I bid farewell to four people this month who I’ve been caring for in my outpatient psychiatry practice — all under sensitive circumstances but ultimately moving in positive directions. As I write formal discharge letters, the unique role psychiatrists and other mental health clinicians play in the lives and minds of the people we care for is on my mind.
It is the nature of our healing practice to build trust …
A psychiatrist can’t help patients anymore
I’ve noticed a theme in my clinic since I started practicing medicine: when a patient understands what is being said about their care, treatment, and services, they’re more likely to fulfill critical health care responsibilities. No one should be surprised by this, but as our nation and hospitals increase in diversity, the issue of health care equality for LEP (limited English proficiency) patients is becoming more pronounced.
Today, this population of …
Let’s do better for patients with limited English proficiency
Relaxing on the couch, my family already in bed, watching TV to calm my mind before leaving for a busy night shift in my emergency department, I was shocked to see an advertisement that insulted me, my colleagues, and my profession.
A trailer for a show called “Nurses” is shameful.
The idea behind the show is admirable — nurses do not get recognition from society for the work they do and the …
Why a new TV show offends physicians
Most physicians recall the rigors of their residency training through a mixed lens. In prior generations, a single-duty shift could stretch to 36 or more consecutive hours, but the exhaustion was buoyed by the camaraderie of sleepless on-call nights in the hospital. Despite the exhaustion, resident well-being received scant attention. Beginning with the 1984 Libby Zion case, and later the Accreditation Council on Graduate Medical Education (ACGME) duty hour restrictions …
A paradoxical fix to physician burnout: more patients, less supervision
Ninety minutes before my Sunday night shift, my two-year-old, Titan, comes screaming up the stairs looking like a scene out of a slasher horror movie. His older sister sheepishly admitted to chasing him into the edge of a door frame. We created an ED bed on our kitchen counter and slipped a pillowcase up his arms, behind him, with him laying …
Doctors: Always be prepared to suture wounds
Year 2000. I’m sitting in a semi-fancy hotel ballroom near LAX along with several hundred slightly edgy emergency physicians. We’re all awaiting the start of our ABEM written re-certification examination. This was in the old-school days of live exams. We had an MD master of ceremonies, a famous EM leader; and I can still remember his message to the assemblage. “If you’re re-certing for the first time, welcome, relax, good …
Tales of an emergency physician, recertifying for the third time
I went to a bar last night — and I looked good: red coat, black dress, knee-high suede boots. I was feeling pretty good.
I met my best friend at this bar — he lives elsewhere now — but this is his favorite spot in the world. Like Norm in Cheers, he is also their favorite customer.
We ordered dinner, and my best friend stepped away to talk to the bartender. I …
An orthopedic surgeon goes to a bar. Here’s what happened next.
We live in an era where plastic surgery is routine. Indeed, in many parts of the country, plastic surgery is an expected rite of passage. Years ago, facelifts and “tummy tucks” were done on those in middle age who were trying to experience a surgical time machine. Now, folks in their 20s are having all kinds of work done, not to recreate a prior image, but to create a new …
Patient demand doesn’t justify medical excess
The night I almost swallowed a bottle of Percocet post-call in residency is still clear in my mind, as is the hours leading up to it; the thoughts going through my head, the swirl of emotions seemingly pulling me like an ocean undertow. I can only attribute my pause to a power greater than myself. The truth is when I look back on that night, I can see that those …
The thought cancers that almost took my life
I recently had the pleasure of interviewing famous television and film actress, Claudia Christian. She has played significant roles in many notable movies and shows, including lead roles in the long-running sci-fi series Babylon 5 and the Disney film, Atlantis: The Lost Empire. In our podcast interview, we discussed treating alcoholism using the FDA-approved drug, naltrexone.
Why listen to an actress about medical treatment for addiction? First of all, doctors generally …
What can a famous actress teach us about curing addiction?
I think I’m finally burned out. And it’s been a long time coming.
It likely started when my private physician-owned emergency group got bought out by one of the big corporate groups. The changes were small at first. Turning us into hourly paid employees instead of an RVU-based salary. Shiny new VPs and directors sending us emails. Things seemed fine for a while. Then came the many, many emails about better …
Burnout is death by a thousand cuts
In medicine, contrary to common belief, it is not usually enough to know the diagnosis and its best treatment or procedure. Guidelines, checklists, and protocols only go so far when you are treating real people with diverse constitutions for multiple problems under a variety of circumstances.
The more you know about unusual presentations of common diseases, the more likely you are to make the correct diagnosis, I think everyone would agree. …
Experience and in-depth knowledge can empower you with an appreciation for nuances
I can’t speak on behalf of all in my specialty, but I wager that there is a good percentage of radiologists out there who essentially work nonstop from the moment they walk in the door to the moment they leave, working through lunch hours, etc.
Throw in a mandatory meeting every now and then and “the list” of studies to be read can explode, and it can truly be demoralizing.
I have …
Combat burnout one bite at a time
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There was a time, before treatment algorithms, when physicians would rely on the detailed bedside and/or office observations of their patients in conjunction with the most recent published peer-reviewed studies.
Time spent with each patient was considered essential and appropriate to reach a proper diagnosis and treatment plan. Now, due to corporate mandates to produce higher RVUs, time is regarded as an unnecessary luxury, to be controlled and curtailed. Yet recent …
Experienced-based medicine has value
Consider a medical trainee, in the second year of her medical training, who has made it a point to always show up early to work no matter the situation. She often times stays beyond the end of her shift to help out either her co-residents or juniors. She is having a bad week and uncharacteristically shows up late for rounds in the ICU. As expected, she is castigated in front …
We need to bring back the feel-good factor to medicine
Many physicians will decide they want or need to make a transition from the practice of clinical medicine to “something else” at some point during their career. Whatever the motivation for their job transition, most doctors appreciate a rational, structured process that enables then to get from where they are to where they want to be. Fortunately, there are some easily accessible resources that can add value to your work/career …
A roadmap for physician career transition planning
Prior authorization — a utilization management (UM) process used by health insurance companies to determine coverage for a prescribed procedure, service, or medication — is now becoming a mandatory requirement by the vast majority of large insurance companies.
While prior authorizations are pursued at the front-end for almost all planned medical services, there has also been a steep increase in denial of payment for services at the inpatient level for both …
The burden of prior authorizations and denials in health care
On the first day of 2019, the reality show Tidying Up debuted. The show features tidying expert Marie Kondo and is based on her international best-seller, The Life-Changing Magic of Tidying Up. The 200-page manifesto details her approach to decluttering homes: discard belongings that don’t “spark joy,” then organize what remains into carefully designated spaces. The philosophy took the self-improvement world by storm, prompting an influx of …
How to KonMari your academic life
A guest column by the American College of Physicians, exclusive to KevinMD.com.
Regardless of specialty, medical practice is challenging in today’s health care landscape.
Increasing demands related to workload and job inefficiencies, an ever-increasing administrative burden, the consuming nature of health information technology, and personal and professional values that often conflict with the expectations of the …
Take 100 patients who are candidates for colorectal screening. We know that a group of them will try to avoid the procedure or postpone it for as long as possible. Evidence of this, for example, would be rescheduling appointments multiple times to later dates.
We also know that among this 100 is another group of people who need a colonoscopy more than others. A family history of cancerous polyps is a …
How predictive analytics help advance population health
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