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.
In the quiet moments of illness, I witness love and loss unfold.
I usually place the beds of relatively sick patients closest to my workstation. While I can monitor all the patients, except for a few female beds behind curtains, this arrangement helps me keep a closer eye on those who are more ill, particularly those receiving chemotherapy.
Directly in front of my counter lies a 50-year-old gentleman recently diagnosed with primary …
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Love and loss in the oncology ward
For over forty years, I worked as a general and vascular surgeon. For the last ten of those years, I was employed under an RVU-based compensation model. That period is when my dissatisfaction with medicine truly began. Complex, life-saving operations were reduced to “productivity units.” The pressure was relentless, the system unforgiving.
And unlike primary care physicians, surgeons do not have the option of concierge or direct-pay models. We are necessarily …
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A surgeon’s view on RVUs and moral injury
When I started practicing medicine more than thirty years ago, I believed the system was imperfect but noble. We worked hard, we cared deeply, and I thought that if we just kept doing our best, things would gradually improve. I trusted that technology, new policies, and better organization would eventually bring us closer to the ideals of medicine. Some of those changes helped. Many did not.
If I am honest, there …
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Reclaiming moral ambition in health care
She clutched her chest, gasping for words that would not come in English. The nurse leaned in, trying to decipher. Her son was not there to translate, and the phone interpreter line was not connected yet. I could see her distress worsening. Precious minutes slipped away before we finally realized she was describing classic heart attack symptoms. That patient survived, but the outcome could easily have been different. And in …
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When language barriers become a medical emergency
Were you the one who always held it together? The responsible one? The one who made sure everyone else was OK, sometimes at the cost of your own well-being?
For most eldest daughters, this role is inevitable. We don’t choose it. We are handed it, early and often, because we are so “capable.” We accept this role and excel at it. That’s what most eldest daughters do with whatever is handed …
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The burden of the eldest daughter
Understanding the legal process in America is not easy, and I do not envy the attorneys who try to defend doctors in court. I do envy them for their protections. Lawyers, for the most part, as elected members of Congress, create our laws. Others, also for the most part lawyers, are selected to be U.S. Attorneys, and they enforce those laws. Lawyers called judges control our courtrooms. Almost all of …
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A doctor’s letter from a federal prison
“Who would you go on a date with, and why?” That was the question that came up in a recent speech workshop. People shared fun, lighthearted answers. But for me, the answer came straight from my heart. I would go on a date with my dad.
My father passed away nearly fifteen years ago, just before my life was about to begin a whole new chapter. I was newly married, preparing …
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A doctor’s tribute to her father
He was five, wiry, and fast, so fast his mother looped her purse strap around his wrist in the waiting room. She spoke softly, in Spanish, explaining that he could not sit still, could not sleep, could not stop. As she described his meltdowns, he interrupted with nonsense sentences, unrelated to her words, untethered from context. It was not defiance; it was overflow.
I and my team of CNA Spanish interpreters …
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Treating autism and ADHD as a spectrum, not a contradiction
Some battles announce themselves with trumpets; others creep in silently, spreading their fire unseen. His battle was the latter. What began as a hidden spark in his muscles had grown into an inferno consuming his young body from within.
He was barely thirteen, a boy from Bihar, when fate dragged him into this fight. By the time he reached us, fever had bound him for three relentless weeks. His pulse was …
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The silent victories of medicine
I am a cancer doctor.
It took me many years to become one and while I paid for my medical school tuition, my residency and fellowship training was partially subsidized by government funds for general medical education. Every residency and fellowship is partially funded this way because the government recognizes the need for doctors. I have also had an NIH funded basic research lab where I did research that has contributed …
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A cancer doctor’s warning about the future of medicine
Physician burnout and physician suicide continue to plague the medical profession. Everyone knows the tragic statistic: one U.S. physician commits suicide each day. While some statistics report a decrease in the problem over time, the accuracy of these reports is questionable. The reality is that it is far too common.
The term burnout, while a necessary label, implies that a single factor causes it. In reality, each burned-out physician is different. …
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Teaching medical students what it is really like to be a physician
Every week, I see patients not because they need to, but because their insurance company says they must. A patient came in recently for one reason only: Her insurer required a referral before she could see a specialist. She didn’t want to. I didn’t need her to. But we both had no choice. After a 20-minute visit neither of us needed, I did what the insurer required: document, click, submit. …
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The hypocrisy of insurance referral mandates
The patient was in her forties. She experienced chest pain, but it did not appear to be “classic.” Her ECG was normal. Her labs did not raise alarms. The team leaned toward anxiety. Hours later, she went into cardiac arrest from a heart attack. That silence after the code still stays with me. We anchored on the first test. We closed the case too early. We stopped listening to her …
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The timeless art of diagnostic reasoning
At the recent ECTRIMS Congress in Barcelona, researchers presented data that should make every specialist pause. In a claims analysis of nearly 70,000 patients with multiple sclerosis (MS), 98 percent of infections were first detected not in neurology clinics, but in primary care and other non-neurology practices. Even “serious” infections requiring hospitalization were almost entirely picked up elsewhere. The message was clear: Specialists, by design, often miss the forest for …
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What MS can teach cardiologists about disease
“Do you know what it feels like, to know you could die at any moment?” His words linger in the air, heavy, long after the threat of violence has passed, long after our team has calmed him with words and soft gestures. It is not the first time a patient’s family member has swung at me, nor will it be the last. But it is the first time with a …
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What an active shooter taught me about being a doctor
There’s a common belief that leadership requires a title after your name, an office on the top floor, and people looking to you for direction. But in medicine, leadership happens at every level.
Take me, for example. I’m an attending physician, whose role on the team is as a hospitalist. In the hierarchy of medicine, it’s easy to dismiss this role as “just a physician.”
Yet there’s nothing “just” about it when …
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Physician leadership in moments of crisis
The pilgrimage of my dreams included a suitcase full of diapers, extra pants, and a quiet prayer for dignity. Italy has always been a dream destination for me. As a Catholic, I consider Rome the Holy City of my faith, and this year’s Jubilee motivated me to visit the four Holy Doors. I also love art and culture, and Italy is home to many historic sites and great works of …
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A pilgrimage to Italy with prostate cancer
I just spent a weekend doing absolutely nothing. Well, nothing memorable, anyway. The week before, I’d been on home call during an Epic upgrade. If you’ve lived through one of these updates, you know the chaos. In addition to the usual phone calls about echo results, arranging studies, and communicating with referring physicians, I was getting a constant stream of secure chat notifications updating me on the system’s progress. These …
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The power of ordinary joy for physician well-being
When I first stepped onto a college campus, I was the first in my entire family to do so. Coming from a humble immigrant background, community college was my gateway. Like many community college students, I was nontraditional, new to the country, starting from scratch. This was my first exposure to the American educational system, and I was just trying to figure it out while working multiple jobs.
Eventually, I served …
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Leadership is about pulling others up
