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.
In the years since the medical community first got revved up on the idea of “value-based care” — the conceptual antithesis of the “more is better” fee-for-service model — a common target of criticism has been the routine physical, one of the most time-honored traditions in medicine.
The attacks come from all angles: The annual check-up isn’t cost-effective, it doesn’t lead to better outcomes, it actually might lead …
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Ignore the economists: Keep the yearly physical
Today I saw a news story about Walnut, an 18-year-old whippet in the UK, who had his last “walk” on the beach with his owner who had asked social media followers to join them. Shortly after that walk, surrounded by hundreds of family, friends, and supporters (human and canine alike), Walnut was put down. His last moments were spent as near to Heaven on earth as his owner could create …
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Death and dying: Do dogs have it better?
My new patient looked around dodging my eye contact, scanning the ceiling, the room, and me. I felt that she was hiding something. In my clinic, I often find it one of the most difficult challenges to get new patients to open up, and one of the most beautiful moments when they finally do. I stopped interviewing midsentence and took a step back.
“Let’s just get to know each other. I’m …
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How this physician embraces diversity and acceptance in medicine
While visiting a family member in the hospital recently, I noticed the unkempt attire of one of the lab people coming in to draw blood. As she knelt down to better reach my family member’s arm, I noticed her scrub pants were frayed and dirty from her walking on them.
Shortly after I made note of this, one of her co-workers came in the room to see …
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What is essential professional dress in health care?
Cheryl lost her son Sean to suicide in medical school. Just a few months ago. Her only child. Cheryl didn’t know that medical students were at high risk of suicide — until her son was dead. Nobody warned her.
Rhonda lost her daughter Kaitlyn to suicide in medical school. Unable to recuperate from the pain of her daughter’s suicide, Rhonda died by suicide …
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Warning: Medical school may kill your child
Part of being a resident or fellow is to be on call overnight and on the weekends. As any new resident, you’ll be nervous the first time because you think you don’t know anything.
Over time, you’ll gain the knowledge and expertise to be able to ask the right questions, improve your exam skills and make the right clinical decisions. Trust that you know more than you think you do.
Throughout your …
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3 things that make doctors successful
I was sitting in a meeting, listening and participating, but at the same time keeping an eye on my email. I always do this, sometimes to my peril. Email is distracting, and more than once I have been called on to say something and I have no clue where the discussion had gone as I glanced at my inbox. At this …
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Yes, cancer kills oncologists too
Early in my career, I learned that keeping my focus on patients would help me define the physician I wanted to be. One of my first offices was in a cell of a repurposed juvenile detention unit with cinder block walls painted pasty white. Occasionally, I had to apologize to my patients as I explained that the smell was sewage from the toilets backing up. In that cold, harsh room, …
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How do we deal with change in medicine?
To my dear patients,
This has been a difficult time to be an American. I will never forget my walk through Central Park on the morning after the election; I have never felt New York so flat and somber. This election has brought out the worst in many. I have seen its ramifications in people’s health and fear that it may continue to have an impact. I want to express my …
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A post-election physician’s letter to his patients
Thanksgiving is this week, and I have a lot to be thankful for, both inside and out of medicine. Life isn’t always easy as a resident, and to quote the lyrics of Journey, “And lovin’ a [medicine] man, ain’t always what it’s supposed to be.”
What’s a life in medicine mean to me? It’s certainly not the glamorous. I’m on the back half of 30 years old. I’ve been a doctor for little over …
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What a life in medicine means to me: What this resident is thankful for
A few weeks ago, my employer sent me to a three-day out of town conference. I had mixed emotions. It would put a burden on me to work more than usual both before and after it, but I couldn’t help but look forward to the blissful, uninterrupted sleep I would get in a cozy, quiet hotel room. There was guilt when I realized that my wife would shoulder the full …
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Handheld electronic devices are the thieves of our meaningful moments
I was at work a few nights ago. We had had a patient death early in the morning before I got there, and the body was still in the room awaiting the JP’s arrival. The family was en route back with the children (he was only 57) and the body was not presentable. Blood, saliva, a gaping mouth and lividity with rigor were a bad combination for the kids to see. …
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Pretending the world is homogeneous is a dangerous path
Beyonce wasn’t kidding when she wrote the song “Girls Run the World.” We as women wear as many hats as some of us have shoes. However, the cost of that can be grave if we never learn to create balance in our lives. When I say balance I don’t mean the balancing act, I mean the act of giving back to ourselves. Imagine that you have an energy bank account. …
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Dr. Mommy: When will you put yourself first?
In the middle of a five-way thoroughfare intersection, with the early-morning sun’s glare on my windshield, I hit the curb of the median and blew out my left front tire. Amid stopped traffic, I ran to collect my escaped hubcap, whose silver eye stared helplessly from among the automotive debris of previous accidents.
A policeman blocked the lanes until I could pilot my car into the gas station on the other …
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The story of how a stranger helped a physician
It is 6:08 p.m. on a Monday night, and I am sitting in an unlocked patient exam room, my uneaten lunch opened in front of me, clicking through a patient’s chart, all to the constant whir of my breast pump. I last breastfed my infant at 6 a.m. this morning, and the discomfort in my chest has only amplified as the 12th hour has gone by without time to express …
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The disappointment of mothers in medicine
It’s Wednesday, the day after the election. I spent the previous night clicking from one website to another, trying to find someone who was refuting what the others said was true. And when it became inevitable, I held my infant twin boys and cried.
Now I’m in front of my exam room, walking in to see Mr. Bundy. I open the door to find him wearing a red hat embroidered with …
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The exam room post-election
I had never heard the term “throughput” before a meeting at our hospital two years ago. It was used to discuss how the emergency department (ED) could yield greater profits by faster patient turnover. Coordinating various duties (including intake, admitting, and cleaning staff; lab and radiology; nurses and doctors) patients could be shuttled into and out of the ED earning the hospital $2 million more per year.
This strategy was implemented …
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Patients are not fast food. Stop treating them that way.
She is tall, thin and wears torn jeans like a mannequin. A silky top flows around her, masking the thin torso, the exposed ribs. Her hair is long, fine and the ends are perfect. Her face is smooth, drawn, a bit careworn, but that is why she is here. She carries herself with an aristocratic bearing that is not learned but genetically endowed over generations. She is rich, entitled and …
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All patient lives matter
In the technology-thick landscape of modern health care, the physical exam remains in a backwoods.
Sure, there have been advances — blood-pressure cuffs, for example, now inflate themselves — but on the whole, the exam has barely changed in the past century. Patients still open up and say “ah,” take deep breaths and gaze at a tiny light peering into the back of their eyes.
A well-done exam can still determine whether …
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It’s time to update the physical exam
