Physician

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.

Should doctors be required to inform patients of their palliative care rights?

Kevin Haselhorst, MD

Physician

February 8, 2018

I overheard a colleague admit an 84-year-old woman to the hospital from the emergency department for a sizable mass in her uterus — no doubt, cancerous. I pictured a frail woman who’d been suffering for a while and was afraid to tell anyone about it, fearing the worst. Like most, she preferred to ignore it rather than have others tell her what to do. Having fallen ill, she risked losing …

The unintended effects of physician side hustles

Millennial Doctor, MD

Physician

February 7, 2018

A movement is growing in the underbelly of the internet.

On Facebook, a group called Physician Side Gigs has over 11,000 physician members trading tips and words of encouragement with other doctors looking to supplement their clinical careers via side hustles. Physician on Fire and the White Coat Investor are encouraging doctors to achieve financial independence in order to relieve ourselves …

Sailors, surgeons, scheduling: the deadly consequences of fatigue

Suvas Vajracharya, PhD

Physician

February 7, 2018

Sailors are now the latest profession, along with truck drivers and airline pilots, taking the dangers of fatigue and the need for balanced shift schedules seriously. When will medicine finally catch up?

Recently, Navy officials sat down in front of Congress and talked about tiredness. With a $171.5 billion annual budget and some of the most sophisticated military technologies in the world, it is increasingly looking like human …

Harassment of women in medicine: We are all in this together

Rita Agarwal, MD

Physician

February 7, 2018

Almost every day there is a new revelation about men committing horrible, criminal, bizarre, or nauseating acts of sexual misconduct. Harassment and assault seem to be rampant. The #MeToo and #TimesUp movements have illuminated the vast scope of the problem. Most stories have focused on famous men in politics, business, sports, and entertainment, but this type of behavior is pervasive. Lately, the lay press, medical blogs, and social media have …

A typical day in this physician’s household

Tara Vijayan, MD

Physician

February 6, 2018

There is peanut butter on the doorknob.

Coffee cup in one hand, I stumble after my 17 month-old who is chattering away Mogwai-style, and quickly wipe my other greasy hand on my pajama pants. I ensure that she is not about to ingest any number of the choking hazards my 4 year old has left splayed on our floor.

It is 6:45 am on a Saturday morning, and in about an hour I will rush off …

As a doctor with cancer, I have opinions on opinions

J. Edward Les, MD

Physician

February 6, 2018

The modern news cycle’s obsession with all things Trump has moved light years beyond dispiriting with cacophonous reams of vitriol shoveled endlessly back and forth.

One could opt out, I suppose, and simply take an elongated holiday from all things media-related. But like moths drawn to a flame, we can’t seem to help ourselves, and your humble scribe is no exception.

And so, I took note last week of Andrew Coyne’s ruminations …

How racism affects this physician

Ameet Nagpal, MD

Physician

February 5, 2018

I was fortunate enough to be able to go to my friend’s wedding in Indianapolis in October. My three-year-old son called it “India with Apples.” This is a friend that I’ve known since I was in first grade, and my parents and his parents are good friends. We were at the Friday night celebration and enjoying ourselves and decided to walk back to our hotel. We made it to the …

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How racism affects this physician

What I learned from the ICU (other than medicine)

Michelle Ramirez, MD

Physician

February 5, 2018

This week I had some particularly emotionally tough cases at work, and it got me thinking about life in general and how, in spite of having a tough job, I have learned so much from it.

When I think of childhood diseases, there are the ones that are chronic, the ones that let you process that your baby is sick and has a potential life-threatening condition. You have weeks and months to …

What physicians what their patients to know: 13 more things

Joanne Jarrett, MD

Physician

February 5, 2018

After reading “13 things every doctor wants their patients to know,” here are 13 more things good doctors wish their patients knew.

1. We need the complete truth. I feel for patients who hesitate to reveal something embarrassing. But we hear so much. Very little shocks us. Also, we realize we haven’t walked a mile in your shoes. Or an inch. We take in the facts and get down to …

5 mistakes this doctor made when negotiating his contract

Mitchel Schwindt, MD

Physician

February 5, 2018

The final year of any residency is a time of accelerated independence, moonlighting, and an intense search for that first job as an attending. This decision is critical as one embarks on a life-long career in medicine, and it will undoubtedly blend a mix of analytics, emotion, and finance into the final analysis.

With a bit of candor, I want to share the mistakes I made when accepting my first contract …

What to do when a patient wants to leave the hospital against medical advice

Robert Donnell, MD

Physician

February 5, 2018

There’s an interesting article in the Journal of Hospital Medicine on what to do when a patient wants to leave the hospital against medical advice. After reading and rereading it, I had to disagree with the conclusion, but it took me a bit to get there because the article, with its confusing use of terms, is a masterpiece of obfuscation. The most obvious example is the oxymoronic use of the term “AMA …

Concierge medicine sucks for specialists. Here’s why.

Anonymous

Physician

February 3, 2018

As a private practice specialist in an affluent metropolitan area, I am often inundated with requests for consultation by local residents and primary physicians. That’s fine — it’s what I do, and it’s what I enjoy doing. Hey, it pays the bills, and I won’t complain about that.

Concierge medicine has taken a foothold locally, and this means more referrals directly from doctors who insist we take care of their patients …

Immigrant health care workers serve a vital function within the American health care system

Raymond Jean, MD

Physician

February 2, 2018

Early this month, it was reported that President Donald Trump, having grown frustrated from discussions regarding a bipartisan deal on immigration, asked why proposals continued to provide special protections for immigrants from the countries of El Salvador and Haiti, and the continent of Africa. He reportedly exclaimed, “Why are we having all these people from sh*thole countries come here?” The statement has been largely denounced both at home and abroad, and …

Think critically about for-profit donor entities and their commitments to health

Emi Okamoto, MD

Physician

February 2, 2018

At my job as a primary care doctor in a federal safety net clinic, I was given a free T-shirt to wear the following day. It reads “Crucial Catch — Intercept Cancer” in between the logos of the National Football League (NFL) and the American Cancer Society (ACS). This celebrates the 8-year partnership of almost $18 million dollars donated to fund cancer screening and prevention. These philanthropic gestures of large donors …

Why medical scribes are accidental blessings

Jonah Mink, MD

Physician

February 2, 2018

Some doctors choose medicine because of the medicine, and some doctors choose medicine because of the people. I veer towards the latter: Medicine is my tool to help the person sitting across from me.

However, I am finding more and more stuff getting in between me and my patients, primarily my computer. The increasing burden of gathering coded health data in the EMR, especially in light of the impending MACRA, MIPS …

Let academic physicians recover more of their clinical revenue. Here’s why.

Cory Michael, MD

Physician

February 2, 2018

I spent considerable time after college working in academic labs being indoctrinated with the theory that publication is the currency of academic value and that researchers should always want to have their work printed in the journal most cited by other journals. You are supposed to be impressed when somebody claims that he or she is from a highly ranked university or institution, as these well-regarded institutions are synonymous with high achievement.

That all changed for me during residency when I met …

On mountains and miscarriage: a physician’s story of loss

Meredith Bourne, MD

Physician

February 2, 2018

I feel the mountain in my bones. The methodical plodding of feet over uneven terrain, a meditation, the grace of a single forward path, with no decisions, no guilt or what-ifs, no fear. Just forward movement, forward momentum. I hear Mary Oliver’s words at my core: “I don’t know exactly what a prayer is. I do know how to pay attention … how to be idle and blessed.” It’s taken …

I don’t know if this test will save your life

Justin Reno, MD

Physician

February 1, 2018

“So, will this mammogram save my life?” she asked.

I thought for a few seconds …

“I have no idea.”

“What?” she sounded perplexed.

“Well, if you have a cancer that’s aggressive enough to kill you before everything else, but not aggressive enough to have already had cells metastasize, and not so aggressive that it responds appropriately to chemo but it still needs to be rapidly dividing enough to respond to chemo, and we …

It’s important to proactively manage your resident progress. Here’s how.

Todd Rice, MD, MBA

Physician

January 31, 2018

Physician training is an extremely high stakes business, not only for the patients that will be under the care of the eventual independent, fully-trained, board-certified doctor, but for the trainee herself. The financial and time costs of the entire training process are enormous. To become derailed from the board certification path can have significant and permanent career consequences. With so much at stake, what does a resident do when she …

It’s time to debunk the myth that doctors’ dollars come easily

Nisha Mehta, MD

Physician

January 31, 2018

A few months ago, I hired a contractor for a home improvement project. He didn’t know that I was a physician at the time, and we came to a mutually agreeable price.

Fast forward a few weeks, when we realized that we needed an extra, seemingly small, addition to our project. By this point, we’d gotten to talking, and he’d learned that my husband and I were both physicians.

To my surprise, …

Physician

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