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.
Most people are surprised to hear that the way doctors are recertified every ten years is through a multiple choice test. “Really?” they’ll say. “You take a multiple choice test? As a doctor?”
Unfortunately, after all these years that’s the most efficient way we can think of to evaluate professionals. But the method is so flawed. And your ability to answer questions on the multiple choice test isn’t necessarily linked with …
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Multiple choice questions are a terrible way to test doctors
It is a master of stealth, stretching less than half an inch long and weighing in at 2.5 milligrams with as estimated air speed of 1 to 1.5 miles per hour. It is virtually soundless in flight, registering zero decibels from ten feet. Its tracking systems hone in on targets by detecting infrared radiation from warm bodies, chemicals such as carbon dioxide and lactic acid, body odors from as far …
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Military tests of the Zika virus mosquito
After surgery for my broken tibia, I realized that there were only four points on the pain scale that really mattered to me:
- I’m OK. This acetaminophen/ibuprofen/whatever is enough.
- I wouldn’t mind a little something more, preferably something that binds mu
- Um, could you please hurry that up?
- NOW! NOW! I need it NOW!
On the 0 to 10 pain scale, who really cares if you are at a 2 or …
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Finding the right balance in pain relief: A physician’s story
To close out my first week of medical school, the class was treated to a talk by a stuffy but soft-spoken lecturer on the relationship between poverty, education, and poor population health. “Social determinants of health,” he labeled them, a clunky and unwieldy term if ever I’d heard one. In those days, audiovisual aids consisted of an overhead projector for black-and-white transparencies. And boy did that talk have transparencies. Chart …
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Social determinants matter most to a person’s health. Here’s one story.
Author. President. Teacher. Doctor. These are all gender-neutral words which happen to relate to a person’s profession. However, I find it particularly interesting that while “doctor” is a gender-neutral word, the field of medicine is riddled with institutional sexism.
Let me begin by explaining that I am a military physician currently training to become a gastroenterologist. If being the only woman in any room bothered me, my journey would imply that …
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Sexism in medicine is a public health issue
After rotating in the ICU, I began to wonder about the limitations of modern medicine. In a short time, we have come a long way with the discovery of antibiotics, high-resolution imaging, and the development of advanced surgical procedures. The medical field saves millions of lives. Nowadays, people do not go to a hospital to die; they go to be healed. As physicians, we are very skilled at extending life.
Heart …
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Do physicians play God?
We are standing at a crossroads in health care. Behind us lies a long-lost, nostalgia-tinged world of unfettered provider autonomy, sacred doctor-patient relationships, and a laser-like focus on the art and humanity of medicine. This was the world of my father, an immigrant and primary care physician in rural California. The world of Health 1.0.
While many still pine for these “good old days” of medicine, we shouldn’t forget that those days weren’t really …
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A love letter to those on the primary care journey
As a long-distance truck driver, he did not have time to visit a doctor. In fact, the last time a doctor ever examined him was decades ago. When his leg started hurting, he ignored the pain for months before it got too severe and started interfering with his ability to drive. He showed up in my office in severe pain and limping. And while he tried to joke it off, …
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Even if doctors are demonized, they do make a difference
Recently a measure was proposed to allow APRNs full practice authority in the VA health care system. With this measure, the embattled VA hopes to help optimize access to health care for our veterans. A measure to help with the firestorm of problems we witnessed unravel at the Phoenix VA system two years ago. Sounds great, right?
Nothing is ever that simple in American medicine. The professional organizations are, once again, …
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Who cares about our turf wars? Patients don’t.
Dear medical student, resident, or fellow,
You will one day forget something. We are currently in a systematic plot to have everyone forget something important. We are quietly unaware it is happening. We are asked to forget how we got here. I want to remind you. I want us all to remember.
You undoubtably were more mature than your peers. You undoubtably sacrificed to develop the persona that one day would impress …
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Welcome to the medical profession
Summer is heating up, and so is the election rhetoric. In this year’s campaign for the White House, when it comes to verbally attacking each other, neither candidate seems to recognize any limits. Personally, I think this behavior reflects poorly on both candidates.
In heath care, it’s almost impossible to escape this negativity. The media devours and thrives upon it. In our hospitals, televisions in the doctor’s lounge, cafeteria and in …
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It’s time to stop using the language of war in health care
My eyes open. The blackness of the call room envelopes me. Consciousness sets in with a lingering disorientation. A small green light, is speaking … ringing. “Are you standing up?” The resident on the other end knows her attending too well. She’s right not to risk my falling asleep mid-conversation.
A woman has arrived laboring at 24 weeks gestation. Records aren’t available, but she reports her fetus has a diaphragmatic hernia. …
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This is the only time she will hold her daughter alive
Dear Dad,
I often think about the night you passed away. I was caring for you while you were dying from metastatic colon cancer. Every hour I woke up to give you Dilaudid so you wouldn’t feel pain and Ativan so you wouldn’t be scared. You had only just been diagnosed eight months before. Despite aggressive chemo, radiation, abdominal surgeries, and all the hope and prayer in the world, the cancer …
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I will not let medicine dehumanize me
Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent — in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to …
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Fixing the breakdown in patient satisfaction
The morning my patient Evan tried to end his young life, I woke up early to make banana pancakes. It was a warm spring day, and I pushed up the windows in my kitchen. That same morning, Evan opened his window with a different intent. He had argued with his parents the evening before, not unexpected at 16, yet this was different. Evan is transgender, and his parents were not …
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We are all connected to the well-being of LGBTQ youth and their families
In the medical field, it is said that July, not April, is the cruelest month. It even has a name, the July Effect. In June, hospitals hum and smoothly operate after a year of working out the kinks. In July, they welcome, or dread, the arrival of new recruits: newly minted physicians and medical students, eager to prove themselves, yet raw and untrained. For me, as a senior resident, it …
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This is what makes a good doctor
I sat across from her and in my most official yet trusting psychiatrist’s tone gave the spiel I delivered many times.
“Amanda, I’d like to start you on a medication that might help your depression. Like every medication it can cause side effects, however, many people have no side effects or only have minor ones. This drug can cause weight gain, increased risk of diabetes, and increased risk of heart disease.”
A …
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The psychiatrist with a psychiatrist
When diagnosed with abdominal mesothelioma, a rare cancer with a blighted future, evolutionary biologist and writer, Stephen Jay Gould, turned his attention to the statistics; specifically, the central tendency of survival with the tumor. The central tendency — mean (average), median and mode — project like skyscrapers in a populated city and are the summary statements of a statistical distribution.
The “average” is both meaningful and meaningless. The average utility of …
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The most powerful driver of medical costs is hope
