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.

Surgeons are human, not superhuman: The agenda behind the FIRST trial

Dr. Eunice J. Minford

Physician

February 28, 2016

The FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees) trial randomized American surgical residency programs to one of two arms:

Standard group continued with their current standard restricted hours practice of 80 hours per week with time for breaks/rest and a limit to hours of work at any one time.
“Flexible” hours group removed current restrictions on hours worked at any one time and waived the need for breaks …
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Surgeons are human, not superhuman: The agenda behind the FIRST trial

Doctors should define who they are

Natasha Deonarain, MD, MBA

Physician

February 27, 2016

There’s stress written all over their faces.

Poised in that precarious time of life, transitioning between the teenage freedom years and the responsibilities of adulthood, those six first-year medical students look anguished. Their collective eyebrows knit together.

I’ve given them a challenging homework assignment: “Write a 500 to 1,000 word essay and read it to the class next week.”

“I’ve got a question,” J says. “You told us to write an essay about …

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Doctors should define who they are

A story of how one physician overcame burnout. He is not alone.

Robert Centor, MD

Physician

February 26, 2016

Donald Ross (an obvious pseudonym) has practiced in a medium sized town for around 20 years. I count him as a protege as we worked together during his residency. As a clinician educator, we work with many interns and residents, and sometimes we develop lifelong relationships. Donald Ross and I share a love of golf, ACC basketball (although we root for rival teams), and internal medicine. We periodically communicate through …

The medical subplots of 2016’s Oscar-nominated films

Lipi Roy, MD, MPH

Physician

February 26, 2016

I’ll just come out and say it: I love movies. OK, perhaps not the most scandalous statement of 2016. Yet after a long, stressful week of caring for sick patients, watching the big screen, spellbound by the expressive dialog and thrilling action sequences, my mind subconsciously gravitates to one thing: the medical aspects of the film. Even when one would least expect it, as in the finance and mortgage juggernaut, …

No textbook can teach doctors the stages of grief

Katie Lin, MD

Physician

February 26, 2016

It’s 2:00 a.m., and the fluorescent bulbs flicker gently overhead along the quiet hallways of the intensive-care unit.

Tonight I’m the ICU resident on call, and the weight of that title sits heavily on my shoulders. My team is in charge of keeping our critically ill patients safe from harm overnight. Although the supervising physician is only a phone call away, I’m the acting team lead for any codes called during …

Fix high-deductible health insurance. But it won’t be easy.

Michael Kirsch, MD

Physician

February 25, 2016

May I whine for a few sentences, please? My staff and I have a high-deductible medical insurance plan. As the costs of coverage increased each year, we had to find a product that we could afford for our small private practice. As any small business owner knows, margins are tight, revenue is declining and expenses inexorably rise. And physicians, unlike other retailers, cannot raise our fees. Would you want to …

The stories have gone from medicine and that’s a shame

Suneel Dhand, MD

Physician

February 25, 2016

I was at a dinner meeting for our hospital last week, and before everyone went in to sit at their tables and hear the evenings’ speeches, there was some time for the usual networking over wine in the reception room. I got chatting to an established local primary care physician, a respected member of the hospital staff who has been in practice for over 30 years.

He’s quite a presence and a …

Why are mental health questions still allowed on physician job applications?

Pamela Wible, MD

Physician

February 24, 2016

DearPamela

Dear Pamela,

Question for you in regards to disclosure about mental illness. In every job that I have applied for, as part of the credentialing process, there are questions about felonies, treatment for drug/alcohol abuse and mental illness. Why are mental health questions still allowed to be on there? I have had postpartum anxiety/depression three times now, and I feel like it is …

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Why are mental health questions still allowed on physician job applications?

An oncologist reflects on his inpatient internal medicine service

Nathan A. Pennell, MD, PhD

Physician

February 24, 2016

I recently finished 2 weeks of inpatient hospital service, and the sense of relief was so palpable it felt like taking a breath after swimming the length of a pool underwater. At first, there is anxiety and a sense of excitement at the challenge, but soon you feel strong and assured that you’ve got this under control. The house …

Helpful tips for your first day at a new hospital

Elizabeth Lumpkin, MD

Physician

February 24, 2016

An excerpt from Road Warrior Physician: Locum Tenens a How-to Guide.

There are few things that are more frustrating than to be delayed while en route to your assignment. It happens, so be prepared for it. Keep all travel emergency contact numbers handy. This is one of my prime Evernote …

Why daughters need their fathers

Meg Meeker, MD

Physician

February 23, 2016

Men, we need you.

We — mothers, daughters, and sisters — need your help in raising healthy young women. We need every ounce of masculine courage and wit you own because a father, more than anyone else, sets the course for a daughter’s life.

After more than 20 years of listening to daughters — and doling out antibiotics, antidepressants, and stimulants to girls who have gone without a father’s love — I …

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Why daughters need their fathers

The challenges this doctor faces when caring for the homeless

Vincent DeGennaro, Jr., MD, MPH

Physician

February 23, 2016

“Fifty-three-year-old homeless woman with diabetic ketoacidosis and severe emphysema exacerbation.” And suffering from adomicilia, too, I added in my head.

Much like apraxia means the inability to perform purposeful movements (praxis), adomicilia jokingly means those who are not domiciled, a pretentious attempt at gallows humor in the medical profession.

I read through the patient’s electronic record imagining a withered woman, wrinkled from years of drinking and smoking, perhaps with signs of schizophrenia. Most …

A Generation X physician embraces the millennial doctor perspective

Sherwin Gallardo, MD

Physician

February 21, 2016

I have been practicing family medicine as part of a large urban managed-care organization for about 15 years now. As part of my practice, I teach medical students and residents. And as a card-carrying member of Generation X, I often find myself right in the middle of the ebb and flow of the work-life balance and physician wellness discussion between my older Baby Boomer “workaholic” and “pay-your-dues” vocation-driven colleagues, and …

Trust is the foundation of quality patient care at the end of life

Brian J. Carlisle, MD

Physician

February 21, 2016

“It’s those pain medicines you are giving her. She’s very sensitive to them. I think that’s why she’s confused — she is doped up.”

Two months after receiving her diagnosis Mrs. M signed up for hospice. At our first visit, she was suffering and visibly uncomfortable. Her skin appeared excoriated from weeks of scratching. She was confused, restless, and racked by pain.

Mrs. M had metastatic liver cancer resulting from underlying cirrhosis. …

The psychiatric secrets that harm physicians

Melanie Watkins, MD

Physician

February 20, 2016

I know your secrets. I keep secrets for a living.

I know about the eye opener before your shift; the Adderall prescribed for your son that you take in the morning; the Xanax a colleague gave you for upcoming air travel that that you take at night; the near DUI that you got out of by showing your hospital badge, the letters “Dr.” prominent on the left side; your wife who …

A tribute to Paul Kalanithi

Tom Peteet, MD, MPH, MEd

Physician

February 19, 2016

There are few aphorisms in medicine that stand up to reality. Here are two: Physicians get the patients they deserve, and we tend to die like we live.

Paul Kalanithi’s posthumous memoir proves both: As a neurosurgery resident at Stanford, he took on the most challenging cases, and when diagnosed with terminal lung cancer, he lived and died pursuing excellence and truth. I read When Breath Becomes Air …

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A tribute to Paul Kalanithi

I was unprepared to deal with a homeless patient today. I won’t be tomorrow.

Seema Khosla, MD

Physician

February 19, 2016

I met a woman today who was well-groomed, articulate, insightful and undeniably intelligent. She provided succinct responses and understood the matter at hand. Our ability to treat her, though, will likely be derailed in two weeks when she will once again become homeless.

In the midst of a booming job market in my area lies a cluster of people who are unable to find work — either due to transportation issues, not …

What does it mean when a patient calls a doctor by his first name?

James C. Salwitz, MD

Physician

February 18, 2016

Romeo and Juliet, Act II, Scene II: “What’s in a name? That which we call a rose by any other name would smell as sweet. So Romeo would, were he not Romeo call’d, retain that dear perfection which he owes without that title.”

I saw a consult the other day, an older gentleman with a new cancer requiring complex evaluation and extended care. Scary, hard stuff, but with the possibility of …

In the fight against MOC, physicians are the underdogs

Meg Edison, MD

Physician

February 17, 2016

Wow. For those who think MOC isn’t a big deal, my open letter to the American Board of Pediatrics just hit 70,000 views. That’s stunning.

For those commending my bravery, realize efforts like this are not done in isolation. I am not alone. I have the most amazing partners. I can’t even express how blessed I am to work with the ten doctors in our private practice. Not only do we …

Who is responsible for OR delays? And what can we do about them?

Skeptical Scalpel, MD

Physician

February 17, 2016

Every two or three years, someone, usually a hospital administrator, decides that delays in operating room turnover time need to be looked into. A committee of 20 or 30 stakeholders (love that term) is appointed and assigns someone the job of measuring the time between cases and identifying reasons for delays. In years when turnover time is not being studied, first case starting delays are on the agenda.

In my nearly …

Physician

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