Physician

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 alarmist approach to medical errors solves nothing

Julie Craig, MD

Physician

May 30, 2016

The British Medical Journal recently published a paper boasting the astonishing conclusion that medical error is the third leading cause of death in the United States. Headlines aside, the study suffers from questionable statistics that serve up alarmist conclusions about the prevalence of serious medical errors and obscure the road to addressing the tragic phenomenon of death by medical error.

The analysis cites four observational studies on incidents that …

Fixing medical errors is more difficult than you think. Here’s why.

Marjorie Stiegler, MD

Physician

May 29, 2016

Recently, a paper written by researchers at Johns Hopkins asserted that medical error was the third leading cause of the death in the United States. This received — as you might imagine — considerable coverage in the media. The researchers proposed that death certificates should include a qualifier or indicator that medical error was linked to the death, if in fact it was, so that better statistics could …

Hyperbole is seldom helpful. Especially when it comes to medical errors.

Dr. Saurabh Jha

Physician

May 29, 2016

Josef Stalin famously said: “One death is a tragedy; one million is a statistic.” Perhaps 250,000 preventable deaths from medical errors, according to an analysis by Makary and Daniel in the BMJ, maketh a Stalin.

The problem with Makary’s analysis, which also concluded that medical errors are the third leading cause of death, isn’t the method. Yes, the method …

Physicians in health IT have to be better communicators

Suneel Dhand, MD

Physician

May 28, 2016

The chance interaction occurred at a large medical conference I attended recently. I happened to bump into a leader in health care information technology from a major integrated medical system. As soon as I saw him and his name badge, I thought I would go over and introduce myself, seeing as I have an avid interest in health care IT myself.

He was standing alone having just finished lunch, and there …

More needs to be done about sexual harassment in health care

Cory Michael, MD

Physician

May 27, 2016

Having recently watched a cable television recreation of the Clarence Thomas confirmation hearings, I am left thinking about how far some of us have come and how far some of us haven’t.

The confirmation hearings of Supreme Court Justice nominee Clarence Thomas in 1991 changed the concept of sexual harassment in the workplace by bringing the issue to the forefront. By the time, I started residency nearly 20 years after the …

I will make a concerted effort every day to do my job with love

Angelina Somoracki, DO

Physician

May 27, 2016

Since beginning my medical education, I had been on one side of the curtain; the side where the doctors confer and discuss before telling the patient his or her fate, going from room to room giving updates and prognoses. I interacted with patients for the purpose of getting their histories and physical examinations, collecting all the data so that I could present the case to my attending. I was engrossed …

A patient with a right brain injury. And an accusation.

Freida McFadden, MD

Physician

May 26, 2016

You can’t pick your parents, and you can’t pick the side of your brain that you damage.

I always thought that injuries to the left side of the brain would be the worst, because that’s where the language centers generally are. And talking is basically all I do. But after seeing uncountable numbers of strokes and brain injuries, I’ve changed my mind. Right brain injuries are worse.

The right side of the …

California’s End of Life Option Act will provoke meaningful conversations

Tenessa MacKenzie, MD

Physician

May 26, 2016

I hoped that my feisty patient who prevailed over brain cancer would be spared another terminal diagnosis, but after two years in remission, her mammogram showed breast cancer. She agreed to surgery, but declined further chemotherapy. When the time comes, she asked, would I help her end her life?

The End of Life Option Act goes into effect in California on June 9, 2016, joining a handful of other …

How I am leading doctors through change

Karen Weiner, MD, MMM

Physician

May 26, 2016

Here’s a leadership challenge: Get a group of highly independent, intelligent individuals to come together to build a boat. But imagine the blueprint for that boat is vague and untested. Now imagine that this boat must be built in choppy, progressively inhospitable waters, while said individuals are frantically treading water to stay afloat. Convincing these smart people that there’s a problem isn’t the issue. Convincing them to abandon their desperate …

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How I am leading doctors through change

Here are the lessons I learned from caring for my ailing father

Michael Goldberg, MD

Physician

May 26, 2016

I very distinctly remember March 16, 2015. I was the chief surgical resident on call for trauma at my busy urban training program. Like any other springtime trauma call I was steadily busy, running back and forth from penetrating and blunt trauma victims in the trauma bay to inpatients, OR cases, and attending rounds. The characteristically hectic flow of the day was interrupted when I got a call from my …

Thinking of starting a cash-based practice? Here are the pros and cons.

Ashley Maltz, MD, MPH

Physician

May 25, 2016

As an integrative medicine physician, I am often questioned about what I do and how I decided to diverge from the normalcy of allopathic medicine. I usually go into a short spiel about my love for thinking outside the box and creating solutions for patients that seek a kinder, gentler style of medicine; one that blends effective healing modalities from all over the globe with my traditional allopathic training.

Most people …

Maybe it’s time to go back to index cards for medical records

Niran S. Al-Agba, MD

Physician

May 25, 2016

During our dermatology section in medical school, a classmate recounted having had Henoch-Schonlein purpura as a child. Over a holiday break, he visited his primary care physician and asked if he could review his records out of curiosity. His family physician pulled out the index card that served as this man’s medical record. Yes, you read that correctly. It was not a chart or computer printout; rather a 4 x …

The enemy is not death. The enemy is needless suffering.

James C. Salwitz, MD

Physician

May 24, 2016

Among hospice staff, it is called “getting it.” One says, “He doesn’t get it,” “I think she gets it,” or, “They definitely get it.” It is a little hard to define, but as with pornography, you know it when you see it. Nonetheless, given the importance of “getting” good end-of-life care, let us take a moment to try and explain.

The 92-year-old patient is bleeding into her head, but has blood …

What I learned after 41 years of practicing psychiatry

Bruce Hershfield, MD

Physician

May 22, 2016

Now that I’m getting ready to turn 70, I thought I’d summarize what I’ve learned since I finished my residency, when I was 28. Of course, I didn’t learn all this only by being a psychiatrist, since I would hope that most folks have also learned lots in the last 41 years.

1. Psychotherapy is important, particularly if the patient is on the right medication. I won’t do “med checks,” since I …

The myth of critical care

Angela Jarman, MD

Physician

May 22, 2016

When asked during a recent ICU rotation if I was considering critical care as a subspecialty, I offended more than one person with my response: “No, I really don’t enjoy torturing old people.” Granted, that unfiltered comment came at the end of a long and sleepless 28-hour shift, but the sentiment holds true.

As doctors, we have a number of tools to assess quality of life in research. We use fancy …

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The myth of critical care

Naturopaths have weaseled their way into the health care system, and they want more

Britt Marie Hermes, ND

Physician

May 22, 2016

Naturopaths are currently engaged in an intensive lobbying effort at the Capitol in order to gain recognition as medical practitioners and inclusion in Medicare. As a retired naturopath who was licensed in two states, I want to offer a primer to this political maneuver: Naturopaths are not who they say they are.

To be fair, naturopaths (NDs) are no longer obscure practitioners. NDs are currently licensed or registered in 18 U.S. …

How to change patient behaviors? Don’t lecture them.

Rob Lamberts, MD

Physician

May 22, 2016

Taxes.

Doing taxes feels like a financial rectal exam. I hate doing taxes. Yeah, I don’t like getting rectal exams either.

It’s not that I resent paying the government for the fine services they render and the high quality of elected officials we have. It’s not the existence of taxes I hate; it’s just doing taxes make me feel extremely insecure. Sharing my personal and business finances with my accountant and the …

With doctors losing respect, perhaps it’s time to expose medicine’s dark side

Ahmad Yousaf, MD

Physician

May 22, 2016

The following is paraphrased documentation, authored by a physician I know, regarding an intoxicated patient in the ER:

1 a.m.: Patient is telling nurse, “Before I leave, I need everyone’s name for my lawsuit. Tell the phlebotomist that if he’s good, he’ll get a cut.”

1:40 a.m.: Patient is making inappropriate sexual comments and is verbally aggressive with medical staff. He is advised to stay in bed.

2:02 a.m.: Patient (who had been sleeping comfortably) wakes up and …

Plastic surgery is more than Botox. Hopefully doctors can remember that.

Miranda Fielding, MD

Physician

May 21, 2016

My friend Dawn and I recently attended an evening meeting of the Houston Society of Plastic Surgeons. Since we were invited guests, and not plastic surgeons, we didn’t stop on the way into the lovely formal dining room to pick up our name badges because the organizers had not made them for us. On the way out, however, we both noticed clear plastic perfectly formed oval objects sitting on the …

Do doctors reveal too much about themselves?

Hans Duvefelt, MD

Physician

May 20, 2016

Physicians play many roles in patients’ health care and lives in general.

In one encounter we may be the only one encouraging a hesitant or discouraged person to look inside and outside themselves for the strength to move forward with a difficult decision.

In the very next appointment, we may be taking charge as a patient develops chest pain and shortness of breath in front of our eyes.

We sometimes find ourselves in …