Do you ever see other people in their careers and think to yourself, “Maybe I could do that?”
I am a board-certified pediatric physician with over 25 years of experience in private practice, and I recently decided to try my hand at acting.
Much to my surprise, I was awful. It was almost as if there were basic premises of the craft that I did not understand at all. But I suppose that …
Maybe being a physician was just not enough
An excerpt from Technology and the Doctor-Patient Relationship.
As disturbing as the structure of malpractice insurance is in America, a more significant problem is the defensive style of medical practice it induces. In a large-scale survey done by Jackson Healthcare in 2010, between 73-92% of physicians self-reported ordering unnecessary tests and procedures to protect themselves from lawsuits but which may not have been clinically necessary. This equated to …
A solution to reduce defensive medicine
There are times in our journey as doctors when life gets in the way. Well, life got in the way, and I had to go back to the basics and deepen my understanding and connection to myself and my source to easily navigate the curves and the bumps in the road.
I had to figure out a way to move through the tears that came with the diagnosis and poor prognosis …
What physicians should do when life gets in the way
Between 2011 and 2015 there were over 21,000 children killed by guns. This recent study in Pediatrics, the journal of the American Academy of Pediatrics, further analyzes the question; it compares pediatric firearm fatality rates among the various states and then tests for correlation between children killed and the degree of strictness or not of the state’s gun laws. There are extensive data on whole populations showing that stricter …
Increasing strictness of gun laws correlates with fewer children killed by guns
It’s Monday, I recall as I step into work;
“Preparing for battle,” I say with a smirk.
Surviving all weekend with a sick kid in tow,
the parents’ relief as they waited to show
you their child with fever, diarrhea and sneezing,
the one who is too hot, too cold or is freezing,
the one who forgot that a helmet is needed,
the one who is eating too much, they conceded.
The one who still haunts you when …
A poem for the pediatrician on a Monday
We can learn a lot about ourselves by looking at, and thinking about, perceptual illusions and our biases.
Look at the image above. The classic, Muller-Lyer illusion.
We know that the two lines are the same size. But no matter how much we intuitively “know” this to be true, we see the top line as bigger. We can’t unsee it — even if we …
How illusions impact how we practice medicine
Doctors need to be true to themselves, but at the same time, they must be chameleons.
A doctor fills certain roles in the lives and stories of patients. It is a two-way relationship that looks different to each person we serve throughout every workday and even in the most casual interactions we have.
Some patients need us to take charge for a while because they’re exhausted; others need us to listen quietly …
Why doctors need to be chameleons
Start at the origin. Over two, up four. Down three, right six. Left five, up one. Keep connecting the dots. Everything will take shape.
I liked graphs. Plotting coordinates — whether it be for a parabola or ellipse — was always calming for me: numbers told you exactly where you needed to be.
But my numbers scared me. My 8-year-old feet would hesitantly step on the scale at the doctor’s office. I …
The weight of it: a pediatrician’s thoughts on how words last a lifetime
The family doctor used to be almost the only source of medical information patients had access to. Now, few people need us to bring them the latest news. It’s there for everyone to see. There’s even too much of it.
Today, our role is to help make sense of it all. In order to do that, we must possess and project authority, but we have no reason to put ourselves on …
Why physicians should adopt the role of guides
My 83-year-old patient had outlived peoples’ expectations on several occasions. Faced with a critical illness three years ago, she underwent emergency surgery and spent several months in the hospital with a series of complications, including septic shock, renal failure, and hospital-acquired pneumonia.
I’d seen her in the office for a new visit soon after she was discharged. It took nearly 20 minutes to go through her history before walking into the …
Letting go when people let go of their lives
Research shows that as many as 50 percent of physicians report some level of burnout that manifests as depression, dissociation, indifference, and even substance use disorders. Medicine has become focused on monetary gains by large corporations, major hospitals, and insurance companies. As much as doctors want to focus on quality patient care, they are forced to focus on electronic medical records that are cumbersome, seeing multiple patients with quick assessments …
What rushed patient encounters are doing to patients and physicians
The other day I asked myself why do I focus my attention on immigrants when there are plenty of other underserved and neglected populations. When an opioid crisis surrounds me, why do I speak of a crisis at the border? When structural and overt racism contributes to an infant mortality rate of 10.97 for black women’s babies, twice the rate for the nation as a whole. When only 18 states …
In most other human activities, there are two speeds, fast and slow. Usually, one dominates. Think firefighting versus bridge design. Health care spans from one extreme to the other. Think code blue versus diabetes care.
Primary care was once a place where you treated things like earaches and unexplained weight loss in appointments of different lengths with documentation of different complexity. By doing both in the same clinic over the lifespan …
Why primary care will soon only treat chronic conditions
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A guest column by the American College of Physicians, exclusive to KevinMD.com.
The administrative burden associated with caring for patients in today’s health care system has emerged as a primary driver of the loss of joy in the practice of medicine and the epidemic of burnout among physicians.
No medical specialty is immune from the upward …
How the administrative burden contributes to physician burnout
As doctors, most of us went into medicine with a true desire to help other people. What was once a noble profession is now being worn down by outside forces trying to control us. Third-party insurance companies are driven by profits, not by optimal care of patients. Politicians are driven by their own political agendas and party alliances without even acknowledging the real problems existing in the health care system.
Most …
Has health care lost its humanity?
Twenty-five years ago, when I entered medical school, clinical notes were written in paper charts that were filed numerically on shelves. We didn’t have the electronic medical record (EMR), and burnout wasn’t on the radar.
In the past few years, this has changed. Burnout rates among medical providers have increased dramatically as professional fulfillment has decreased. We have the burden of EMRs weighing us down with excessive nonclinical work. We are …
To fight physician burnout, empower nurses
It hasn’t always been this way.
For years, I worked at the typical high-achiever pace, like many striving to become a doctor. Upon entering medical school, I set challenging expectations of myself — graduate at the top of my class, study a relentless number of hours, score at least one standard deviation above the mean for boards (two would be better). It was an exciting time fueled by the desire for …
How this physician reset her life
In the emergency department, we see them all the time. The person with a medical problem too serious to ignore, but not quite bad enough to require admission. The patient referred to the specialist who comes back to the ER. “I couldn’t afford the cash upfront.” The new cancer in the uninsured. The pneumonia without a doctor. The homeless not eligible for Medicaid.
The senior barely able to stand, but whose …
What can I do differently in the ER?
Though I owe a debt of gratitude to all of my internal medicine attendings, none of them can claim credit for getting me through the gulag of residency. That distinction, instead, belongs to Zubin Damania, alias ZdoggMD, an internist and purveyor of viral YouTube music videos.
I first became aware of Damania’s videos when a med school friend sent me a link to his online archives, resulting in one …
How ZDoggMD inspires this physician
With the epidemic in health care of overwork, stress, and burnout, psychological safety is a crucial factor in achieving the highest levels of quality of care and quality of work environment. While simple in concept, psychological safety is also quite fragile and needs careful attention on a day-to-day and conversation-to-conversation basis to assure it.
Psychological safety means that people feel safe to speak up about concerns, new ideas, negative feelings, and …
Psychological safety in health care: simple, important, fragile
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