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.
Among surgeons, it’s pretty common knowledge that residents and other providers may perform non-critical parts of a patient’s procedure. This not only helps residents and other trainees gain valuable surgical experience, it also gives patients better and faster access to high-demand surgical expertise.
The question is this: How well are surgeons explaining these facts to their patients?
Recent guideline updates by the American College of Surgeons (ACS) underscore the need …
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4 scenarios surgeons need to explain to their patients
As physicians ready themselves for the future of medicine under onerous MACRA regulations, it seems appropriate to glance into the future and visualize the medical utopia anticipated by so many. Value-based care, determined by statistical analysis, is going to replace fee for service.
Six months ago, I received my first set of statistics from a state Medicaid plan and was told my ER utilization numbers were on the higher end compared …
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MACRA makes it easy to game the system
It would never have gone down this way ten years ago when length of stay was all the buzz. The CT scan would have been done in the emergency department, and the patient would either have been discharged or admitted for a quick observation stay. Bing, bang, boom. One, two, three.
Instead, the CT was pushed until morning. A resident saw the patient at midnight and then not a single practitioner …
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Here’s how and why patients lose in our current system
I use an ongoing spreadsheet to keep track of and to report my demographics and stats for each telepsychiatry consult shift I do. I’ve done thousands of consults in over two dozen South Carolina emergency departments over the last half-dozen years. We have now gone over thirty thousand consults as a group.
It never ceases to amaze me, as I fire up my computer, log on to my systems and bring …
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Why do people kill themselves?
Medicine, what a noble profession. As the keepers of human health and longevity, we are entrusted with a huge but solemn responsibility. It’s an ancient artwork, passed through the generations from pre-antiquity, hand in hand from physician to physician. The Hippocratic oath ensuring that we first “do no harm” and commit ourselves to the honorable calling. We often hear “see one, teach one, do one” and so propagates the training …
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All good doctors listen to nurses
Part of a series.
Those of you who have read some of my past posts are aware that I wrote mostly about various aspects of primary care and our dysfunctional healthcare delivery system overall. About 18 months ago I wrote a post for KevinMD on moving to a retirement community. More recently I became focused on the primary care needs of older individuals and from there got …
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On aging: Deny, accept, or rejoice?
Since the study of science is the most common route taken to a career in medicine, there’s a tendency among doctors to neglect, if not outright scoff at the arts and humanities. That’s a shame, and not only because an appreciation of history or philosophy might make you a better doctor. I’m in complete agreement with that notion, but as an opinion, it can’t be definitively proven.
Instead, I think it’s …
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Take a second look at what a good medical story has to offer
Monday night, at Lincoln Center waiting for Beethoven’s Ninth to begin. Masses of glass spatially dividing David Geffen Hall from the Metropolitan Opera, are still allowing for the majestic Viennese crystal chandeliers next door to provide the necessary visual interruption between the two symphonic masterpieces, Beethoven’s Eight and Ninth.
For me, the excitement about this particular event is deeply personal: Ode to Joy became part of my classmates’, my friends’ collective …
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The Lincoln Center needs emergency medical supplies
The onset of the new millennium has brought about a shift in not only the technological aspect of our industry, but also the mindset of physicians who are entering the field. Gone are the days of “work 40 years at the same practice, retire and live the good life.” Physicians are finding more creative ways to be doctors including entering non-clinical careers, being entrepreneurs on the side, and moving into …
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Life coaching for physicians is an underused physician burnout tool
“I’ve got to use the right tool,” I thought to myself as I attempted to pound a nail into the wall with the bottom of my coffee cup. Kneeling on the exam room table, I was attempting to hang a picture on the wall before the clinic day began. I have all sorts of useful tools in my clinic: scalpels, special scissors and a multitude of precision instruments for surgical …
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Science is the right tool to improve health
In the past few weeks, we have lost two female physician colleagues tragically to suicide, a pediatrician and psychiatrist. In the general population, males take their lives at four times the rate of females. However, for physicians specifically, the suicide rate is evenly distributed between genders; making our occupation the one with the highest relative risk for women to die by suicide. …
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Physicians must stop losing their own
A couple years ago, I reached the seven-year mark after my initial board certification with the American Board of Anesthesiology (ABA). At the time, it was a significant milestone. I was eligible to take the all-important Maintenance of Certification in Anesthesia (MOCA) exam.
Diplomates of the ABA — that’ right, I’m considered a diplomate — in other words, a board-certified anesthesiologist. Diplomates were encouraged and incentivized to take the $2,100 exam …
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A physician’s MOC debacle: Nevermind that $2,100 exam he just passed
As a physician and businessman, I wish the future looked better for PCPs. But history suggests things will get still worse.
The history of business teaches us disruptive innovation always starts from below. The “untouchable” market leader is threatened by a less expensive version of its own product. The smug incumbent ignores the unprofitable downscale threat. Then the new competitor decides to go upscale, is forced to innovate as a result, and …
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Where will disrupted primary care physicians go?
A few years ago, I was in a position where I was quickly going down the route of hospital administration. I thought it was interesting at first, but realized it wasn’t quite my cup of tea, at least in the circumstances that I was exposed to. What I didn’t like about it was the feeling that I was losing touch with the front lines. And wherever my career takes me, …
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The top 3 questions hospital administrators ask
She burst into tears when I asked if she wanted to get pregnant.
Eman, a beautiful young woman from Jordan, sat in my family-practice office with her husband, Ali, and two adorable children about one and two years old. With her scarf and dark clothing covering all but her pale face and enormous sable-brown eyes, Eman looked closer to fourteen than twenty-four, and scarcely old enough to have any children.
“How can …
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His power over her was cultural. How could I do the right thing?
It was my turn to be on call during Christmas. I held the long list of patients signed out to me, and began my rounds early that morning in the hopes that I could be home in time to open presents with my family that evening.
I went from room to room on the surgical floor, talking to patients. I knocked on one door and pushed it open. A white male …
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How religion influences the doctor-patient relationship
I’m humbled by the honor to practice medicine. We have the opportunity to be frontline participants in an ever evolving cascade of events in the lives of others. Our decisions, directions, and split second actions have the ability to unite families, sustain breath or literally a beating heart. Although biased, I can’t think of many professions more fulfilling and honorable. There are issues and concerns, but they pale in comparison …
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Compartmentalization failed me, and I’m forever grateful
“We must not allow a mineshaft gap!” famously spoken by George C. Scott as General Turgidson in Dr. Strangelove as the post-nuclear holocaust planning begins in earnest. For some reason, this quote goes through my mind as I sit through meetings, assemblages and retreats that talk about the future state of medicine in a large gobble-gobble network that has aspirations to provide population health as an Accountable Care Organization to …
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What’s the fix for the care disparity in corporate-owned health care?
Mukhwas are the Indian equivalent of an after-dinner mint. Sweet and flavorful, but typically only distributed through one tiny spoonful at a time, mukhwas are the perfect way to completely clear your palate, wiping clean the last remnants of a tantalizing meal. A small dosage of the mukhwas completely nullifies the aftertaste, so that the attention is no longer on the meal that has just passed. It’s the gustatory equivalent …
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How practicing mindfulness between patients makes you a better doctor
I’m probably crazy. I ride my motor scooter to and from work at the hospital. Some consider it unsafe. Perhaps it is, but feeling the wind and rain, those unfiltered elements. And after 12 hours inside a controlled environment, it’s too refreshing to pass up. So at 2 a.m. Friday night, I’m zooming (you always “zoom” on a scooter) through the industrial district after a tiring admitting shift. I see …
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We must remember to humanize our patients
