Should white coats be only worn by physicians?

Physician
May 7, 2016

Maybe it’s just me, and maybe this is a regional/local phenomenon, but I have noticed a sharp increase in the number of non-physicians who sport their white coats on a daily basis around the hospital.

First, let me preface this piece by saying I have absolutely nothing against any person who partakes in the care of patients; in fact, I commend all the helping hands that routinely dedicate themselves to health …

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Should white coats be only worn by physicians?

When patients cry, please don’t do this

Physician
May 2, 2016

Just three weeks earlier, she had noticed something strange about one of her breasts. An irregular shape. Her daughter brought her to the doctor, and soon the patient, I’ll call her Amanda, was diagnosed with breast cancer, stage “to be determined.” In fact, she was now in an oncologist’s office, learning what tests she would receive to determine the extent of her tumor. And sitting between her and the doctor …

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When patients cry, please don’t do this

Conquering guilt as a trauma surgeon mother

Physician
April 30, 2016

Guilt was not a huge part of my vocabulary until I became a mom.  I never felt much guilt about how I spent my time.  Didn’t feel guilty about sleeping in, or working out, or having a girls’ night out.  And so on and so forth.

And then I became a mom.  You know, that moment when you get shoved into the most beautiful world; a place more beautiful than you could …

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Conquering guilt as a trauma surgeon mother

“You can’t create an addict in the ER.” Yes, you can.

Physician
April 29, 2016

I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs.

I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in …

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“You can’t create an addict in the ER.” Yes, you can.

What this physician learned from the starfish story

Physician
April 27, 2016

I thought about the rather corny starfish story when I was driving home after clinic today. You know the one. It goes something like this:

A man was walking along a deserted beach at sunset. As he walked, he could see a young boy in the distance. As he drew nearer, he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again …

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What this physician learned from the starfish story

Surgical residency hurt the people that mean the most to me

Physician
April 27, 2016

Three weekday call shifts left and two more weekends. The light at the end of the tunnel is shining bright, and I am relieved to be walking towards it. The only question that remains is what will I have left of myself and my life when I get there?

I started residency with a husband who I loved more than life itself. I was codependent to a fault, never wanted to …

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Surgical residency hurt the people that mean the most to me

Every physician is a wounded healer

Physician
April 24, 2016

I recall during my freshman year in medical school, sitting in class and listening to what were supposed to be 50-minute lectures from people who’d been teaching the same course for years. These were highly educated and intelligent folks; they knew how much material they could cover in 50 minutes. Yet, they frequently went past their time; encroaching on what was for some a badly needed bathroom break, and for …

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Every physician is a wounded healer

Ask patients how they feel, along with how they are feeling

Physician
April 23, 2016

“How are you feeling?”

It’s a question we frequently ask patients — on rounds, in the clinic, post-operatively — and with all good intentions and gentility.  But, do we ever stop to think: What is really the point of this question?  What information are we trying to glean?  I think for most of us, we’re asking the question with a cognitive bias towards the physical.  How are they “physically” feeling: better, …

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Ask patients how they feel, along with how they are feeling

Medicine is the most emotional profession. This story proves it.

Physician
April 19, 2016

There you are in your father’s arms. He is practically running to keep up with the triage nurse. The nurse is walking quickly toward the room that we leave open for true emergencies and the sickest patients. Your father’s eyes are full of fear, and the nurse’s tone is worrisome.

I look down at you all snuggled up to your father’s chest. You are beautiful. So small and bright-eyed. You don’t …

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Medicine is the most emotional profession. This story proves it.

You should want surgery residents for your operation. Here’s why.

Physician
April 19, 2016

A few months ago, I got the dreaded 2 a.m. consult from the emergency department. I met Mr. Smith, a man with a very strange looking and inflamed gallbladder. The abnormal appearance on ultrasound meant we had to discuss the possibility of malignancy. Instead of the usual 15-minute spiel about removing the gallbladder, I spoke to the patient and his wife for nearly an hour. I drew the anatomy. I discussed …

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You should want surgery residents for your operation. Here’s why.

How to destroy a great ER: A step by step guide

Physician
April 19, 2016

I took a fantastic emergency medicine (EM) job when I finished residency.  There was no question in my mind that it was the best job within a hundred mile radius, maybe more.  When I first started, my expectations were met.  My group held a contract to staff a busy but well-staffed suburban emergency department, and had held that contract for almost 20 years when I signed.  The hospital was independent, …

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How to destroy a great ER: A step by step guide

Doctors need to fall back in love with medicine. Here’s how to do it.

Physician
April 17, 2016

If you are a doctor, everywhere you hear or read about all that is wrong in medicine.  Please do not get me wrong, the medical profession is under assault.  Change is occurring all around us, and much of it has the potential to be disastrous to not only us and our families, but more importantly to our patients.  For many of us in the profession, we feel helpless.  We feel …

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Doctors need to fall back in love with medicine. Here’s how to do it.

Your anger towards doctors is misplaced

Physician
April 17, 2016

I learned that the 148-year-old community hospital that I did my residency at will be closing, and I am angry. Who am I angry at? Myself. Oh, and you. I’m angry at us because we as a country have turned our backs on one another. And in the end, your relationship with your own doctor is in jeopardy.

Pawtucket, Rhode Island, home of Memorial Hospital, used to be a prosperous mill …

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Your anger towards doctors is misplaced

Doctors can’t see the forest from the trees. And it’s cost them.

Physician
April 15, 2016

Doctors have an interesting problem. They have an ingrained professional obsessive-compulsive habit; they fixate on the care of individual patients and on the science of healing. This is an admirable trait; it results in high-quality care. However, when physicians need to change their attention from healer to leader, from medicine to the business of medicine, from health care to the health care system, they falter. Stuck in silos, they fail to …

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Doctors can’t see the forest from the trees. And it’s cost them.

Who are the patients that stay in the hospital for a very long time?

Physician
April 11, 2016

I just finished reading a very delightful A Piece of My Mind essay in JAMA.  JAMA is primarily a research journal, filled with new scientific or semi-scientific studies and comments on those, plus reviews of the literature and editorials on science or politics. There are also letters and announcements and educational sections for doctors or patients, even poems, but the part I like to read all the way through is …

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Who are the patients that stay in the hospital for a very long time?

Making your own infant formula at home is a recipe for disaster

Physician
April 9, 2016

Recently, former reality television star Kristin Cavallari released a potentially lethal recipe for homemade baby formula in her new lifestyle book, Balancing in Heels.  Cavallari, who rose to fame as high-schooler on MTV’s Laguna Beach, is attempting to rebrand herself as an all-organic Suzy homemaker and offering dangerous medical advice along the way.

In her book, Cavallari goes against all conventional medical wisdom, advocating for feeding young babies a homemade concoction instead …

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Making your own infant formula at home is a recipe for disaster

American health care has a customer service problem

Physician
April 7, 2016

No, customer service in the U.S. is terrible when it comes to health care.  No, the customer service in the U.S. health care system is horrendous.  No, health care has the worst customer service of any industry in the U.S.

There.  That seems about right.

What makes me utter such a bold statement?  Experience.  I regularly hear the following from people when they come to my practice:

American health care has a customer service problem

Patient-centered perioperative checklists to improve surgical care quality

Physician
April 4, 2016

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

With the recent expansion of ambulatory surgical centers, the number of outpatient surgical procedures has increased at an exponential rate. Coupled with the rise in volume has been the increasing complexity of procedures and underlying diseases of patients. The convergence of these factors …

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Patient-centered perioperative checklists to improve surgical care quality

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