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.
Over the past year, I have been faced with the challenges of being a consumer of the health system that I confront daily from the physician perspective. My health needs ranged from a stubborn sinus infection to a terrifying brush with Guillain–Barré syndrome. I sampled experiences ranging from the clinic to the urgent care and then the emergency department and even dappled in the forbidden territory of self-diagnosis.
All experiences rendered …
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Health care has lost its heart
Waiting to get help to improve your life and relationship is like waiting for the cancer to spread. You feel a lump on your body. Do you wait a few months to see if it gets bigger? Do you make an appointment right away? Do you avoid making an appointment altogether and hope it just goes away on its own?
Many times, we wait until after the divorce, after the accident, …
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When should doctors see a therapist?
I was working at the free clinic late in the first semester of my third year of medical school when I met a patient I will call Mary, the last patient to be seen for the evening. Mary had a fairly typical story among uninsured individuals. She was 26 years old and worked three jobs near minimum wage to make ends meet, none of which offered cost-sharing for health insurance. …
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What does “do no harm” really mean as a doctor?
I quickly finished my day’s work in the resident’s clinic (documentations, relaying results) and raced home to hurriedly double check the list of things that I would need for my week long medical mission in Roatán, Honduras.
The air was frigid, and my pace matched the wind. In the 2-hour car ride to the airport, my mind was alive and restless; making mental note after mental note about our endeavor but …
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A physician volunteers in Honduras. Here’s what she learned.
I walked into my bathroom feeling the wet floor. I traced the source back to a toilet overflowing with a neon green T-shirt lodged in it. The T-shirt failed to evacuate into the nexus of sewage. My 7-year-old son hates the T-shirt. Having watched for years foul things disappear when flushed down the toilet, he attempted to rid himself of something he disliked. It failed and the toilet overflowed.
I called …
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Opioid addiction is a social failing
I remember the first time I experienced the paradigm shift when it came to pain management. Sometime around the late nineties while I was on call, I received a phone call from a floor nurse stating that a patient that had their ankle operated on that day by another surgeon was having increased pain that was not controlled by the pain medication that had been ordered. As I had been doing for …
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Making pain a vital sign caused the opioid crisis. Here’s how.
Evidence-based medicine. It is what we all strive to provide. It means employing the most up-to-date knowledge to the approach of medicine, from preventive care to screening to the diagnostic work-up and treatment. Wherever the data point us, that’s what we should do. Yet putting it into practice can sometimes be the most challenging part of being …
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Evidence should not be used to enforce mandates
Opioids are common pain medications that are used for the treatment for mild to moderate pain. These medications are highly addictive and bind to particular receptors in the brain and spinal column that produce a feeling of euphoria along with the relief of chronic pain.
However, in the U.S. they are becoming a leading cause of death due to overdoses. Opioids — such as oxycodone, Percocet, and others — are now …
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Physicians and patients must work together to halt the rise in opioid use
Once upon a time, there was a land where parents were anxious, information was pervasive, and trust was hard to come by. Misinformed celebrities with impressive influence (despite minimal education) were spouting ideas that provided concrete solutions to poorly understood situations, and parents were clinging to them as if their (child’s) life depended upon it.
Pediatricians everywhere were scratching their heads, wondering, what has happened? Why are our patients doubting us? …
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The day that the pediatricians quit
Sometimes prospective new patients ask me over the phone, “Are you a medical provider?” or “Are you a provider for [name of their particular health insurer]?” And that gets me started.
Provider. Such a generic and seemingly inoffensive noun, and yet it repels me. To me, it is the verbal equivalent of a hair ball my cat barfs onto my pillow. And so I feel obliged to clean it up by …
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I am not your provider
Becoming a physician requires a great amount of financial patience. Living on the meager remains of your student loans for four years and then transitioning into a position where the pay is not commensurate with your debt obligations can be challenging. Especially when your student loan debt is growing exponentially throughout your schooling and then growing with interest throughout your graduate training. After this kind of sacrifice, it can be …
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Be frugal: The key to physician financial fitness
As a physician, I knew exactly what was happening when I walked into the emergency room. My eyes were nearly swollen shut. My throat was closing. I was in the midst of a severe allergic reaction known as anaphylaxis. I urgently needed epinephrine, a potent medicine that could halt my life-threatening symptoms. When I told the nurse what was happening, she rushed me to the trauma room where doctors and nurses encircled …
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A physician experiences a medical error. Here’s her story.
These days, I work most of my shifts about 45 minutes from my “house on the hill.” At one of those jobs, the day shift starts at 6:30 a.m. Which means I’m rising from my bed at 4:30 a.m. in order to get on the road in time. I’ve started waking up at four, spontaneously, as if it were the most natural thing in the world.
I lay out my clothes …
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The serenity of an emergency physician’s commute to work
On the day that I penned this post, I rounded at our community hospital. My first patient was in the step-down unit, which houses patients who are too ill for the regular hospital floor. I spoke to the nurse in order to be briefed on my patient’s status. I learned that this nurse was assigned six patients to care for — an absurd patient volume for a step-down unit.
“Why so …
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We are not taking care of nurses. Who will heal the healers?
I recently spent a week with the Floating Doctors in Bocas del Toro providing medical care to the Ngabe people in western Panama. In the jungle, there is little concern about prior authorizations or deductibles. There is also a critical lack of access to services that we have available in the U.S. The Ngabe people do not own much. In fact, some kids do not even have names.
In the Ngabe …
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Practicing medicine in a place where the children have no name
Most people know from experience or through intuition that there is a right time and a right way to ask important or sensitive questions. You don’t usually just blurt out requests for raises or marriage proposals, for example.
In many areas of life, knowing when and how to ask difficult questions is viewed as an extremely valuable skill, for example in criminal investigations and in journalism.
In some cases, this kind of …
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The lost art of asking questions
As doctors, we love to think we are intelligent, rational, thoughtful and caring human beings, and we take pride in our profession and the privilege and status it accords. We like to hold our heads high, puff out our chests, speak with authority and convey our hard-earned knowledge acquired over many years of undergraduate and post-graduate study. We like to think we know; we have answers; we can cope; we …
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We are all responsible for physician suicide
I probably set a record for the earliest a physician ever burned out: less than a year after earning my MD. Some may not call it burnout; it could just as well be called “internship.” I call it burnout because beyond the exhaustion and can’t-take-it-anymore, there was a gnawing sense that something fundamental was missing — something that no amount of time would fix.
Over the next year or so, the …
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Physician burnout challenges our assumptions
When we think about the technology revolution, we often get excited at the thought of getting what we want instantly. We wait in line for new smartphones. We instant message. We love fast. Getting something done faster, with as good a result, is usually seen as a virtue — unless one is a doctor.
In these times of fast information, we find ourselves bombarded with surveys. Part of the downside of …
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I don’t apologize for being a fast doctor
