Physician

Physicians with anxiety shouldn’t suffer in silence

Anonymous

Physician

January 1, 2016

I thought about you, the patient that I’m about to perform surgery on, all night last night and because I doubted myself, I took clonazepam to calm the anxiety so I could sleep. Today I’ve taken 10 mg of propranolol and some Kava, a natural supplement known to decrease anxiety.

As I start the surgery, the propranolol coursing through my veins blocking the sympathetic nervous system, I fear it will come. …

The exotic choice of staying home: Why CME rules have to change

David M. Mitchell, MD, PhD

Physician

December 30, 2015

San Diego, Tucson, Orlando, and Dallas. Those are a few of the modest destinations to which I have traveled, as a hospitalist, to attend CME conferences, using the pre-tax CME benefit from my employer, including paid days off.

As a young professional, my yearly CME trips gave me a mildly magical sense of privilege: “Really? They’re going to pay for all of this?” Browsing through various CME conference options and dreaming …

Doctors and nurses need better support when they make errors

Nina Shapiro, MD

Physician

December 28, 2015

In September 2010, a seasoned pediatric intensive care unit nurse administered an accidental overdose to a critically ill baby, giving ten times the amount of calcium that was prescribed. Five days later, this baby, with an already tenuous heart condition, died. The nurse recognized her mistake immediately, informed her superior, and also told the family and physicians. She was, however, escorted out of the hospital, put on administrative leave, and …

When “healing” loses its meaning: A cynical medical resident meets Patch Adams

David Zacharias, MD, MPH

Physician

December 26, 2015

The afternoon began like any other day in medical school. Students arrived at the lecture hall and took their seats. An individual with long blue-and-white hair and handlebar mustache entered the room wearing oversized fish-print pants, a loose-fitting clown shirt, and a single earing fashioned out of a bent fork. He casually strolled up to the front, introduced himself as Dr. Patch Adams, and told us …

How the meat industry is acting like big tobacco

Shivam Joshi, MD

Physician

December 26, 2015

Recently, the World Health Organization (WHO) released its report condemning processed meat as a group 1 human carcinogen — a classification that includes such notorious companions as tobacco smoking, smokeless tobacco, and second-hand smoke. This is not surprising considering that processed meat contains many of the same known or probable carcinogens as cigarette smoke, like heterocyclic amines and N-nitrosamines.

Red meat was labeled in the runner-up category as a …

How physicians can resist succumbing to hubris

Lucy Hornstein, MD

Physician

December 25, 2015

Dr. Robert Centor has an important post about hubris. It’s not a long post, if you want to click through and quickly read it. It’s about the danger of overweening pride and overconfidence that can come from blindly believing the praise that is often heaped upon us by those in our care. Essentially Dr. Bob is saying that we must avoid believing all the wonderful things our patients …

7 things doctors should consider before signing for a new job

Eve Shvidler, MD

Physician

December 16, 2015

So, you’ve finished all your job interviews and think you’ve found a perfect fit. Graduating from residency is exciting, but did you get any training on what it all means to sign on the dotted line?

Below is a quick and dirty run-down of the contracting process from an industry insider.

1. Non-compete clauses. Non-compete clauses are not just a big med phenomenon; they are part of contracts in many different clinical settings. …

Physicians are jaded, but this is what keeps them in medicine

Cindy Winebrenner, MD

Physician

December 15, 2015

I am constantly coming across articles of physicians with strong voices. Physicians that are jaded. Physicians that didn’t go into medicine to be defined by patient satisfaction surveys. Physicians that didn’t go into medicine expecting that people wouldn’t trust in their training because the Internet begs to differ. Physicians that cringe at the drive-through mentality that patients can present with diagnoses in hand and demands for tests to be done. Physicians …

We should radically change the way we play football

Keith Pochick, MD

Physician

December 12, 2015

As the awareness and recognition of concussion in sports continue to increase and the frightening long-term outcomes for frequently and severely concussed athletes are realized, as a physician I cannot help but advocate drastic changes in football. Of the major sports, it sees the highest rates of concussion, and for every highly publicized Greek tragedy of a broken NFL star (Jim McMahon, Junior Seau, Dave …

Why a patient panel is an outdated concept in primary care

Lucy Hornstein, MD

Physician

December 10, 2015

“How many patients do you have?”

I’m not sure what you mean. How many patients do I see on average each day? About twelve.

“No. How many patients do you have?”

Let’s see: Last week I saw about sixty patients altogether. Five of them were new patients.

“No, no. How many patients do you have on your panel?”

My panel? I don’t know what you mean by that. I don’t work as an employer in …

The general radiologist is still valued. Here’s why.

Dr. Saurabh Jha

Physician

December 4, 2015

In times of shortage, we find out what we value most. And in these times of relative penury in the job market for radiologists, it appears that employers value — above and beyond anything else — the general radiologist.

Yes, the general radiologist. The radiologist who is able and willing in one shift to perform a barium enema, follow the intricate anatomy of the inner ear on an MRI of the …

Do psychiatrists have value? Yes, they do.

Maria Yang, MD

Physician

December 2, 2015

While slogging through a crappy first draft of a document about the value of psychiatrists in mental health and substance use disorder services, I did a literature search for supporting evidence.

I found nothing. (1)

“So how exactly are we helpful?” I mused out loud. Maybe we aren’t: There are groups out there who do not believe that psychiatrists can or do help anyone.

I am an N of 1. …

Listening to the patient is the first part of the physical exam

Ira Nash, MD

Physician

December 1, 2015

The first posting on my blog explained why I chose to name it “Auscultation.” I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod to my being a cardiologist, I believe auscultation has long been an act that defines us as physicians and connects us in a profound way with our patients. The act of …

Physicians are not providers: An open letter to the AMA and medical boards

Suneel Dhand, MD and William J. Carbone

Physician

November 30, 2015

Dear AMA and state medical boards,

The last few years have been a period of unprecedented change in the world of health care. The need to reign in costs, expand access, and ensure higher quality care — all at a time of rapid medical and technological advancements — has changed innumerable aspects of the practice of medicine.

Throughout this, one common theme has been the dedication and determination of hundreds of thousands …

If urgent care centers don’t innovate, how long will they last?

Stephen C. Schimpff, MD

Physician

November 27, 2015

Part of a series.

Urgent care clinics provide a useful service to the community, but their days may be numbered with survival questionable resulting from intense competition from the chain pharmacies and soon from Walmart.

Urgent care companies began to proliferate 30 years ago but have gained traction in recent years as emergency room wait times rapidly lengthened. Urgent care is less expensive than the ER, is open 24/7 or …

Physicians looking for a new job should beware these 4 red flags

Eve Shvidler, MD

Physician

November 26, 2015

Recruitment season is my favorite time of year. The CVs pile into the database, and we sift through the resumes, searching for candidates that would make a great fit for our organization. Next, I get on the phone and assess their level of interest and try to sell them on everything we have to offer. We fly them out for a live interview, and the negotiations begin.

Last year was a …

Who’s in charge of the patient? It’s a question increasingly difficult to answer.

Ira Nash, MD

Physician

November 24, 2015

I spent a couple of hours today discussing a topic that has become increasingly important in the world in which we live, and which would have completely mystified an earlier generation of physicians. The subject was attribution. Simply put, how should one decide which patients “belong” to which doctors? On a more technical level, what algorithms should be employed to connect patients, or episodes of care for those patients, or …

The question about education that this doctor asks every new patient

Greg Smith, MD

Physician

November 24, 2015

“How far did you go in school?”

This is a question that I ask every new patient as a matter of course.

Granted, I have gotten some very odd answers, including hearing from a very successful businessman who only finished the seventh grade, or a very psychotic person who has a double master’s degree. Not implausible, but certainly not expected or the mainstream answer from the majority of my patients.

Now, leaving the …

What worries me about husbands and wives in the exam room

Hans Duvefelt, MD

Physician

November 23, 2015

When a wife suddenly comes in for her husband’s appointment, I usually worry a little; when a husband shows up for his wife’s visit, I sometimes worry a lot.

I have come to expect that when I enter an exam room, and a male patient has his wife with him in the room, she is there to make sure I hear some part of his symptom history that he has never …

We lose a medical school full of physicians every year to suicide: An interview with Dr. Pamela Wible

Pamela Wible, MD

Physician

November 21, 2015

TEDMED-WIBLE-PHOTO-shrink

Christine Sinsky, MD, from the American Medical Association interviews Pamela Wible, MD, after her TEDMED talk. Watch periscope video here. Fully transcribed below:

Dr. Sinsky: This afternoon we’re here in Palm Springs, and I’m delighted to be here with Dr. Pamela Wible, who gave a terrific TED talk last night. I’m Dr. Christine Sinsky, the vice president of professional satisfaction at the …

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