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.

ACOs: Another layer of oversight for physicians?

Fred N. Pelzman, MD

Physician

November 29, 2014

A sleeping dragon awakes.

At our weekly health policy colloquium recently, the presenter described plans for our organization to form its own accountable care organization, or ACO.

The idea behind an ACO is to find patients who get the majority of their primary care within our system, and then “attribute” their health care and all of its attendant costs to that system, making the providers ultimately responsible for providing both high-quality and …

Improve the lives of primary care doctors. Here’s how.

Davis Liu, MD

Physician

November 28, 2014

Making primary care better for doctors currently in practice and attractive to medical students and residents is critical given the needs of our health care system. It also has been a major focus of the health care organization where I work. A few colleagues and I noticed that many primary care doctors still stayed later than others despite lowering patient panel responsibilities and the implementation of the nation’s most robust …

Having children during medical residency: 6 tips to survive

Jasmine Almeida

Physician

November 27, 2014

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We had our first child during the fourth year of my husband’s ophthalmology residency, and our second son joined us during the first year of a surgical retina fellowship. Juggling long hours, multiple medical commitments and the needs of two small children can be exhausting but every day is complete with fulfillment and laughter — and who can ask for anything …

What medicine can learn from the Secret Service failure

Ira Nash, MD

Physician

November 26, 2014

I was listening to the news on my way to work recently, and heard a story about the review conducted after the well-publicized security breach at the White House. Like many people, I was shocked when the story of the fence-jumper first broke. How was it possible that some guy with a knife managed to get over the fence, cross the lawn, enter the White House and get deep into the …

What is it about doctors that makes them think they don’t need help?

Starla Fitch, MD

Physician

November 26, 2014

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It was a Friday morning, in the wee hours. I had come in to the hospital early to get caught up on the ever-present computer work. As I got a quick cup of tea, a young surgeon I’d seen around the operating room came in. He’d clearly been up most of the night.

We exchanged a few pleasantries. And then he cut to …

Health care monopoly: How it affects the nursing home

Jordan Grumet, MD

Physician

November 26, 2014

Check.

The administrator’s voice wavered as I picked up the phone. He was calling about the nursing home patient that I admitted the day before. While normally forthright, I could feel the discomfort in his tone as he danced around the issue. The patient’s insurer had called. Apparently they made an “arrangement” with the mega-ACO owned by the latest consolidation of Goliath health systems. They wanted my patient transferred to another …

Even if no life was saved, an ER physician makes a difference

BirdStrike, MD

Physician

November 26, 2014

I walk out of the patient room. My eyes stare at the computer screen. I’m behind, way behind. I roll my head on my neck. My neck feels tense, and I have a headache. It’s been a long week. I need a vacation. Hurry up, click-click-click this computer, I think to myself. Dammit, is this EMR really freezing up again?

I look …

Physician goes first: A way to not interrupt patients

Val Jones, MD

Physician

November 25, 2014

Much has been made about physicians’ tendencies to interrupt patients. Studies have shown that patients are permitted 12 to 18 seconds of talk time before they are redirected (or interrupted) by their doctor. This leads to patients feeling that the physician didn’t listen or didn’t care. I believe that there is a way to solve the problem without wasting time or being rude. …

When the art of medicine gets lost in the business

Hans Duvefelt, MD

Physician

November 25, 2014

Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm.

Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months.

A slender, middle aged man, …

What a messy house has to do with medicine today

Abigail Schildcrout, MD

Physician

November 25, 2014

I spent this past week worrying that my in-laws were going to divorce me. For sure. No getting out of it this time.

I do not keep a neat house. There are piles everywhere. Piles of books. Piles of papers. Piles of clean-but-unfolded laundry. Piles of mail. Piles of music. Piles (believe it or not) of instruments. Piles of shoes. Piles of …

Ezekiel Emanuel’s wrong ethical view of aging

Jim deMaine, MD

Physician

November 24, 2014

Ezekiel Emanuel wrote an article for the Atlantic on “Why I Hope to Die at 75: An argument that society and families — and you — will be better off if nature takes its course swiftly and promptly.” As an oncologist and ethicist, he says he speaks for himself but implies not so subtlety that avoiding our declining years may be in our best interest — and that …

When physicians need backup during a routine procedure

Michael Kirsch, MD

Physician

November 24, 2014

A few days before I wrote this, a patient had a complication in my office. I have discussed previously the distinction between a complication, which is a blameless event, and a negligent act. In my experience, most lawsuits are initiated against complications or adverse medical outcomes, neither of which are the result of medical negligence. This is the basis for my strong belief that the current medical malpractice system …

A diagnosis of HIV: God had nothing to do with it

Lawrence Rifkin, MD

Physician

November 23, 2014

It didn’t seem like my college-age patient Quincy had any idea what was in store when I entered the exam room.

“Hi Dr. Rifkin,” he said with a warm smile as I sat next to him. Quincy (not his real name) had been my pediatric patient for years.

I didn’t delay. “Hi Quincy. I’m afraid I have some terrible news. Your lab work came back — you’re HIV-positive.”

His head went back slightly. …

(Dis)comfort measures

Jay Baruch, MD

Physician

November 23, 2014

Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that’s more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now …

Read more…

(Dis)comfort measures

Transforming primary care to spend extra time with patients

Eunice Yu, MD

Physician

November 22, 2014

When I started my internal medicine residency, I was pretty sure I was going to rock this primary care thing. I knew the drugs for hypertension, the guidelines for diabetes management, and depression management seemed like nothing more than an algorithm. I felt buoyed by familiarity as I looked at the problem list for my first primary care patient: basically diabetes, hypertension, and depression.

As I opened the exam room door that early July day, I …

A letter to Dr. Oz for his inbox

Jennifer Gunter, MD

Physician

November 21, 2014

dr oz

Dear Dr. Oz,

I know the #OzsInBox question on Twitter didn’t exactly go the way you or your social media team expected. You told Sen. McCaskill when she asked you about the so-called miracles and medically baseless products that you promote on your show that you view yourself as a cheerleader, but consider #OzsInBox a wake-up call that …

Read more…

A letter to Dr. Oz for his inbox

Innovation in cardiac surgery: When doctors worked with engineers

Rod Tanchanco, MD

Physician

November 21, 2014

The term “Golden Age” seemed to permeate multiple domains in the 1950s, almost to the point of triteness. The field of cardiac surgery, however, deservedly earned the term as pioneer after pioneer introduced innovation after innovation that advanced the specialty. Walter Lillehei in Minnesotta, Wilfred Gordon Bigelow in Toronto, William Chardack in Buffalo, and Ake Senning in Stockholm were just some of the trailblazers of that era.

The four surgeons also shared …

Is it ever appropriate for us to choose the timing of our death?

Afshine Ash Emrani, MD

Physician

November 20, 2014

Human life is a gift. Death, too, can be a gift. Is it ever appropriate for us to choose the timing of our death?

Brittany Maynard, 29, was diagnosed with a stage 4 glioblastoma, an aggressive and uniformly fatal brain tumor. With the blessing of her family and millions of supporters around the world, she ended her life in Portland, Oregon, with a fatal dose of barbiturates prescribed by a physician. …

A factory model of health care can only go so far

Tom Peteet, MD, MPH, MEd

Physician

November 20, 2014

What we are trying to do is create a system that gets rid of the human factor.
– an internal medicine physician

I heard this statement in a patient safety seminar designed for medical residents. I paused, shuddered even, as a resident who writes poems and reads novels in my free time. To my surprise no else blinked an eye. And why should they? The concept that physicians’ humanity and empathy shape health …

We owe it to our patients to put on our game faces

Starla Fitch, MD

Physician

November 19, 2014

When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?”

When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?”

When you steel yourself …

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