Physician

Surgical error: The difference between mistake and complication

Physician
March 3, 2011

One of the benefits, or aberrations, depending on your point of view, of the fee-for-service model is that we surgeons are remunerated for correcting our mistakes and complications.

At first glance this seems wrong. But perspectives differ, and when a doctor has to deal with serious, undeserved complications and is self-employed he deserves to be compensated adequately.   So what really is the difference between the two?

A complication may be described as …

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Can I be a doctor with bipolar disorder?

Physician
February 25, 2011

“I have bipolar disorder. Can I be a doctor?”

It’s one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick …

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The biggest problem faced by pilots and obstetricians alike is nature

Physician
February 21, 2011

It’s a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery.

That’s because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless …

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What makes a good, competent psychiatrist?

Physician
February 16, 2011

A reader recently asked, how does someone find a good psychiatrist?

Stated another way, the questions are:

  1. What qualities make a good, competent psychiatrist?
  2. How do I find a good, competent psychiatrist?
  3. How do I get my concerns heard about the direction of my treatment?

I typed the question “How do I find a good psychiatrist?” in Google and got almost half a million results from around the world. I find it hard to believe …

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Difference between proactive and reactive medicine

Physician
February 16, 2011

Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem.  A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master.

What do I mean?  Here are some examples from my field.

Treating …

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How to become a licensed, board certified doctor

Physician
February 12, 2011

I am licensed to practice medicine and surgery in Georgia. But that doesn’t mean I should, or that you ought to let me—at least not the surgery part. I’m actually pretty good at carving a turkey, but that’s pretty much the only kind of surgery that I’m qualified to do.

Don’t let the license fool ya, I’m no surgeon. So what, exactly, does a doctor have …

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The threat of malpractice means doctors cannot acknowledge their fallibility

Physician
February 2, 2011

An excerpt from The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine (Chelsea Green Publishing, 2011).

We all make mistakes. To err is human—unless you are a doctor. This is a lesson that began in med school. If something went wrong, some­one else was to blame. Attending physicians blamed the residents, who blamed the interns, who blamed whomever else was within range—med student, nurse, patient. We gave …

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Depersonalization of the patient and the loss of compassion

Physician
January 25, 2011

A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.

So let’s take a look at compassion.

Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that …

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Can a doctor and a nurse be friends in the OR?

Physician
January 23, 2011

One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven’t seen her since I was in school, we’re still in touch and expect to be seeing each other at last in a couple of months.

By some coincidence one of my best friends now is also an O.B. nurse. I’ll call her Ziva (yes, I …

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How MD anesthesiologists have become victims of their own excellence

Physician
January 22, 2011

The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.

Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that …

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Kind and thoughtful words from a fellow physician colleague

Physician
January 13, 2011

I was sitting on one of the hospital’s nursing units having a difficult telephone conversation.  Anyone working nearby could have easily discerned the situation from my end of the call.

Patient’s family member wants to keep aggressive care going for a comatose, terminally ill family member against the best advice of the medical team.

Having never had to make such a decision in my own life, I am left to imagine how …

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Hospital meals make it difficult to control blood sugars

Physician
December 30, 2010

My mom doesn’t take any diabetes medicine.  She keeps her blood sugars normal through a combination of common sense and careful carbohydrate consumption.

A few months ago, she had to be hospitalized for what she calls a “minor procedure.”  The procedure went fine, but not the food.  The first meal they brought her consisted of breaded fish (frozen), mashed potatoes (instant), corn (canned), a dinner roll (frozen), and tea (2 sugar …

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Tips to find a good psychiatrist

Physician
December 29, 2010

Seems like a simple enough question: How do you find a psychiatrist?

It’s not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there’s the overriding insurance question. Not to mention location, location, location.

We’ve talked before about insurance, and if you haven’t read Why Shrinks Don’t Take Your Insurance, …

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Reduce phone calls in your medical practice

Physician
December 28, 2010

A physician approached me at the end of a talk on optimizing practice efficiency and improving service to patients and said, “I dream of an office with no phones.”

Do you have days where the phones are ringing off the hook? Or the phone message forms in your in-box seem to be reproducing? Maybe it’s been one of those days when you can never get your nurse’s help because she’s been …

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The cost of keeping the terminally ill alive

Physician
December 16, 2010

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives.

And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and …

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A physician story of addiction and recovery

Physician
December 16, 2010

by an anonymous physician

I am a physician now in recovery.

I don’t like that term. The correct thing to say is, I am sober.  I am going on a year sober without any problems. Recovery suggests some disease state and I don’t think it is that simple.  It also suggests an ongoing daily struggle or effort to remain sober, and I don’t find that the case, either.  I know this …

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Medical errors that involve handwritten prescriptions

Physician
December 14, 2010

by Daphne Swancutt

Two people in the United States just died in the last hour. Seventeen more will die in the next 7 to 8 hours. Over a year, that number will accumulate to about 7,000.

The reason? Medical errors that include misread or otherwise misinterpreted handwritten prescriptions. Believe it. This means that doctors are being sloppy, pharmacies are making mistakes and people are getting dead.

Even more …

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7 favorite ER superstitions

Physician
December 12, 2010

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Emergency physicians, nurses, and paramedics are a superstitious lot. I thought it might be interesting for those not in the business to read about some of our superstitions. In no particular order, here are my favorites.

1. The “Q” word. “Quiet.” it’s truly the kiss of death. The “S” word, “slow,” carries the same jinx. Usually some newbie nurse or clerk who is …

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Stercoral perforation as a deadly cause of colon rupture

Physician
December 9, 2010

I got the call from the ER because I was the “no-doc” surgeon, meaning I was the guy to call when a patient showed up needing a surgeon, and who had no primary care doc to direct the referral. Usually it meant trouble. A drunk who smashed his car and himself, possibly others. Stab-wound, gun-shot. People who don’t have their own doctors include more than those down on their luck; …

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