2019 is here.
I started my year by doing an urgent care shift on New Year’s day. It was not quite as busy as I expected; most of the shifts I’ve done around the holidays were high-volume, with lots of flu, other respiratory infections, and lacerations sustained while cooking holiday meals. New Year’s day was a little slower on the illnesses, but the acuity of the injuries was high. That’s what …
A physician’s New Year’s resolutions
Does any living, breathing human believe that there is not enough paperwork in our lives? While we are all burdened, I believe that the medical profession is uniquely deluged with an absurd volume of documentation requirements, most of which should be filed under “N” for nonsense. Ask any physician or nurse about this and have antacids on hand as you will soon see some sizzling smoke emerging from the medical …
How carefully do most patients or doctors read medical forms?
86 minutes.
That’s what I found when I added up how late patients were through a single practice session earlier in the week.
Some patients arrived on time, and some a few minutes early, but the average was about 8 minutes late, ranging up to one patient who showed up an hour and 12 minutes after their scheduled appointment time.
The reason I …
Patient care suffers when you squeeze patients into a tight schedule
“What took you so long? I’d have thought you would address this issue sooner.”
I felt a like a scolded child sitting in the principal’s office. In fact, the small couch I was sitting on rested nearly a foot lower than the chair on which he perched. All the while, the exam table glared back with unfriendly eyes.
I smirked and tossed the question back in his lap with a degree of …
3 things this physician wished he could have done differently
I am beginning to think that we should not see chronic care patients between Thanksgiving and New Year’s Day. It just makes us look bad.
Our quality metrics make the last blood pressure and the previous diabetic lab test of the year for each of our patients our final report card. We should quit while we’re ahead, in mid-November.
So here we are: The office has Christmas decorations up. There are trays …
We need to be more focused on those patients who find the holidays hard
This article is sponsored by Careers by KevinMD.com.
It’s no secret that some businesses are family businesses and medicine is no exception. The anonymous Northern California cardiologist known as “Dads Dollars Debts” confesses in a blog that, yes, some days he feels like he’s made a difference, and other days, “I just feel like a customer service rep at …
When medicine stays in the family
1. Very little revolves around the patient. For a place dedicated to healing, the hospital does a poor job accommodating patients. Labs are drawn in the middle of the night, so the doctor has them early in the morning. There is no standard rounding time, so the patient is constantly awakened throughout the day. Vitals must be measured every few hours. Patients often comment about being happy to be discharged …
10 surprising things you need to know about the hospital
Last year, in response to a continued groundswell of criticism focused on requirements for maintenance of certification (MOC), the American Board of Medical Specialties (ABMS) formed an independent “Vision Commission” on MOC, designed to “reimagine a system of continuing certification.”
Although led by ABMS board members, many of the 27 commission members are not directly associated with ABMS. After …
MOC harms physicians in surprising ways
I have been a neonatologist for 30-plus years. Throughout my career, nurses and neonatal nurse practitioners (NNPs) have guided me, assisted me and comforted me through difficult patient care issues that arose. Even more importantly, they allowed me to leave the neonatal intensive care unit (NICU) without worrying about how my patients were being taken care of.
I am writing this because our profession (MDs and DOs) continue to devalue these …
The discrimination against nurse practitioners must stop
How can you work for 24 hours in a row? My friends outside of medicine ask me that often. What is it like? I wondered the same thing the night before my first 24-hour shift or “24.” I lay awake worrying, ironically, that I should have gone to bed earlier to rest up for the ordeal.
When I get to work, full of nervous energy, I am relieved to find out …
A commentary in the New England Journal of Medicine titled “Beyond Evidence-Based Medicine” received much well-deserved criticism for not only mischaracterizing EBM, but advocating for a novel approach, “interpersonal medicine,” that was explicitly codified in the recognition of the U.S. specialty of family practice nearly 50 years ago. Here’s what the authors wrote about this practice of medicine that is, apparently, new to them but well-known …
Interpersonal medicine already exists. It’s called family medicine.
I have had a complex relationship with music. As a child, I had several instances of feedback that I was “bad at music.” When my class would sing at assemblies, I would get side glances and subtle and not so subtle clues that I should be at the edges and sing quietly.
I played the viola from second to ninth grade. I had fun in orchestra class. For the rehearsals, I …
How music transformed this physician
I sat knee-to-knee with a nurse practitioner at a school-based clinic in rural Ohio. Choking back tears, she described a patient she couldn’t get out of her head: a middle-school girl, accompanied by her mother and a social worker. Just days prior, the girl was dropped off at her father’s home for the weekend. Before the promised Friday night football game, she discovered him unconscious on the bathroom floor. Within …
Inaction is driving our collective burnout
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There is no doubt about it, I am my mother’s son. What would you expect? My father died when I was eight years old. During my formative years, I was brought up solely by my mother. I believe this is a unique lens in which to see both life and financial independence. As the years pass, I feel lucky. The importance of female role models cannot be …
The importance of female role models
Long ago, and far away, I encountered a patient that changed the way I practice. I was with a medical student while examining a middle-aged woman who presented with a dramatic eruption that was probably DRESS syndrome (DRESS syndrome was not yet described). I prescribed prednisone and asked her to come in a few days later so I could assess her progress. She returned – I did not recognize her …
Patients and physicians need to talk more and tweet less
I am a pediatric hospitalist in middle America. I believe in you, and I hope that you believe in me. Many of my patients’ parents do not believe in me, you see, and it makes it hard for me to do my job and to take care of these children in the way that I have been trained and believe to be in their best interest.
A toddler has just died …
A physician’s plea to Santa Claus
A guest column by the American College of Physicians, exclusive to KevinMD.com.
When reading (or writing) blog posts, it’s easy to be left with a mostly negative and often depressing view of the current state of medicine. This is completely understandable as people usually write on topics and issues about which they feel strongly, and …
Reclaiming our mission in medicine
Recently, news broke about a disturbing act of medical battery carried out by doctors at St. Joe’s Medical Center in Syracuse, New York. The case began when police officers conducted a pretext stop and elected to harass their victim about a small amount of marijuana.
As the situation escalated, the cops took the man to St. Joe’s Medical Center for him to be searched for …
Physician gives in to police pressure to conduct a forced invasive rectal exam
Net promoter scoring (NPS) measures customer experience and predicts business growth. Recently it is becoming more common for health networks to adopt NPS. The word “customer” should be a red flag. In medicine, we do not have customers; we have patients.
It is common practice for a patient to receive a text message after they leave an office asking them to rate their experience. It generally looks something like this, “How likely …
Net promoter scoring needs to be tweaked for medicine
Even though physicians do not talk about transferring residencies, it is more common than is often believed. According to the AAMC website, about 30 percent of residents do not finish the initial program they started. Quantifying that number further, the ACGME recently reported 1,044 residents transferring from their program.
There are a variety of reasons for transferring residencies: A spouse being accepted for a …
How to transfer residency programs
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