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.

Shared decision making: How this oncologist did it right

Peter Ubel, MD

Physician

May 20, 2016

Sometimes in my research on physician/patient communication, I come across a doctor who is so good with her patients, I have to share their bedside manner with you. The most recent example is a (to remain unnamed) oncologist in the northeastern United States who practically gave a primer on shared decision making when caring for a patient with metastatic cancer.

The patient (I’ll call her Jennifer Decker) had stage 4 breast …

Is it possible to be a Christian and practice emergency medicine?

Edwin Leap, MD

Physician

May 20, 2016

Many young physicians in training have asked me, quietly or by e-mail, “Is it possible to be a Christian and practice emergency medicine?” I think that they ask a good question, and likely for good reasons.

In their rotations, they have witnessed, first hand, life in the ER. They are uncertain, perhaps, because they see the frustration that boils over in the words and actions of otherwise compassionate and caring doctors …

The evolution of the grieving physician

Rashmee Patil, MD

Physician

May 19, 2016

I remember my first death. He was my patient, a 59 year old who suffered an episode of asphyxiation. His story was tragic, a reminder of the frailty of human life. After choking on a food bolus at home, he had called 911.

Unfortunately, he suffered a prolonged cardiac arrest that resulted in irreversible brain damage. He spent two weeks in the intensive care unit in hopes of a recovery, but the …

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The evolution of the grieving physician

How primary care physicians can work with patients to change behavior

Glen R. Stream, MD

Physician

May 18, 2016

The behavioral aspects of poor health are even more important than we may have thought. That’s according to a new study finding adults who engage in even one unhealthy behavior double their risk for fair-to-poor health. And the risk increases meaningfully with each added unhealthy behavior.

Spotlight: Impact of Unhealthy Behaviors, a publication from United Health Foundation’s America’s Health Rankings® released in partnership with Family Medicine for …

I’d hate to be his patient

Daniel L. Meltzer, MD, MPH

Physician

May 17, 2016

I don’t know about you, but I’m up to my eyeballs in patient experience focus, metrics, and nomenclature. Of course, we all get it and are committed to taking great care of our patients, but, with all due respect, what about us? The caregivers, the clinicians, the physicians. Does anyone care about our experience?

I do. In fact, it’s pretty much what I spend most of my waking hours thinking about. …

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I’d hate to be his patient

This pediatrician declined to do MOC. See what happened to her.

Meg Edison, MD

Physician

May 17, 2016

voluntary

The American Board of Medical Specialties says “board certification is a voluntary process, and one that is very different from medical licensure.” This is echoed by my board, the American Board of Pediatrics, who says, “Board certification is a voluntary process that goes above and beyond state licensing requirements for practicing medicine.”

Over the past few years, …

A letter to a suicidal transgender teen

Florencia D. Kantt, ARNP

Physician

May 17, 2016

To the suicidal transgender teen I had the pleasure of meeting,

I have been thinking about you a lot recently.

I have been thinking about your struggle and how to support your transition into a healthy and happy adult who feels like the world is a safe place.

I have been thinking about how to best help alleviate your fears about being ridiculed, discriminated against, bullied, threatened, abused, assaulted, or killed.

I have been …

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A letter to a suicidal transgender teen

My relationships with patients last generations

Niran S. Al-Agba, MD

Physician

May 16, 2016

At 6 a.m. one morning, I was playing tennis at our local athletic club a few months ago. Sam, working at the front desk came running down onto the courts. “There is an emergency and a woman on the phone says she needs your help.”

I will be honest; I panicked a little. My husband was home asleep as were my four children. My thoughts as I raced up two flights of stairs …

A patient encounter that almost pushes this doctor over the edge

Raj Waghmare, MD

Physician

May 16, 2016

It’s the beginning of October, it’s Sunday, and it’s been an uneventful shift thus far. However, in exactly seventy minutes, a patient that I’ve just seen — one that I think has nothing more than an upset stomach — will collapse and begin a fight for her life.

I’m at the nursing station scribbling on a chart when a lanky man leans over me, a toddler in his arms. He’s looking at the …

Are female physicians really bad negotiators?

Katharine Lawrence

Physician

May 16, 2016

As a fourth year student in her last few weeks of medical school, I recently found myself in an interesting new course: negotiation skills for graduating medical students. As part of a push from accrediting organizations like the LCME, the final weeks of our medical education are being devoted to lesser-taught subjects in medicine: licensure processes, malpractice, wellness and resiliency training, and contract negotiations. At the start of the lecture, a …

Picking up the pieces with the ACP’s Yul Ejnes

Yul Ejnes, MD

Physician

May 16, 2016

A guest column by the American College of Physicians, exclusive to KevinMD.com.

When I accepted the invitation to write this monthly column for the American College of Physicians (ACP), I assumed it would be a one-year assignment. Even so, I wondered if I could come up with a different topic each month. Now, over 40 columns and …

Your patient should get a health coach. Here’s why.

Nicole Calloway Rankins, MD

Physician

May 15, 2016

We are all familiar with the statistics. Chronic conditions like obesity, hypertension, and diabetes are present in our population at unacceptably high and costly levels. More than 78 million American adults are obese, and more than 1 in 20 is extremely obese. About 70 million U.S. adults have hypertension with only 52 percent having the condition under control. Just over 29 million Americans have diabetes and an additional 86 million …

Foreign policy through the lens of an emergency physician

Sam Slishman, MD

Physician

May 15, 2016

These seem unrelated, but give me a chance. I was eating outside at a restaurant with my 5 month old, Max, and a car with a modified muffler hit the gas right in front of us. In Australia, you’d call the driver a “hoon.” The noise terrified my boy, and I felt something I’m not used to: protective rage. When Max stopped crying my mind went to struggling families, kids, …

Why the 15-minute doctor appointment is dangerous

Peter Pronovost, MD, PhD

Physician

May 13, 2016

How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys.

Yet in medicine, it’s common for practices to schedule patient visits in 15-minute increments — often for established patients with less complex needs. Physicians face pressure to mind …

It’s time to formally classify pediatric intensive care units

Christopher Johnson, MD

Physician

May 13, 2016

There are over 400 pediatric intensive care units (PICUs) in the USA, as most recently estimated by the Society of Critical Care Medicine. These units vary widely in size, from 4 or 5 beds to fifty or more. The smaller units are generally found in community hospitals; the larger ones are usually in academic medical centers, often in designated children’s hospitals, of which there are 220.

Given this size range, it is not …

What I learned from negotiating my first physician contract

Tate Hinkle, MD

Physician

May 13, 2016

For almost ten years now, family physicians have been the most recruited specialty in the medical profession, and that is not likely to change anytime soon. We face a huge shortage of primary care physicians that is only going to get worse because we aren’t training family doctors as fast as they are retiring.

Business training isn’t in the curriculum

What this means for me and my fellow family medicine residents is …

A family physician duped by a patient on chronic opioids

Hans Duvefelt, MD

Physician

May 12, 2016

A woman in her mid-thirties with a terrible limp and a past surgical history in the dozens became my patient two years ago. Her prosthetic left leg served her well, but her right leg was moving awkwardly because of advanced hip arthritis and a formerly shattered ankle.

She was on long-acting morphine and short acting oxycodone. Her Social Security disability insurance didn’t cover the long-acting form of oxycodone.

She told me several …

The story of an exhausted doctor daughter

Shelley W. Collins, MD

Physician

May 12, 2016

I am a doctor daughter. I am exhausted. My emotions are bubbling close to the surface, and I fear that at any moment, someone will do or say something to me that will cause me to lose control, which I’m not allowed to do because I’m also a female physician in a leadership role, and our emotions must be held in check.

I watched one of my mentors be memorialized last …

Talk to patients in a language they can understand

Charishma Nayyar, PA-C

Physician

May 11, 2016

You ask your patient to follow instructions and when they see you at their subsequent visit, they have not made the changes you suggested. We have all been there, often placing the blame on their lack of interest in their health. Have you ever thought to dig a little deeper?

The average American reads at a middle school level. There have been a series of studies trying to shed light and …

Could talking about physician burnout create more burnout?

Skeptical Scalpel, MD

Physician

May 11, 2016

Almost every day over the last few years, someone has written about physician burnout or depression.

The problems begin in medical school. A recent paper featured drawings that medical students had done depicting faculty as monsters. One student felt so intimidated during a teaching session that she drew a picture of her urinating herself.

peeing