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.
I find myself spending close to an hour on the computer each morning at the hospital. I spend this time dutifully looking up vital signs, labs, recent radiology or pathology results as well as many other valuable pieces of information about each of my patients. I watch as my colleagues frantically record values, while making sure to point out important trends and gross abnormalities.
When we round, there is always a …
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This doctor spends more time at a computer than with patients
“So, I’m getting routine labs on her.”
Wait, what?
Statements like these often make the hair on the back of my neck stand up. One of our residents was seeing a healthy young woman for her “annual physical,” seen just a few days after a routine postpartum visit with her OB/GYN after the uneventful birth of her third child two months ago.
The resident was coming for his afternoon continuity clinic from an …
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It’s time to stop it with the “routine” labs
I entered the room to see a face that I recognized. As soon as I looked at my chart, I immediately knew this patient. I saved their life last year. I know this because the patient told me so.
The teachers and mentors that I was privileged to learn from and train with 25 years ago emphasized the essential principle of osteopathic medicine — we make physical contact with our patients. …
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In Iraq I saved lives. Now, I can’t give an allergy shot.
My intern gazed blankly at her notes from the day.
“You OK?” I asked.
Her face was quivering with restrained tears as she turned to me, “I don’t think I helped anyone today.” This was not the first time, nor would it be the last time, that I had heard those words from a resident physician.
Medical training is no joy ride. How could it be? First, there is the intellectual challenge of …
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How to find joy in practicing medicine
I have been working on this essay for some time now. It has been difficult for me to convey in words this complex issue of physician-patient relationships that, to me, is the crux of the art of medicine.
The first time I met Rachel was when she showed up at my office with Mary, her closest friend for her first prenatal exam. When a year later, I walked into my office …
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What does trust mean to a patient?
Sexuality can be hard to talk about. I think this is true for adults far more than for children. Children are naturally curious and nonjudgmental. They just want to know: What is that, what’s it for, why are yours different from mine, and why does he have one of those and I don’t? It’s we adults who squirm and dodge, deflect and bolt. From a very early age, children learn …
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Skirting around language is a disservice to your patients
Is the practice of medicine a different experience for male and female physicians? Two recent studies from athenahealth suggest that it is — in ways that should make us rethink what we value in health care.
The first study found that male physicians are more productive than their female counterparts. In an analysis of 47 million visits on the athenahealth network in 2016, male physicians generated 30 to 40 percent more …
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For women physicians, is there a connection between productivity and burnout?
I used to practice locums medicine; which for the lay person means traveling to different jobs, sometimes several states at a time. During that time I stayed in a lot of hotels. But, occasionally, I had more unique accommodations. Obviously, if you travel enough, you’ll sleep in an airport here and there. No big deal. I actually like sleeping in airports occasionally. When you’re stuck, you’re stuck. Weather or …
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The surprising sleeping arrangements of an emergency physician
I’m a physician, a husband and dad, a guy who tries to live by the golden rule. But sometimes I’m an escort into sadness and despair, plunging families into the darkest emotional depths with the news I must give.
One particular case from years prior stands out. Mary (whose name and identifying details have …
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The toughest task in emergency medicine
For the last several weeks, I have been working as a medical volunteer on a remote island off the coast of Fiji called Batiki. Home to 234 natives, Batiki has no running water, and no electricity (other than solar generated power). The inhabitants are subsistence fishermen and farmers. They are filled with joy and a real sense of community. While on the island, I found extremely high rates of high …
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This South Pacific island will change how you think about health care
One of the biggest points of contention in the ongoing discussion of burnout is that the system of health care is flawed. The endless bureaucracy, decreasing physician pay, and increasing meaningful use requirements that spawn endless clicking on an already inefficient electronic medical record platform have become unbearable by most practicing physicians today.
Furthermore, all the talk about mindfulness only riles up more anger in physicians as they feel they are …
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Take back our practices with physician cooperatives
Two months into my pediatric residency, while working on an overnight call, I encountered my first medical mistake. We, fortunately, had had a very good night, and all patients had remained stable. It was an hour before sign-out to the morning team, that I received a page. I quickly held my pager and dialed the 4-digit number, only to find a busy dial tone. I was a little surprised and …
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A safe space is needed to talk about medical errors
As an attending and educator, I give a lecture to the residents each year about stroke syndromes. In the lecture, I use mnemonics, pictures, and associations, so that the trainees can retain the information in non-traditional ways and have fun learning what could be otherwise dull material. When I talk about the internal carotid artery stroke syndromes, I bring up the possibility of “the good, the bad and the ugly” …
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What it’s like to be on call during a hurricane
As a second-year family medicine resident, wife of a nurse and mother of an almost-two-year-old, the feeling of just not being enough has a suffocating hold on me some days. Non satis. Sounds like a pretty good gig when I talk with others outside the medical profession and friends from home. Training to be a doctor? Great. Happily married to an amazing man who’s taking time off work to raise …
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A resident deals with being a wife, mother, and doctor
I sat on my floor, surrounded by boxes in various states of organization and disarray, sifting through a pile of papers. I was moving for my surgical fellowship and, of course, put off packing to the last minute. However, in the middle of the hectic and scattered process, a particular stack of papers caught my eye; I felt the need to pause and go through them. They were old and …
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What rejection taught this doctor
During elementary school, I saw my dad mostly on weekends, because he traveled for business during the week. Between watching soccer games and running errands, he never missed an opportunity to tune the radio to Car Talk. He is an engineer with a passion for cars, and Car Talk was his Holy Grail. He would guess what was wrong before the expert hosts spoke, and he was usually right. “Aha, I knew it …
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When we are in need, we crave someone who knows us
As a pediatrician, I have always known the value of my presence. At least, that is how I remember feeling during long nights in the hospital taking care of sick children, in the clinic or in any situation that required pediatric expertise. “How can I help?” I would always ask as I entered an exam room. Answering questions from wide-eyed parents about their foreign and frightening new bundle of joy, …
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Being a CEO isn’t that different from being a clinician
The writing’s on the wall. The last few decades have seen two groups of people:
One group that is “dying longer,” yes some might call it living long but not healthy. (As a physician, I call it dying longer). These are folks who are disabled, obese or emaciated and depressed or demented, with multiple medical issues spending a quarter of their life in the medical system, and the last decade of …
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Health care is obsolete. Let’s fix it.
As an oncologist, I have spent my career learning how to break bad news. I am still not entirely sure how to tell my children about the tumor in my pancreas, why I will be gone from our home next week for a Whipple operation, or my excuse for abstaining from wrestling matches for the foreseeable future.
I am blessed with two kids, temperamentally diametric: a careful, sagacious nine-year-old daughter and …
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Cancer doesn’t take away from the beauty of life
