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.

United Airlines and Dr. Dao: Who we should be really mad at

Suneel Dhand, MD

Physician

May 10, 2017

As the world digested the events that unfolded aboard United Airlines Flight 3411 at Chicago O’Hare, and watched the horrific video of Dr. David Dao being forcibly dragged off the plane that was supposed to be taking him home, social media was red with rage at United Airlines. People vowed never to fly with them, customers ripped up their loyalty cards, and United’s stock fell over a billion dollars in …

It’s bad luck to say that in a hospital

Sarah Fraser, MD

Physician

May 10, 2017

Doctors and nurses like facts. After all, we’re evidence-based thinkers — rational scientists. Yet, we can be surprisingly superstitious.

Many of us believe in a thing called “call karma,” which is when certain doctors attract sick patients while working on call (these people are said to have bad call karma). Other doctors attract less sick patients, meaning they have good call karma.

As a medical student, I quickly learned that I fell …

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It’s bad luck to say that in a hospital

3 communication mistakes doctors make. And how to fix them.

Suneel Dhand, MD

Physician

May 8, 2017

It is not something that is taught enough in medical school, but practicing physicians quickly realize that in this business: Communication is everything. The reality of health care is that you can be the worst physician in the world clinically (not that it’s something desirable to be), display great interpersonal skills, communicating well with your patients — and they will do absolutely anything you say and put you up on …

The evolution of prior authorizations

Hans Duvefelt, MD

Physician

May 8, 2017

My old strategy for getting insurance approvals for imaging tests doesn’t seem to be working anymore.

I used to put my thinking in my office notes so that a reviewer at one of the imaging management companies would clearly see my rationale for ordering that CT scan or MRI my patient needed.

Now I am getting more and more requests to initiate a “peer-to-peer” call instead. My heart sinks every time; each …

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The evolution of prior authorizations

What’s the difference between health care in the U.S. and Haiti? Not much.

Vincent DeGennaro, Jr., MD, MPH

Physician

May 8, 2017

“How long have you had the bleeding?”

“About seven years,” my patient replies stoically.

Ange’s angular face no longer retains the beauty of her youth. The sharp lines around her mouth speak of a long life packed into a brief 42 years. She is well dressed, but her manner of speaking betrays the poverty in which she exists.

Ange has advanced cervical cancer — a completely preventable disease. In fact, cervical cancer can …

To be an oncologist today is to be a part of a revolution in medicine

Don S. Dizon, MD

Physician

May 8, 2017

When I was a resident, my colleagues chided me for wanting to be an oncologist. Back then (and it pains me to be old enough to use that phrase, by the way), oncology was thought of as a field of futility. We administered toxic drugs to patients with cancer, and far more often than not, they …

The vaccine study you’ll never see

Chad Hayes, MD

Physician

May 7, 2017

I’ve seen a lot of social media posts or comment threads that say we don’t have any studies to prove that the CDC’s vaccine schedule is safe or effective.|

As a pediatrician, the first time I read that, I was surprised. But now, I think I know what they mean.

I think they mean that we haven’t done the best study. Those of us in the scientific and medical fields frequently demand …

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The vaccine study you’ll never see

MACRA penalized this doctor for going the extra mile for his patients

Matthew Hahn, MD

Physician

May 7, 2017

We’ve taken care of Jane and her son, Sam, for a long time (the names are fictitious, but the rest of the story is true, and the real patient approved this story, in case you were wondering). At first, the focus was Sam, with typical well and sick visits. He was one of the sweetest kids we knew.

Sam also had a very significant learning disability. At one point I asked …

Never forget the patients we do not see

Dave A. Chokshi, MD, MSc

Physician

May 6, 2017

In medicine, we speak of “seeing patients” when we are rounding in the hospital or caring for those who come to our clinics. But what about those people who may be sick but do not seek care? What is our responsibility to the patients we do not see?

This question takes on greater urgency in the current political climate, as patients face the threat …

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Never forget the patients we do not see

The sad reality that medical consultants face

Michael Kirsch, MD

Physician

May 6, 2017

What should a medical consultant do when the referring physician wants a procedure that the consultant does not favor?

Of course, this sounds like a layup. The consultant, readers would surmise, should have a conversation with the referring colleague to explain why the procedure is not in the patient’s interest. The colleague then thanks the consultant for his thoughtful input, and for sparing the patient from the risks and expense of …

5 things doctors should know about compassion fatigue

Jennifer Lycette, MD

Physician

May 5, 2017

For many physicians, the term “compassion fatigue” may imply, as the words describe, that fatigue leads to the loss of ability to feel compassion for others.

After all, what physician doesn’t have a day when s/he is too tired, running on too little reserve, and feeling some degree of emotional numbness?

Many physicians may not realize, however, that compassion fatigue can go much deeper. According to the Compassion …

Focus on the outcome, not what’s negative

Shabbir Hossain, MD

Physician

May 5, 2017

A free moment to read my favorite health care blog is hard to find. The days are packed with complex and time-intensive patients. In between them, I struggle to complete documentation and take care of a myriad of tasks, making phone calls and plodding through cumbersome electronic medical records. Then, there’s still actual paperwork to review and complete. I still have to make time to read clinical literature in addition …

I want to quit medicine, and it has nothing to do with patients

Rosalind Kaplan, MD

Physician

May 5, 2017

I think a lot about quitting medicine lately. A lot.

Then I have a morning like yesterday morning:

I see a patient I’ve known for more than twenty years, caring for him through an adrenal tumor, a major gastrointestinal surgery and now renal failure, for which he needs a kidney transplant. As we review his last set of labs (stable, thank goodness), he is sanguine, hopeful. He may have found a donor, …

An extraordinary day in the life of a physician

Jeremy Topin, MD

Physician

May 3, 2017

Walk with me, why don’t you? It’s time, don’t you think? We have been avoiding this for quite a while. But it’s best to bring this out from the shadows and into the light. Let’s take a walk through part of my day.

Be careful.

You won’t like what you see. I don’t like this much, but I just keep moving forward, one foot in front of the other. Don’t stop. Can’t …

Your on-call doctor probably didn’t receive training in telephone medicine

Michael Kirsch, MD

Physician

May 3, 2017

Physicians spend a lot of time counseling patients on the phone. Often, these conversations occur at night with patients we have never met before. When I am on-call in the evenings or on the weekends, these are some typical phone calls I receive from patients I have never met.

I have a very bad stomach ache for the last hour.
I started having rectal bleeding an hour ago.
My wife tells …
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Your on-call doctor probably didn’t receive training in telephone medicine

No, pregnancy did not help Serena Williams win the Australian Open

Jennifer Gunter, MD

Physician

May 2, 2017

The New Scientist wonders if Serena Williams pregnancy is making her a better athlete?|This is a new low in “pregnancy angles.”

I often get asked to comment on celebrity/athlete pregnancies, and I always decline. Why? Partly because I don’t want my name in articles like this, but also I don’t care what anyone does in their pregnancy and neither should you. If a celebrity or athlete is offering …

What is the right way to deliver bad news?

Andrea Eisenberg, MD

Physician

May 2, 2017

Recently, someone close to me was diagnosed with cancer. Due to a series of missed phone calls on both sides, he had not heard the results of his biopsy prior to his follow up appointment. When his young doctor walked in, he started with, “So you know you have cancer, right?” I just wanted to scream, “What the f*ck!” It is never easy to give someone bad news, but this …

Here’s how your commute can help you

John Merrill-Steskal, MD

Physician

May 2, 2017

This is an open letter to everyone everywhere, especially people who live in small communities such as mine:

If you drive to work, you are missing out. If someone offered you an opportunity to improve your health, enhance your happiness and creativity, boost your self-esteem and even make you richer, what would you say? Many might think it would be an offer that was too good to be true — a …

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Here’s how your commute can help you

In their obsession with numbers, doctors sometimes forget who patients are

Rob Lamberts, MD

Physician

May 2, 2017

The consultant note read:

Weight 250 lbs. BMI 40.3. Patient is morbidly obese. Counseled on the dangers of excess weight. Counseled to increase exercise and decrease calories.

I walked into her room. She smiled at me as I walked in, a lovely smile that reached her eyes. I scanned her record. She was in my office for an ankle injury. Blood pressure normal. Weight 248 lbs., BMI 40.

When I looked back at …

My first mistake could have been fatal

Rogue Dad, MD

Physician

May 2, 2017

Recently, our three-year-old wandered into our bedroom around 4 a.m. waking me up, saying he was scared. As I did the previous few nights when he did this, I muttered a curse word to myself and picked him up to carry him back to his room. Upon lifting him, a wrinkle in the routine emerged — he was naked below the waist. At some point, before he entered our room, …

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My first mistake could have been fatal

Physician

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