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.
I remember seeing so many charts in my career on which the well-meaning emergency room physician wrote the following: “Follow up with your primary care doctor.” Or, if they didn’t have one, “Follow up in one week with a primary care doctor.” I laughed to myself. Usually, the people we say that to have either no insurance, inadequate insurance or inadequate motivation to even call the persons to whom we …
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Let’s apply a little reality to the referrals from the ER
The last couple of decades have seen a dramatic shift of power and clout away from individual physicians and towards administrators and the business side of health care. In many ways, physicians have nobody but themselves to blame collectively; because for any large and respected group of people to surrender so much autonomy so quickly, a lack of strong leadership must always be a factor.
So many different reasons for this …
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The time a 28-year-old MBA told a physician where to round first
Thanks to all the nurses who take care of my patients and every other patient. I may be a doctor, but you are the ones who deliver the care. You give the medications and hang the IV fluids. You wash the patients and turn them. You check their vitals and listen for bowel sounds. You walk with them. You talk with them. You fulfill their needs. And you provide comfort to …
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Not everyone can be a nurse
Once upon a time, there was a man who was a very good cook. He was just an ordinary man, but he had real culinary talents. He could create the perfect meal for anyone who came to see him in his modest café.
His maître d’ and waiting staff were warm and well trained, and the menu was designed specifically for the clientele of his eatery. He gave each person his …
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The story of a man who was a very good cook
Monday morning. As I click through the usual beginning of the week barrage, I open an email from my ER chief. My heart drops into my stomach, where it begins to race. He’s forwarded a letter of concern from a specialist from a different hospital. It’s about a patient that I failed to help, and failed to diagnose, so she had to seek help elsewhere. As I read the details, I remember the case. I pick …
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Respect your nurse. Your life may depend on it.
In 1991, I took a sub-internship in cardiology with a clinically-minded attending named Eddie Atwood. One day he stopped me in the hall: “You have a few minutes toward the end of the day?”
“Sure. What’d I do?” I just knew some sort of defining verdict headed toward my Dean’s letter, to be shown to all residencies and preserved in an archive of medical student iniquities, was surely coming.
“You students are …
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How a patient gave this doctor his first coaching session
USMLE Step exams are a rite of passage in medical education. They mark the transition from pre-clinical years to clinical years, from medical school to residency and from intern to resident. One of the more difficult aspects of the transition to residency was convincing myself that I really was a doctor. The habits of explaining my role as a student, of hedging every statement with “I’ll need to ask the …
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The proctor seized during a USMLE Step 3 test. See what this doctor did next.
I settle into the bent-wicker chair on my lanai and try to relax. It’s a perfect island day, the temperature warm, the breeze cool, and I gaze out over the pool to the tops of the coastal mangroves. I’ve just come home from a shift at the local free clinic, and my mind is occupied by the work we did today. My fourth-year medical students encountered some difficult patients, and …
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I thank my father for the gift of freeze-frame
Medicine can wear down our hearts and souls. My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency. By that final year of training, I was no longer certain medicine was really the right choice for me. I was struggling with the notion that after almost 11 years of education, the destination was not quite …
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This pediatrician learned why it’s so important to listen to a parent
Sometimes before I go on a run, I take the laces of my jogging shoes and tie them together in a knot. I wear the pair around my neck with each shoe falling to opposite sides. The heels clunk against my chest as I make my last minute rounds. It’s as if running is my job and the shoes are the instrument I use to perform that job. Eventually, I …
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When practicing medicine is like running
The American Board of Internal Medicine has been under fire for the excessive testing requirements of physicians and they recently have been seeking clarity for the maintenance of certification process. In my opinion, the answer is to eliminate the examination completely and create a better, ongoing assessment using CME chosen by the physician that meets their needs, especially in a time where medical knowledge changes so rapidly.
Doctors are essentially tested …
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Why board exams are like Name That Tune
My father was killed by an Islamic fundamentalist in Cairo, Egypt when he was just 47 years old. It was October 1993, exactly eight months following the first World Trade Center bombing. Terrorism was still a new word — and a new concept — to many Americans, and so my father’s death was featured prominently on the evening news and in the New York Times.
For over 22 years, this has …
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Stories influence how I practice medicine. Here’s how.
Maybe it’s just me, and maybe this is a regional/local phenomenon, but I have noticed a sharp increase in the number of non-physicians who sport their white coats on a daily basis around the hospital.
First, let me preface this piece by saying I have absolutely nothing against any person who partakes in the care of patients; in fact, I commend all the helping hands that routinely dedicate themselves to health …
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Should white coats be only worn by physicians?
Recently during rounds on a busy inpatient teaching service at a county hospital, I led a group of medical students into a patient’s room. I asked the same question I have asked well over 10,000 times: “What do you see?”
Observation is a powerful tool at the bedside, and offers us an opportunity to learn from one another.
My student replied, “I see a white man sleeping in no acute distress.”
I repeated …
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A gentle reminder that healing begins with feeling
I’m a physician, part of the enormous all-consuming machine called modern health care. This machine is driven by value-based best practice and end results. Literal life and death decisions are required daily, so naturally I become impatient when my son can’t decide between chocolate and vanilla or which movie to watch.
My cultivated Achilles’ heel of impatience has a tendency to interfere with daily interactions or decisions because of the dreaded …
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The momentous power of sincerity and good communication
If the act of organ donation is among humanity’s greatest gifts, what can be said of living donors who undergo surgery to extend and improve the life of another? It’s truly a courageous and inspiring sacrifice.
I was honored recently to be able to perform my first living-donor liver transplant. Jason Clark, 28, donated about 60 percent of his liver to his father, Lynn, 57, who had been sick for many …
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Why I’m doing one of the riskiest surgeries in medicine
I’ve held many hands, been generous with my hugs, and tried to treat every patient as though they were my mother. I lost my mother to leukemia almost one decade ago. I know what it’s like to feel defeated by the health care system, by health care providers, by medications, and by the human body’s response to all of the above.
A patient will never forget a health care provider that …
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Make a patient’s journey easier with a simple act of kindness
Talking to health care professionals about the importance of loving your patients and colleagues — as I often do — might raise eyebrows.
How can we be expected to love our patients during a 15-minute clinic visit? How can love form among hospital teams coming together for a surgical procedure but then moving on to other work? Perhaps most importantly, how will this love make any difference in our patients’ lives …
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Maybe the key to patient care is a little love
Nothing brings out the mama lioness in me more than seeing one of my cubs not being treated as well as I think it should be.
Recently I had the unusual experience of accompanying my oldest daughter into an unfamiliar hospital for a minor surgical procedure. Now, this daughter isn’t exactly a cub; she’s a full-fledged adult, with a master’s degree in health care administration, a husband, and two small boys of …
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The family member in the corner may be paying more attention than you think
