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.
Patient-centered care (PCC) seems to be a popular buzzword among policymakers and administrators in recent years. Indeed, many physicians see our health care system as payer-centric, many patients see it as physician-centric, and no one seems to see it as patient-centric. While putting the patient at the center of what we do as physicians is critical to improving the triple aim of better care, better health, and lower costs, it …
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Patient-dictated vs. patient-centered care. What can physicians do?
Recently, I watched a disturbing video of a fellow physician being dragged out of an airplane. I find it hard to understand how these events unfolded despite Dr. Dao being a customer who chose to fly United, paid hundreds of dollars for his ticket and legally boarded his flight. Whether blame belongs with United or the Chicago Department of Aviation, this was an unsettling occurrence. Yet somehow — I wasn’t …
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The problem in health care: Caring too much
The setting: an inpatient unit in the Bronx, circa 2005.
I was a resident (and hence was likely disheveled, groggy or exhibiting some other outward display of exhaustion) of the internal medicine program at Albert Einstein University Medical Center/Moses Division, aka Montefiore. The fact that the program was considered “malignant” by those in my industry — mainly due to the strict nature of the training program — likely strengthens the possibility …
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A patient thought she knew who the real doctor was. She was wrong.
At the end of my daughter’s first week of preschool, she came home with a burning question: “Mom, my friend at school says that she has two days in a row when she and her mommy and daddy are all home at the same time. They call it a weekend. Will we ever have a weekend?”
I was floored. That simple question encapsulated the only life she had known as a …
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Telemedicine: A cure for physician burnout?
Making a diagnosis is one of my most common challenges. Families and patients are understandably more interested in the therapy to alleviate illness and suffering than exact diagnosis. We are swept along with this laudable therapeutic objective in the current of prompt empiric therapy bringing relief and hopefully confirming an empiric diagnosis and buying time before more definitive testing.
I object to this approach even as I engage in it. Necessary …
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Trust your instincts, but verify them
Free speech is one of our bedrock constitutional rights. The battle over what constitutes lawful free speech is ongoing. But the issue is more complex than I can grasp with legal distinctions separating political speech, commercial speech and noncommercial speech. And, of course, the right of speech does not permit the free expression of obscenity or “fighting words” along with some other exclusions.
There is no right to free speech in …
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Doctors have First Amendment rights too
The patient, I surmised, was the one in the wheelchair with nasal oxygen and an unhealthy red color of her cheeks. The younger woman in the room with her looked like she might be a daughter.
I introduced myself. I had been right about the other woman being her daughter.
It was Saturday clinic, urgent care at our country doctor practice, and the plastic holders with “express check-in” history forms and a …
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I doubt this patient’s other doctors listen
There are parts of medicine that are horrendous. Moments too painful to recount, and events that will break even the most innocent participants.
And then, there is unspeakable magic.
I live for the days when a patient comes to the office with a particularly vexing set of symptoms. Specialist after specialist bows their head in disagreement. Laboratory values whisper falsehoods with jeering tongues. Symptoms are transient, physical exam signs inconsistent and in …
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Sometimes, being a doctor is magical
The day after I told Nell she had seven metastases to her brain, she sent me flowers.
She was my patient; I was her oncologist. I had met her one year prior, when she was well into her cancer journey, stage IV breast cancer at diagnosis. I took over from her current oncologist, who was moving. At our first visit together, she grilled me without mercy. Her questions were insightful, and …
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How a cancer patient impacted her oncologist
As physicians, we are seen as leaders whether we like it or not. And as such, we are charged with modeling greatness. But do we? Our training, while teaching us to be experts and authorities, does not teach us how to be leaders. However, somehow we get out into practice and are automatically seen as leaders, and thrown into positions that require a skill that we don’t have. And we …
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Face it, doctors are bad leaders
During medical school, I made it a goal to graduate with a degree in one hand and a baby in another. I had a supportive husband, so we started trying to conceive when I was in my third year of medical school. We didn’t get pregnant as quickly as I thought, and we almost gave up on the idea of having a baby at that time. I was already 28 …
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5 things I learned while having 3 kids during medical school
In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back.
What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and compassionate humanitarians. Soon, we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? Attention, medical …
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Top 5 reasons why doctors lack self-confidence. And how to fix it.
“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other.
“Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave …
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The dangers of being overly apologetic
When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability of allowing a patient who refuses necessary blood products to die. For this reason, these institutions are not welcoming to Jehovah Witnesses. This is of special concern in surgical specialties …
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If she gets pregnant, she might die. Do I help?
Decisions regarding medical care are often not very straightforward due to the uncertainties, risks, and limited options involved. But, above and beyond the actual choices to be considered, the process of how the choices are made has become a red-hot topic. And the value of the patient — as opposed to the doctor — as the driver of medical decision is, quite curiously, just beginning to be recognized in a …
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Shared medical decision making is a not a new concept
“Ice! Ice! I need ice!” Paul yelled, rushing into a store.
It was a skate shop. They looked at him like he was crazy. “Ice! Ice! I need ice!” he continued to yell.
The store employees looked at Paul with a blank stare. They pointed to the restaurant next door and suggested that he try there to get ice.
They had no idea what was going on.
Paul’s girlfriend had overdosed on heroin and …
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Take it from a patient: Naloxone is life saving
“Wait. When did you say you started that medication?”
“Two weeks ago.”
“And when did you say you started having those symptoms?”
“Uh … about … let me think … it was — two weeks ago.”
This kind of circumstance is my holy grail. It is the ultimate moment where I connect the dots. It has happened several times recently where patients have had chronic symptoms and have related to me that they have …
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In any situation, listening is always best. Doctors should remember that.
Over 1 million virtual doctor visits were reported in 2015. Telehealth companies have long asserted that increased access to physicians via video or phone conferencing saves money by reducing office visits and Emergency Department care. But a new study calls this cost savings into question. Increased convenience can increase utilization, which may improve access, but not reduce costs.
The study has some obvious limitations. First of all, …
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Does telemedicine save or cost money?
Before I started my residency program at Boston Medical Center (BMC), I had no idea that residents were unionized at 60 hospitals across the country. I actually didn’t know much about unions or the labor movement until I got involved in contract negotiations between my own union, the Committee of Interns and Residents (CIR), and Boston Medical Center administration. Through this process, I now know what it is like to …
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The importance of a doctors’ union in the age of Gorsuch
