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.
The time has come. The time has come for patients to know how dangerous the state of health care has become and to finally do something about it. I’m ticked off. So ticked off that I’m writing this in between office patients, and I really try very hard to prevent my patients from waiting. Apparently insurance companies feel practicing medicine is as easy as checking off boxes, like hanging chads …
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It’s time for doctors to tell insurance companies how they really feel
“I love you,” she said as she was leaving the room.
“I, I um …”
“Not you. Your computer.” She cast my computer, still warm and glowing with its brilliantly colored logout screen, a glance of longing and desire, and left the exam room.
“Oh, I thought …”
The slamming of the exam room door clipped off whatever the end of that sentence might have been.
I sat down and rolled my chair over to …
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The story of a doctor who destroyed his EMR
The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice.
Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any …
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It’s time for physicians to demand a national medical license
I have a love-hate relationship with the no-show patient. Like most doctors, I’m a reasonably good multitasker, adept enough at charting while emailing while waiting on hold with insurance companies and planning what to prepare for dinner when I get home. But there are days, more than I’d like to admit, when I feel like I need just a little bit more time, and I find myself compulsively refreshing my …
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We need to show empathy for patients who miss their appointments
One day into our medical center’s newly announced colleague appearance policy, nobody has yet approached my office with a steel wool soap pad to make any of the docs or medical assistants shine. My active white coat went into the laundry bin the day before, having inserted my left sleeve into a puddle of spilled coffee. The other two lab coats with hospital logo remain in their plastic protective coating, …
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Do hospitals need a formal appearance policy?
This is a very controversial essay, but I am going to express how some women physicians, like myself, feel at the VA hospital.
I came home one day after my clinic and was perturbed. I called my significant other and the emotion of the day unraveled. I was reporting an uncomfortable interaction I had with an older male patient. During this patient encounter, his tone and comments became sexually charged and …
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A culture of misogyny at a VA hospital
Ever since the U.S. government decided to link Medicare reimbursement dollars to patient satisfaction scores, hospital administrators have been obsessed with improving the quality of care for patients visiting their emergency departments. While the motivation may be partly financial, the goal of improving the patient experience during emergency department and hospital visits is an admirable one.
Unfortunately, many of the tactics used by administrators have done little to achieve that goal. …
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Patient satisfaction must start with nursing satisfaction
Residency is a time of immense learning. You learn from your attendings, your patients, and your colleagues. Of all the teaching moments during my residency, one that frequently stands out in my mind now is the day when one of my co-residents told me about the “post-training phenomenon.” He had previously completed a different residency and practiced in that field for a decade prior to switching to our specialty.
“Once you …
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How do you define success after residency?
“Someone else will lend a helping hand,” a physician told me once, when asked to help with an emergency in public. As a PALS instructor for more than a decade, I have always responded when possible. In the last decade, there have been three in-flight emergencies, two elderly individuals who passed out in church, and a host of other less serious maladies. A week ago, I discovered the best reason I …
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Physicians have a duty to respond to emergencies if they can
As a member of the general population, we see physicians as those who were born with a calling. Though society acknowledges that becoming a doctor is difficult, it is near impossible to fathom exactly what that title entails.
I was raised in a small rural community in which resources were quite limited. The nearest grocery store was a 35-minute drive away, there were no coffee shops or traffic lights, and we …
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The path to becoming a physician is not easy
Diagnostic tests such as CT scans are not perfect. A test can make two errors. It can call a diseased person healthy: a false negative. This is like acquitting a person guilty of a crime. Or a test can falsely call a healthy person diseased: a false positive. This is like convicting an innocent person of a crime that she did not commit. There is a trade-off between false negatives and false positives. To …
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A false positive is precaution by another name
Most primary care physicians (PCPs) who admit patients to a hospital are family practitioners or internists. Since medicine becomes more complex each day, PCPs must remain up-to-date on the latest treatment related to drugs, surgery, procedures, risks, complications, and costs. This might require your PCP to be a quarterback bringing together a team of consulting specialists to guide you through your hospital stay.
The economics of hospitalization are changing, and since …
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If you are admitted to the hospital, will a specialist see you?
“Was the delay in deciding to open influenced by the presence of an audience of 100 surgeons expecting to see a laparoscopic liver resection?”
“In addition to his tumor, the patient had hepatitis and cirrhosis. Was he a good candidate? A major complication was inevitably to occur during a live broadcast.”
As I predicted last year, it had to happen sooner or later.
In that post, I wrote, “A major complication will inevitably …
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A patient dies during live video surgery. Who’s to blame?
I love being an academic pediatrician. I didn’t start out to do that; I thought I would be writing novels and working part-time in an inner-city clinic. I wrote with Robert Penn Warren in college and my first (and only) novel was published when I was a senior in medical school. But things don’t always turn out the way you expect them to. In my case, I didn’t expect to be …
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The loneliness of a long-distance academic
When, aged thirteen, my best friend died of complications from sickle cell disease, her parents could not attend her funeral or find out where she was buried. My mom explained to me that in the Yoruba culture because parents are not expected to survive their children, it is considered an abomination for a parent to know where their child is buried. So, the young adults in the extended family attended …
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The death of a child is an abomination
The American medical establishment has systematically clogged his arteries with paperwork, lined his lungs with rules, and filled his intestines with, that’s right you guessed it, shit. There he lay, in a comatose state, awaiting to be pronounced. Only one thing is sustaining his overworked body.
Idealism.
Four months into my intern year and I’m just realizing how crucial maintaining my idealism — as unrealistic as it may be — is to …
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The idealized doctor is dead. Or at least on death’s door.
They played Taps at my dad’s funeral. Two teenagers on trumpets. First, the girl, positioned to the back and left of the crowd. Ta-ta-dah, she starts boldly, without the unease of her youth. Each simple note pierces the dry winter air.
Yes, you have our attention. Not another sound. Not even a breath by gathered friends and family.
In time, the second musician’s reply from the front. Ta-da-dah. And a pause. Their …
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They played Taps at my father’s funeral. They played it beautifully.
A 6-year-old boy with abnormal pupils and gasping for breath. A 26-year-old pregnant woman with a gunshot wound to her abdomen. A 54-year-old male with blood pouring from a wound in his thigh.
Now add 43 more patients.
Imagine you are the paramedic at this scene. Who do you take to the hospital first? Who do you have to choose to walk past and leave at the scene while you take your patient to …
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The superhuman efforts of the trauma surgeons at Orlando Health
A primary care physician named Ashley Maltz recently discussed advantages and disadvantages of a cash-based practice. I appreciate her evenhanded tone: She prefers this model yet expressed concern for patients who can’t use it. In the comments section, several physicians extolled the virtues of cash-pay, but patients were mixed. It’s attractive for those who can afford it, while it worries, and maybe angers, those who can’t.
I enjoy the personal and patient benefits of a mostly cash-pay psychiatric practice (I …
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How can patients accept cash-based practices?
