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.
Me: Hello Mrs. Smith, my name is [BEEP!] Dr. Gandolfo and I am a [BEEP!] gastroenterologist. [BEEP!] Your doctor wanted me to [BEEP!] talk to you about something that showed up on [BEEP!] your CT scan.
Mrs. Smith: Who are you? I [BEEP!] didn’t hear your name?
Me (louder): It’s Fred Gandolfo, I am the [BEEP!] stomach doctor. [BEEP!] I need to talk to you about [BEEP!] that CT scan you had. You see, there was … [BEEP!] [BEEP!] [BEEP!] Can you straighten your …
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Noise pollution is an epic problem in hospitals
As surgeons we are privileged to have our hands work inside someone’s body with the intention of alleviating suffering, removing sources of pain, excising diseased organs, fixing this or that, ultimately to improve someone’s quality of life, prolong it or at times even save it.
Yet we also know that people can suffer complications from surgery, that in some cases are fatal, and where our good intentions seemingly backfire. Patient deaths …
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How do surgeons deal with their mistakes?
I walk out of a room filled with emotion and despair. A battle lost but the war rages on. I’ve seen miracles, often only a daily basis. Life is precious but peculiarly fragile while resilient and strong. Every emergency provider understands the feeling after a patient has passed. It’s the unexplainable reverence and daunting silence as I put on the white coat. It’s the echoing footsteps that never go away …
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I became a physician when I took off my white coat
Despite the years, I have not talked about this case. It is not a privacy/ HIPAA problem; rather, I did not want to upset the patient and family. I am not certain that was the right decision; at the time, it seemed best. Still, the patient died, the family moved on, and I carry a guilty memory.
It was after deteriorating months of corrosive cancer that we met. Multiple systems were …
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When doctors from another specialty miss a cancer diagnosis
Closing a medical practice to new patients is like cutting off the very top of a tree. It’s the beginning of the end.
The top of the tree, the crown, is where the newest leaves are. It’s also the part that continues growing ever upward, at least until it reaches it’s maximal genetic height, depending on environmental factors like the availability of water and sunlight (both of which also depend on …
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Why this doctor won’t close her practice to new patients
It’s amazing what you can learn from the stranger sitting next to you on a flight.
As I wait for my neighbor to grab her seat next to me, I secretly hope she embodies the qualities I hope for in a fellow passenger — keeping to herself and not requiring in-flight medical assistance. I make eye contact with a young woman who gives me the nod that she has the middle …
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Celebrate National Women Physicians Day #Iamblackwell #NWPD
Today I met a man who wanted to interview me before transferring his records.
He was about my age and seemed polite and pleasant enough. He told me his doctor of a dozen years had started to taper him off his long-term narcotics after he reported some of them missing because of theft. He used to take the equivalent of about 1,200 mg of morphine per day for his back pain. …
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The interview before transferring to a new doctor
I like to consider myself an “evolved” clinician — one who believes in the patient’s voice, personally invested in shared decision-making, always ready to support my patient’s decisions, as long as I know it’s informed by the best data I have available, even when it is not the course I would want them to make. Most of …
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This is the key to shared decision-making with patients
As a goal-oriented individual, I pack my days with appointments, deadlines, and to-do lists. Unfortunately, the time I spend getting from one task to the next gets lost in my focus on end results — a common blindness of Westerners who measure success or achievement by results and not by how one “plays the game.” As parents, we teach our children it’s not whether you win or lose, but how …
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A kind word at bedside can be life-changing for patients
Imposter syndrome (n.): Term coined in 1970 by psychologists and researchers to informally describe people who are unable to internalize their accomplishments despite external evidence of their competence.
When I was in medical school, I remember walking outside the library and trying not to glance inside to see how many of my classmates appeared to be meticulously studying for final exams. I remember trying to ignore their off-hand, and occasionally self-congratulating, …
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Doctors: Feel like a fraud? You’re not alone.
You see your gastroenterologist with long-standing stomach pain. You have undergone a reasonable evaluation and all the endoscopic bodily invasions, and imaging studies of your abdomen have been normal. Repeated lab work provides no clue explaining your distress. You have been twice to the emergency room and were sent home with prescriptions that didn’t work. You are frustrated and so is your gastro guy. You are convinced that there is …
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Don’t rely on Google for medical judgment
Mnemonics can be incredibly cool. When I was in medical school, there was just too much stuff to remember and memory aids were so very helpful. Most specifically I refer to the vile and inappropriate one that helped me remember the cranial nerves which I remember to this day and will not share in print.
In ancient times orators used memory palaces to memorize long speeches or poems, associating words with …
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Customer service in health care: Does AIDET really work?
Dear American Board of Pediatrics:
On December 17 2015, at 3:01 in the middle of my busy day seeing patients, I voluntarily gave up my American Board of Pediatrics certification. I thought I should write this letter, hopefully preempting any more threatening emails warning me that I must pay up or lose my certification. This was not mere oversight on my part. This was purposeful.
The reason I am no longer ABP …
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Stop MOC: An open letter to the American Board of Pediatrics
Within the last several weeks, I’ve had two plumbing issues that have caused me to reflect on the honorability of various professions and the way in which people go about earning an honest day’s crust.
Let me take you back to the beginning of the story. I was actually working nights a couple of months ago when I noticed, just before I was about to leave for the hospital, that my …
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Watch out and be informed: There is dishonesty in every profession
Requesting a second opinion can be a touchy subject for a patient. I’d like to think that when I was in practice, I was never offended when a patient’s family requested a second opinion, but that probably doesn’t universally reflect my response in every circumstance. But I am confident in saying that as often as not, I would be the one suggesting that we get another pair of eyes to …
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The evolution of the medical second opinion
“Oh God!” she groaned, looking upward with tears flooding her cheeks, which were stretched into the shape of agony. Her chest heaved uncontrollably with grief.
“I am so very sorry,” I whispered again while leaning in and stroking her hand.
This is what death notification often looks like and feels like. We doctors should be masters of delivering some of the worst news that could ever be uttered; the worst news that …
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Please address suffering in the care of the dying
If you have a life where you never, ever say yes when you mean no, then you can stop reading right now.
But I guess that you’re a lot like me. Now and then, you get caught off guard.
And before you know it, you’re staying late to see that emergency patient. Bringing cupcakes for the second-grade class. Volunteering for the coffee meet-and-greet at church next Sunday.
What’s up with that? We’re smart. …
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Doctors need to learn to say no. Here’s how to do it.
I was a licensed naturopathic doctor in two states. I quit practicing naturopathic medicine after discovering my former boss, also a licensed ND, had been importing and administering an illegal cancer drug. I trusted my boss, as did his patients, because he was well respected in the naturopathic community and his credentials included “FABNO” (Fellow of the American Board of Naturopathic Oncology). This FABNO treated any kind of cancer, even …
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The shocking confessions of a naturopathic doctor
Every business on earth has an angle on the market. Business leaders around the world work tirelessly, attempting to edge out their competitors by delivering the best service to their customers. When all is said and done, physicians want to deliver the best care they can to each patient. As medical students who are eager to serve, we are committed to examining the space where business and medicine intertwine …
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Create magic, one patient at a time
A guest column by the 
