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.
For the last 8 years, I have worked as a locum tenens hospitalist. I began on this path when it was the least popular option upon graduation from residency.
I did countless hours of research trying to find accurate information about locum tenens companies, but never found anything written by physicians, only by the companies themselves. So, I stepped into this field blindfolded and learned the hard way. Since then, I have …
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5 mistakes hospitalists should avoid when starting a locum tenens position
During the 1990s Dr. Jack Kevorkian drove his Volkswagen van through an unmet need in American medicine euthanizing 130 patients who felt death was the only solution to their suffering. He euthanized his “patients” with devices he named the “Thanatron” and the “Mercitron.” The former allowed his patients to administer IV barbiturates and potassium while to latter delivered carbon monoxide. When convicted of manslaughter, he told the court, “Dying is …
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The physician-assisted suicide predicament
My first patient of the day has metastatic pancreatic cancer. She’s had it, in fact, for two years. Getting chemo for two years. Her hair has fallen out, her pain is becoming uncontrollable and she’s been in and out of the hospital.
Her daughters came to the clinic with her. She is tearful. Her daughters pull me aside. “Tell her to focus on the positive,” they request. I wonder if there …
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An emotional day as a doctor
“The worst enemy of a doctor is another doctor,” said one of my professors during rounds when I was doing my internal medicine clerkship as a third-year medical student.
I remained skeptical. That did not match the idea of becoming a doctor nor did it support what Dr. Pellegrini said: “Medicine is the most humane of the sciences.”
Nonetheless, my old professor explained that when it comes to patient care planning and …
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The worst enemy of a doctor should never be another doctor
It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry …
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Am I the cold and detached physician?
Health care has undergone innumerable changes over the last decade, and the pace of change only appears to be accelerating. At the crux of most of the changes we’ve seen is the central problem that the cost of our health care system is unsustainable, and we as a nation need to put the brakes on it. The costs to individual patients are also unacceptably high.
Unfortunately, the prevailing philosophy has been …
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A fight for the heart and soul of health care
It’s easy to be excited about facts when they support our own opinions. It’s nice to believe that uncomfortable facts are fake. Likewise, it’s comforting to believe that everyone who disagrees with us is ignorant. When the truth is so obvious, we say, “How could anyone but an uneducated bumpkin deny it?”
And yet, it seems that much of our knowledge is incomplete and that our deeply held beliefs may be …
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Today’s unassailable fact could become tomorrow’s flat earth
I know a bit about the opioid epidemic ravaging America. My wife and I grew up in West Virginia and follow the news from home. I practice emergency medicine in rural South Carolina, and have worked in Georgia, North Carolina, Kentucky, and Indiana. I have seen the enemy, and it is terrible to behold.
The genesis of the epidemic has been covered over and over. It is a complex problem with …
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The cognitive dissonance of prescribing narcotics
There are many days in primary care when you feel like you are treading water; nobody gets substantially better as time and disease progression seem to always win over your own and your patients’ efforts.
But sometimes you hit a winning streak. The past few weeks seemed to bring me one diagnostic or therapeutic coup after another.
There was the depressed man who came in smiling and said: “I’m shaving again.”
There was …
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A doctor on a recent winning streak
Congratulations! You made it through medical school, got your MD/DO degree, and can officially be called doctor! One day, you’re a student. The next, you’re a doctor and with that come the responsibility, trust, compassion, and professionalism associated with our career. But how do you transition?
It starts with your mindset and then deciding to be the best doctor you can be. Your thoughts inspire your words, which direct your actions.
I …
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The new doc on the block: 7 lessons from my first year of being a doctor
My last patient of the day was an elderly woman with metastatic lung cancer, a non-smoker who had been battling this terrible disease for more than a year. I was running thirty minutes behind. I had a packed afternoon with difficult cases and patients who required more of my time and care. I peeked into her room, said hello and apologized for running late. Ms. B. greeted me with her …
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This physician vows not to rush
I’ve thought long and hard about writing this, so here goes: I am a female surgical subspecialist. I trained at a Harvard program back in the 1990s, and was one of a handful of women to have completed residency training at a stodgy 125-year-old program. The eighth, to be exact. During that time, I was treated as an inferior, sexually abused verbally, routinely given the bottom of the barrel when …
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Not me: the story of a female surgical subspecialist
1. You sleep when you can. Despite what medical television dramas portray, call room beds are for sleeping. Period. As you curl up into the bed you have no idea whether you are about to get a couple hours of sleep or a couple of minutes, but in that moment of sheer exhaustion, the drab hospital cot or bunk suddenly transforms into a luxurious sleeping pad. Bonus if you can …
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7 habits of being on call
It seems like every other day, there’s a new discussion or debate which emerges about the unique challenges that minorities face in America. This is, of course, a sensitive topic, because minorities in any arena will always have their personal story. Whether it’s because of your color, or anything else that makes you feel like you face extra hurdles — there are indeed lots of ways in which society still …
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How this physician deals with race-based comments
Actual conversation heard in the hallway outside an exam room earlier this week:
Doctor: “So, we’re going try this medicine for your blood pressure; you keep checking it at home as we discussed. If the numbers remain high, we can increase the dose or add another medicine.”
Patient: “Well, what do we do if the pressure stays high; if this medicine doesn’t work?”
My partner told me later that she had explained the …
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A better way to follow-up your office visit is needed
Very many years ago, as a medical student, I remember caring for a twenty-something-year-old in the intensive care unit (ICU) with a very severe infection that resulted in her being in the ventilator for months. Let’s call her Jane. Her hospital course was complicated: re-infections, loss of digits, muscle wasting.
The ICU was closed to families during morning rounds which is when all the doctors in their white coats gathered and …
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Don’t go to the hospital alone
The vast majority of births and deliveries are joyful ones. Families celebrate the wonder of the new addition to their families, and clinicians go home at the end of the day with a sense of pride, deriving meaning from their professional lives. This is one of the reasons that many of us chose obstetrics in the first place.
But unfortunately, that is not always the case.
As an obstetrician, I know firsthand …
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When outcomes are tragic, doctors suffer too
Physicians do not have a lot of power these days. But if you know when, where and how to look, we can, on occasion, score some victories.
Case in point: hospital bylaws that every physician is required to acknowledge and sign before being granted privileges. It is always a good idea to carefully read before signing anything, and I did the just that before signing my hospital’s bylaws. I asked a …
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Hospital bylaws saved this doctor from EMR burnout
Nothing troubles physicians more than an unforeseen outcome and a malpractice lawsuit. It cracks open self-doubts and assumptions about medicine and may be life-changing.
It commonly fuels burnout, loss of confidence, PTSD and early retirement. And there are links to depression and physician suicide.
There’s another side to this story, though. Like all of life’s great challenges, a patient’s unexpected loss, and professional litigation present us with huge opportunities for growth.
I am …
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5 ways to live through medical malpractice lawsuits
In his lifetime, William Shakespeare wrote almost 120,000 lines and about 900,000 words. His 37 plays and 154 sonnets burnished his reputation as the unrivaled wordsmith of the English language. So what would the Bard, who had something to say about everything, have said about palliative care of the suffering of the sick? Although I couldn’t resurrect him from his venerated grave, I could unearth quotes from his collective works …
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Shakespeare on palliative care
