certain patients, with up to a third of these occurring in the first 7 days), there is an …
We can do a better job with hospital discharge paperwork
Failure is a guarantee. “Success” assumes that certain metrics have been set and that the words used to describe those metrics are understood in the exact same way by all parties involved. One patient with parotid cancer and given facial paralysis after surgery was thrilled to be alive. Another is furious about a widened scar.
The brain, primed to act on behalf of the organism, works at times without our input …
Why physicians should embrace failure
In the era of #MeToo, Missy Elliot, Whitney Houston, Tyler Perry, Oprah, Ashley Judd, Gabrielle Union, Teri Hatcher and, now, Padma Lakshmi — keeping kids safe and helping adults heal is our job as physicians. I am a pediatrician — and I am an incest survivor. My perpetrator was also a physician. I bore a dirty secret before I knew what a secret was. The person who hurt me was …
Don’t ignore incest: advice from an incest survivor
The medicine I practiced between 1974 to 1992 is gone. Evidence is the coin of the realm in the courts of modern medicine. The rule “first, do no harm” demands a corollary — be paranoid.
We receive extensive training and licensure to “touch” patients. Any person who is not a physician who cuts into another person commits a very serious crime. The same is true for merely talking with a person, …
Care but don’t touch: Being wise in the modern era
A vivid memory stands out from my career.
Driving home from the hospital at 3 a.m., I reflected upon my most recent patient’s middle of the night delivery. It wasn’t an easy delivery, as they often aren’t. However, in the end, we had a healthy mom and baby and the family couldn’t have been happier — nor could I.
I felt a sense of gratitude as I was driving in the darkness …
How physicians’ grit is being taken advantage of
I had the fascinating experience of interviewing for residency at 20+ weeks’ pregnant. Although a number of people told me that I was doomed, I found the experience to be quite enlightening. Since I couldn’t hide the fact that life outside medicine was going to be important to me during residency, I felt empowered to ask the “don’t ask” questions during my interviews. What did I have to lose? The …
If you are ready to become a parent, don’t let residency stop you
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