Physicians writing on KevinMD about the life of the profession: the work itself, the exhaustion, what women physicians are paid and asked to carry, the losses the profession has been slow to name, and who decides how physicians work. Five maintained records draw on this archive: Physician burnout: what physicians say, in their own words, Primary care: what physicians say, in their own words, Women in medicine: what women physicians say, in their own words,, Physician suicide: what physicians say, in their own words, and Physicians and administrators: what physicians say about who runs medicine, in their own words.
“The parts of me that used to think I was different or smarter or whatever, almost made me die. ”
— David Foster Wallace in an interview by David Lipsky
Recent physician-suicides and all those before were committed by people; people caught in an organization rigged against them — one that breeds new and exacerbates existing, mental health issues. Physicians are people. Doctors are people. They happen to be people who care, which makes …
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Physician suicide: Putting words into action
I’ve always likened the job of a primary care physician to that of a chief executive officer of a small business. Family doctors manage the “business” of delivering and coordinating care for more than a thousand patients at an average cost, in the United States, of $8,500 per year: an $8 to $12 million business. Because the actions or inactions of the PCP impact the need for, and cost of, …
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Both physicians and CEOs need time to think
Repercussions.
Every action that is taken, especially when it comes to healthcare, has ripple effects, which often end up being more far more significant than we anticipate, turning that ripple into a tidal wave.
Every time somebody besides actual health care providers steps into the mix and tell those of us taking care of patients that there is “something else that we have to do,” we often see it open up a …
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Why are we treating outpatients like inpatients?
In March 2018, The Collaborative for Healing and Renewal in Medicine (CHARM) published an article titled “Charter on Physician Well-being” in JAMA. The piece describes guiding principles and lists recommendations for promoting well-being among physicians. The charter successfully pulls together, in a 2-page document, a comprehensive approach to preventing burnout and fostering well-being among physicians.
One recommendation especially caught my attention. “Anticipate and Respond to Inherent Emotional Challenges …
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Why physicians need disclosure coaching
Poverty is known to be an important determinant of a person’s health and longevity. A person’s zip code is more relevant than genetic code. Does a physician’s zip code – that is where they were born and raised – have an effect on where they practice? Specifically, do rural born and raised physicians return to their rural roots? The story of Prashant, a physician raised in rural Bihar, India, is …
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The social determinants of a physician’s path
My second foray into Suboxone treatment has evolved in a way I had not expected, but I think I have stumbled onto something profound.
Almost six months into our in-house clinic’s existence, I have found myself prescribing and adjusting treatment for about half of my medication-assisted treatment (MAT) patients for co-occurring anxiety, depression, bipolar disease and ADHD as well as restless leg syndrome, asthma, and various infectious diseases.
Years ago, working in …
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The satisfaction of Suboxone treatment
My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader.
Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a …
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Guidelines, multiple specialists, and the science versus the art of medicine
When a patient is unwell and seeking help, a vast number of emotions could be going through their mind. Their whole life could have been turned upside down, they may have been fearing this moment for a while, and stressing over the implications of their illness. To physicians, it may sometimes feel like just another name on our list or almost become a routine mechanical interaction, but for …
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Reading the body language of your patients
Even though my own internship was a decade ago, I vividly remember the transition from student to resident. Residency was monumental in my path to becoming a physician. There were obvious changes: People now called me “doctor,” my misshapen short white coat was upgraded to a more comforting full length one, and I was often the first one paged to respond to patient problems. Coupled with the positive aspects though, …
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How to thrive during your residency
Never touch your hair. It cannot be down, and it cannot look fancy. Optional styles include bun, ponytail, or braid. I might as well shave it off! I hear you thinking it – we’ve all thought it – but it’s wrong. The only thing worse than looking like a woman that’s too hot is looking like you’re not a woman at all. Woman? Sorry, I meant girl.
Never touch your phone. …
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Female physicians: You’re lucky to be here
In the wake of Pride Month, I have been reflecting on how our health care system impacts the lives of individuals with identities across the gender spectrum. Sometimes, when sending a prescription to a pharmacy for any given patient, we will get a phone call that the date of birth on file with insurance does not match the date of birth we have on file. Typically, this is a clerical …
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Pronouns matter: How we can do better in LGBTQ patient care
My (sometimes solicited, but often unsolicited) advice for graduating medical students, residents, and fellows:
June is one of my favorite times of the year. One, because it’s summer, but also because it’s graduation season. I love seeing and hearing about everyone’s accomplishments, and seeing years of hard work come to fruition – although if I’m being honest, it’s bittersweet, because it’s also a reminder of how I’m getting older.
This year, I’ve …
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6 pieces of advice for graduating medical students and residents
An excerpt from 7 Ways to Stop Drama in Your Healthcare Practice.
Although the ability to initiate difficult conversations is part of good leadership, I’ve never met a leader who enjoys it. Whether your conversation is about body odor, rude behavior, dress code, personal conduct or performance issues, difficult conversations are …
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8 steps to have those difficult conversations
One day, I was full of moderate despair, overworked, befuddled by the EHR with a tinge of burnout, staring at my computer, I treated myself to something I’ve not done before. It was my 62nd birthday that day, and I gave myself a birthday present. Before rising from that swivel chair, I had written down on a sticky pad the day that would be my retirement date, exactly one year …
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My exit ramp from medicine
An excerpt from the Docs Outside the Box podcast, episode 1: When the going gets tough… MOVE!
Dr. Nii: All right, well thank you very much for joining us on the Doc’s Outside-the-Box podcast. You are our first guest — first victim, I guess. It’s the inaugural episode, so I just wanted to thank you for joining us. I know you are in New Zealand, which is roughly 18 hours away.
Dr. Brown: It’s …
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A conversation with a doctor who was tired of feeling burned out
Just like so many teenagers out there, I found myself hooked on the Netflix show 13 Reasons Why from the first episode. The only difference is that I am not a teenager, but a physician practicing child and adolescent psychiatry and managing inpatient child and adolescent psychiatric units for the last nine years. I was surprised to see the number of emergency room evaluations of my admitted patients indicating that …
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The problem with the adults in Netflix’s 13 Reasons Why
I was a second-year resident, doing a 24-hour shift on maternity care. I’d spent some arduous nights on call with my attending physician, Dr. Campbell. Now, we sat at the nursing station, joking about what this one might bring.
“You must be a black cloud,” she teased, accusing me of being one of those unfortunate residents who seem to attract medical emergencies. I laughingly protested, but in fact, these quiet nights …
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Crying when a patient suffers a devastating loss
In medicine, this is the time when one season ends and another begins. New doctors graduate from medical school. They are excited and, at the same time, scared as they enter into residency training. Interns become residents. Senior residents celebrate moving into attending positions or look forward to subspecialty training in fellowship programs. It’s the excitement of completion combined with the uncertainty of charting a new course in medicine. Each …
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3 steps for doctors to move into the next level of career growth
The most high-powered rotation in my medical school was endocrinology. There, you got to see things most doctors never come close to diagnosing themselves. Uppsala University’s Akademiska Hospital served as a referral center for the Swedish population north of Uppsala, an area the size and shape of California.
Back in the seventies, laboratory testing wasn’t as sophisticated as it is now. We didn’t have CT scanners even at the major hospitals, …
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The freedom to admit someone because it was the right thing to do
