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.
When I first met Mary, already in her forties, she had suffered throughout her life from an arteriovenous malformation of the face. As a result, from early childhood, she had endured the discomfort and humiliation that accompanies the stares of strangers. She came to me hoping I could improve her appearance.
The abnormal connection between the arterial and venous halves of her circulatory system caused her cheek, jaw, and neck to …
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As physicians, we learn much from our patients
The U.S. health care system is the world’s top in health care spending per capita, but in terms of performance, we’re dead last among developed countries. As a young physician embarking on a career in this landscape, it’s glaringly obvious that we need disruptive innovation to create better health at a lower cost. Physicians are uniquely positioned to make critical contributions to medical innovation, but even among …
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Physicians as innovators: 6 ways we help and hurt ourselves
I still remember her clearly. She was a wonderfully vibrant 68-year-old woman from Haiti. She was always impeccably dressed, loved to talk, and had an incredibly infectious laugh. Whenever I walked in to the clinic to see her, her eyes always seemed to smile as broadly as she did.
“Nice to see you, Doc!” she would say. I …
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We cured her, but the result was unacceptable
“Be careful. He’s violent.” That was the way sign out began for Mr. T. The intern continued, “He has been in the hospital forever because he was kicked out of his nursing home. Good luck. And, oh yeah … he’s blind.” Puzzled, I looked at my list of patients and, not sure whether I should write “violent” by this patient’s name, I decided instead to write “blind.” I paused. The …
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We let our professionalism suffer when faced with a difficult patient
We have a problem in our clinic.
Between our EMR implementation a few years ago and our PCMH recognition shortly after that, our office visit documentation has become bloated and our cycle time has almost doubled.
There are no brief visits anymore, since every visit entails screening for multiple psychosocial conditions and consideration of various immunization and health maintenance reminders.
Nobody sees over thirty patients a day anymore; we’re lucky to exceed twenty.
That …
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Medical homes weren’t supposed to be this way. What went wrong?
Prescription opioid abuse is on the political radar. “Painkillers” are a recognized cause of thousands of deaths a year. But what to do about it?
A FDA panel recently recommended mandatory training for physicians who prescribe opioids. Congress passed a bill calling for more education, presumably physicians as a prime target. We’ve actually been down this road before, but possibly not how you think.
The politicians and pundits used to …
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Blame the politicians and bureaucrats for our opioid abuse crisis
The United Kingdom’s National Health Service has been facing something of a crisis over the last several months. For those of you unfamiliar with what’s been happening (the issue hasn’t really gained any media traction here in the U.S.), a majority of the country’s 55,000 junior doctors have been holding regular strikes. In the U.K., the way in which doctors train is very different from the U.S., with often over …
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5 things we can learn from the NHS doctor strike
When doctors complete their residency training, they are under a lot of pressure to land their first “real job” quickly. Student loan deferments end shortly after training, and whopping debt faces many of them. But choosing a job that is a good long-term fit can be difficult, and gaining a broader exposure to the wide variety of options is key to success. That’s why “try before you buy” can be …
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Why young physicians should consider locum tenens
It was Saturday evening, and Audrey G lay awkwardly on an emergency department stretcher in search of a comfortable position. She suffered from chronic hip pain, the unfortunate and unexpected effect of pelvic surgery. But her real chief complaint involved her drug-abusing husband, who that morning stole her recently filled bottle of oxycodone, an opioid pain medicine. Her story included the surgeon who doubted her pain and a year of …
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The opioid crisis: Does empathy make physicians more vulnerable?
As a mid-career faculty physician in a family medicine residency program, I have taken a keen interest in the big picture of what is happening to the way our graduates and colleagues practice in the real world. I’ve watched our residents as they prepare to graduate, deliberating among the most prevalent practice options presented to them in our region, usually as an employed doctor in a large multi-specialty practice, or …
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It’s time for academic medicine to embrace direct primary care
I’ve noticed, as I get older life seems to travel full circle no matter your path or destination. I find myself trying to teach my son Grant things that my father attempted to teach me not so long ago.
“Don’t do that, you’ll fall and hurt yourself, or try it this way, and the process will be much easier.”
There is that brief moment of acknowledgment often followed by scraped knees or …
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Compassionate care is at it’s best when selflessly focused on helping others
“I love you,” she said as I was leaving the room.
Although I was stunned for a second or two, I wasn’t really surprised. She and I had gotten along famously from the beginning of our 15 minutes together. She didn’t “love me” in the way a patient with borderline personality disorder “loves” her enabling prescriber. She loved me because I was there, I was experienced, I was kind, and I …
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I’m a better doctor than any computer
Physicians are accustomed to seeing patients at the end of their lives. It is difficult to let families know they may lose their loved one. Clinicians are often accepting of patients DNR orders before family members are ready. This story is about a time where the health care team was ill-prepared, yet a parent made the difficult decision to discontinue intervention. It taught me an unforgettable lesson.
During the first ICU …
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A child’s father knew when to let go. The health care team didn’t.
A good friend of mine recently found herself between jobs, with a gap in her health insurance and a recurrence of her kidney stones. What she needed were fluids and pain relief, fast. I’m a gastroenterologist, and hoping to minimize the financial impact, I went with her to our local ER and had a conversation with the attending physician. Maybe we could pass on the CT scan and extraneous lab …
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When it comes to your health care, buyer beware
Like many physicians, I’m a people pleaser. On my medical school application, my personal statement was a literary cliché filled with my dreams of helping others, easing pain, soothing suffering — and I really meant it. What I didn’t know then was how difficult it would be to negotiate making patients happy while doing the right thing medically.
Medical school and residency didn’t adequately prepare me for the emotional strain of …
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It’s time for physicians to stop being pushovers
I received the sign-out from a colleague that he was to be transferred out of the medical intensive care unit to our service, as we were the team on call that evening. My intern and I prepared to see him in the unit before he was moved to our floor, which involved reviewing his chart and having preliminary discussions about continuing his care.
Soon after, we arrived to the unit, checked …
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A black doctor’s perspective on perceptions by race
A few weeks ago, I woke up feeling under the weather. It was day one of seven consecutive shifts. I looked into the mirror. A sullen face with sunken eyes stared back. As I was getting dressed, I felt fatigue trying to triumph over my body. Next came a nagging and rude cough that kept interrupting my sentences. I started to feel feverish, and sure enough, I measured a temperature …
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A sick doctor must show up to work. That’s wrong.
