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.
To my fellow physicians: I apologize for asking you to do one more job. But I must. It is for the sake of humanity. We are already overburdened with the administrative nightmare that hospitals and insurance companies heap upon us. The struggle to find pride and purpose in our daily life has become a full-time job. We have become oppressed by our increasing allegiance to the demands of administrators as opposed to …
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A call to action to raise respectful children
“Doctor, I need some orders for this patient. Can you do that soon so that I can get started?”
I was just bringing up a preterm infant to NICU due to concerns for maternal infections. Yes, it was July 3, 2016 — my first official day of residency where I was no longer “just” a medical student. I was a doctor!
My initial reaction was to look around me, thinking (and hoping) …
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Doctors grow up so fast, don’t they?
I was scheduled to attend a medical director’s retreat the other day, but because of a horse emergency the day before, I had to stay home, so I offered to skip the retreat and see patients instead.
It would have been almost an entire day hearing about trauma informed care and the lifelong impact of adverse childhood events. As a primer, the conveners of the seminar emailed a “dear doctor” letter …
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Why we shouldn’t pigeonhole patients into groups
Being the intern on the team, I knew the scut work belonged to me. Every medical student understands the hierarchy of the medical team, and there was just no way around that. If a patient needed urgent blood work drawn at 3 a.m., call the scut monkey as we were called. Any patient requiring a rectal exam required an intern to perform the test. Scut basically was any work that no …
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It is easy to pass judgment and much harder to pass empathy
Truthfully, I am not from a military family. Naturally, my grandfathers were in the service, but they didn’t die serving. Also, my birthday has always fallen on Memorial Day weekend, or near it. So rather than visiting a cemetery, we usually have a small party. For some reason, perhaps it’s the political divisiveness in my beloved country, I have been thinking more and more about Memorial Day.
To my understanding, Memorial …
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Memorial Day thoughts from a physician
Some days, I get so frustrated at work. Yes, we all have our frustrations. Maybe traffic is slow, and you get to work late. Maybe you spill your coffee on your work clothes as you walk into your office. Maybe someone calls in sick, and you are short help at work. But this is big! Like so big, it can impact the trajectory of someone’s life. They, in turn, are forced …
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Seeing your gynecologist is not just for a Pap smear
Last fall I was witness to a miraculous event. I rarely take off from work, but did so on a Friday to go to Baltimore to lend moral support to my family doctor friend, Cathy Maslen. She and her workmates at Chase Brexton Health Care (a community health clinic in the Baltimore area with a focus on the gay and transgender community and the inner-city poor) were doing something that …
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To help patients, doctors should consider going on strike
I have a confession to make. I don’t understand the concept of burnout. I mean, I get the idea. Medicine is, at least when you are the kind of doctor who deals with life and death, inherently stressful. And I feel the stress. It’s as if someone applied a vice grip to my insides in the middle of medical school, and it has never let up since. The pressure is …
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You want doctors to be doctors again? Get out of the way.
“So tell me why you think you you’re having a stroke?”
The nice lady, mid 40s, sat on the ER exam table in work-clothes, an anxious look on her face. “Well, I was working the cattle up in the timber, and when I got back to my 4-wheeler my heart was racing, and I was short of breath. My arms were tingling, and so was my face. I’m concerned it might …
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This is what practicing medicine in rural America is really like
My patient was sitting in a wheelchair. He was in his mid-forties, and before the cancer, had held a physically demanding job that he loved. Now, the cancer in his spine had ended not only his ability to work, but any ability to use his legs.
His wife was devoted to him in a way that seemed as natural and understated and unobtrusive as breathing.
In order for me to examine him, she …
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Bearing witness: An oncologist’s role at the end of life
Sometime during my medical training in the early 1980s, a wise, old attending orthopedist taught me this about pain management:
“Pain is a message that something is wrong, a red flag that corrective action is needed. Narcotics should only be used when the cause of the pain is determined and corrected (Post-op or post injury), all other pain management tools have been tried and failed, and it is determined that nothing …
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For doctors, treating pain is a pain
Telemedicine is the new rage in medicine and a very needed service. It is vital in areas that are underserved and doctors hard to come by. Additionally, it can be a great convenience for patients who may not actually need to physically go to the doctor. But, is telemedicine dumbing down the standard of care?
Doctors are held to a certain standard in the way they treat patients. If they fail that …
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Is telemedicine dumbing down the standard of care?
When we walked into the room, you could sense the anger and frustration on the patient’s face, as well as two other relatives in the room.
We knew that the patient had had lung cancer for several months and had failed radiation and chemotherapy. He had labored breathing and looked miserable.
I went to his bed and asked if I could sit down on his bed. I took his wrist and began …
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Patients appreciate our honest concern. And that takes time.
“This latte is too sweet,” I think to myself as the foamy hotness lights up the sweet receptors on my tongue. I stop and try to remember how many pumps the nice lady at the coffee shop slammed into my cup and think it’s somewhere around three or four — will have to go down to one tomorrow. I sigh and spin in my office chair breathing deeply and looking …
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What emotions are doctors allowed to feel?
A comparison of appendectomy outcomes for senior general surgeons and general surgery residents revealed no significant differences in early and late complication rates, use of diagnostic imaging, time from emergency department to operating room, incidence of complicated appendicitis, postop length of stay, and duration of post-op antibiotic treatment.
The only parameter in which a significant difference was seen was that attending surgeons completed the procedure significantly faster by 9 minutes — …
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Residents performing surgery: Why can’t we reach a middle ground?
I woke up at 6 a.m. to my daughter’s annoyingly, loud alarm. Since I was on call, my first reflex was to look at my iPad to see if I had patients in labor. I am part of an 11 doctor call group, so when I am on call, I cover all the patients of those doctors that come into the hospital. I scrolled through the patient list and saw …
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A physician broke down walls, or so she thought
Maybe 10 to 15 years ago, my medical center at the time invited a prominent former resident to give grand rounds. He had become the statistical director for what was a large regional insurer absorbed by a national insurer shortly after that. He spoke very little about the prevalence of disease among his company’s beneficiaries but extensively about how his company assessed the performance of physicians. He also related how …
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Here’s what doctors really think about where they work
“Annie, Annie, are you OK?”
Many of us learned to resuscitate a person who has collapsed using Annie, the mannequin based on a death mask of a young woman who had drowned in the Seine in Paris in the 19th century. Bystander cardiopulmonary resuscitation (CPR) has become increasingly accepted and expected as the years have passed, and we have even begun to make affordable machines to deliver a life-saving shock (defibrillation) …
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Bystander CPR makes a difference
I recently attended the annual Society of Hospital Medicine conference in Las Vegas.
As a proud hospital medicine doctor, this organization has grown exponentially over the last decade, and thousands of hospital physicians from across the nation descended on the city for a few days of great learning and networking opportunities. However, away from the conference, this being Vegas, there had to be some time for fun as well.
On Saturday evening, …
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How the $8 bottle of water in Las Vegas is a health care issue
I am nearing the end of my training at one of the top surgical fellowships in the country. I chose this fellowship not just for the name, but also because the surgeons all seemed like genuine and altruistically motivated individuals. It was two-thirds of the way through fellowship when I found myself in conversation with two male trainees. We were discussing the younger trainee and his girlfriend; he would be …
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There’s no place for locker room talk in the OR
