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.
Transparency — including price, quality, and effectiveness of medical services– is a vital component to lowering costs and improving outcomes. However, it is imperative transparency go hand-in-hand with financial incentives for patients and consumers; otherwise, the quest will be in vain. The single best way of reducing costs while not worsening health outcomes is to redistribute resources from less cost-effective health services to more cost-effective ones. Americans are extremely uncomfortable …
Read more…
The problem with price transparency
When I go to work, I take a lot of things with me. Everyone has their ritual, right? I take my backpack with my computer inside. I take my phone. I take charging cords, the true modern lifeline. I take lunch. I carry a pen, flashlight and pocket knife.
On a more abstract level, I take the wonderful education I received as a medical student and resident, coupled with my years …
Read more…
The one person that sustains this emergency physician
The phones, the phones, the phones.
Every time we look, everywhere we look, getting the phone answered seems to be a problem we just can’t lick, a continual thorn in the side of our practice, something that’s hindering all the other efforts we try to make things better, to get ourselves to the best care environment for our patients, our staff, and our providers.
Without …
Read more…
Solving the telephone problem in primary care
The moment that an accreditation team shows up unannounced can spike the pulse of even the most seasoned hospital executive. The next several days will amount to one big exam for the safety and quality of care, as surveyors meet with executives, managers and care teams, and watch first-hand as care is delivered. Make the wrong move or give a wrong answer, have them see rust on a ceiling sprinkler, …
Read more…
How peer-to-peer review helps hospitals
Dear pharmacist,
You just paged me and, I must admit, I’m not feeling excited to call back. I estimate that I probably get paged, called, texted or stopped in person by you exactly X·102 per day, where “X” is the number of days I’ve been on service. Despite all of the interactions over the years, I have never stopped to really consider our relationship. Here are a few of our most …
Read more…
A tribute to the pharmacist
Think about it; athletes aren’t the ones who document their performance. It’s other people that keep the score. That’s a whole science in itself. People talk for hours after the game or tournament is over about how each athlete did this or that in whatever way they did it, and the numbers are in many cases captured by extremely sophisticated electronic equipment.
Physicians work hard to diagnose and treat their patients, …
Read more…
Let’s pay doctors like we do athletes
Earlier this month, a mourning widower stormed the office of the physician who had been providing life-saving cancer therapy to his young wife which failed. He shot and killed him. Or did he?
Before judging, let’s examine the facts associated with this case.
1. Juan Gonzalez, BCND was not a medical doctor. In fact, his “doctorate” was awarded via a naturopathic program. He did not possess, nor was required to possess a …
Read more…
When anyone can be a cancer doctor
I am working hospitalist right now. On Friday, a man in his 80s was admitted with difficulty breathing. He had a complicated history, including a heart attack at age 35 with all the subsequent sequela of heart disease. He had an abnormal heart rhythm and was taking a blood thinner for stroke prevention. In addition, he had scarring of his lungs (cause unknown).
He was transferred to us from another hospital. …
Read more…
Death is a blessing in its right time and place
“I’m going to write a column about dating you and call it ‘Sleeping with the Enemy,’” I announced from my rocking chair. His rocking stopped. “The enemy?” The rain was falling on the trees in front of my porch and on his parade. “Why am I the enemy?” “You know, clinicians vs. hospital administrators.” “Really?” he naively asked. “Why don’t clinicians like us?”
I was surprised he was so in the …
Read more…
Sleeping with the enemy: When a physician dates an administrator
Her name is Joann. She has cancer. As that disease goes, it is not much, probably curable, one of those “if you have to get cancer, this a good one.” Still, she sits across from me, her skin pale, eyes tight and she rhythmically grasps her cold, moist hands. She fails to gain any comfort from the knowledge that she is going to be OK. Why? I have not told …
Read more…
Doctors must empower their patients with knowledge
The stretcher was wheeled into the operating room. I had been in this room on three prior occasions, under very different circumstances. But today, as I lay flat on the table, listening to the small talk around me, I tried to breathe against the weight of the baby and the pressure of the procedure. My husband will later tell me it happened so quickly, but for me, time stood still …
Read more…
A physician-mother on maternity leave learns how she can’t ignore her job
It will start as a minor curiosity. Maybe a student will seem slightly too close to the resident on your team. When the grades are posted, you’ll wonder why you didn’t get honors, but he did. You might wallow for a few days. Make an offhanded comment to your fellow students. Then you’ll let it go and move on. Or so you think. Until during surgery when the scrub nurse …
Read more…
Angry? Welcome to being a doctor. And here’s how to fix it.
I felt a gust of sharp pain a couple of centimeters to the right of my belly button. It will subside, I thought. All pain subsides. It was an easy dictum to follow as a 39-year-old pediatric eye doc who last spent a night in the hospital as a patient in 1977.
I’d undergone bilateral laparoscopic inguinal hernia repair ten days earlier, so I was accustomed to brief squalls of discomfort …
Read more…
What this physician learned from being an ailing patient
The young woman sat in the corner of my exam room, facing away from me as I asked her questions. Her answers were short. “I’m from El Salvador.” Why did she come? “Because of the violence.” Her voice was flat. Her hands trembled. I knew she had suffered terribly and I needed to ask her how.
Slowly, quietly, she recounted the gang violence she had fled in El Salvador. The assault …
Read more…
Why many patients are afraid to come to the clinic
Being in a hospital is a scary and frightening time, and it’s easy for those of us at the frontlines — doctors and nurses — to forget that as we go about our busy work days. Patients are at a very low point in their lives and will remember everything about their hospital stay, including all their interactions, for a very long time.
As someone with a keen interest in improving …
Read more…
In the hospital? Here are 7 things you must keep in mind.
When I was growing up, RuPaul was all I knew of transgender anything. She was tall, flamboyant, charming, and I would look at her and try to see the man underneath the drag. I didn’t know the definitions of drag and trans, gender identity and intersex, ambiguous genitalia and gonadal dysgenesis.
Now that I’m a physician, I see transgendered patients on a regular basis — unfortunately, it’s usually in the setting …
Read more…
Why bathroom bills are important
“I am not on call,” Dr. Brian Stoltz said over a lot of background noise through what must have been the speakerphone in his car.
“I know,” I said. “Cityside ER said there is nobody on call for ophthalmology this weekend. I have a 54-year-old woman with intense tearing, discomfort and only 20/70 vision in her right eye.”
“And she’s not a patient of our office?”
“No, she has only had to see …
Read more…
What do you do when a patient’s illness strikes an inopportune time?
When Barbara (name changed) recently underwent her fourth Cesarean section, she was appalled by the care she received during her recovery. Her catheter overflowed, and a CNA asked her to check her own incision. When the CNA asked if she was breastfeeding her baby, Barbara replied tearfully that she couldn’t lift her out the bassinette. Rooming-in is a great idea. Unless you’ve had a 36-hour labor or major abdominal surgery.
Pregnant …
Read more…
Hospitals should quit alienating pregnant health care consumers
Doctor Barbie has a laptop. She comes with other accessories, like a white lab coat and stethoscope of course, but one of her largest and most prominent medical tools is her laptop. As a pediatrician’s daughter, my child selected doctor Barbie from the aisle of infinite Barbie options because she knew I was most likely to purchase this one when otherwise walking the store repeating the mantra “no more toys.” …
Read more…
I am grateful to Doctor Barbie
