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.

Behind the scenes: The magic of medicine

Adrianne Westmoreland, DO

Physician

September 23, 2014

Let’s talk about expectations. And I’m talking the Dickens’ kind. When you watch television, the food flaunts itself before you. Tempting you with golden buns and perfectly placed pickles. The models eating those perfectly styled burgers are the same — airbrushed to perfection. Most often, limbs are stretched to unrealistic proportions and curves are molded and erased to fit someone’s view of beauty.

When someone first takes the baby steps to venture into …

Handshakes transmit germs: What are doctors to do?

Alex Smith, MD

Physician

September 22, 2014

In a study in the American Journal of Infection Control, researchers coated a gloved hand in E. coli. One person with the E. coli glove then they shook hands, high-fived, and fist bumped another person with a sterile glove. Transfer of E. coli to the sterile glove was measured.

Results:

highest transfer of bacteria: handshake
lowest transfer of bacteria: fist bump (high five was in the middle)
difference: fist bump less than 10% of …
Read more…

Handshakes transmit germs: What are doctors to do?

How do you know when a hypochondriac is really sick?

Lucy Hornstein, MD

Physician

September 22, 2014

I have a patient who is a full blown sufferer of health anxiety. He firmly believes he has full-blown AIDS after a single extramarital sexual contact (non-genital) one month prior with a woman not known to have HIV. (Reality check: The other person didn’t have HIV, the specific contact as described was ridiculously unlikely to have transmitted the virus had it been present, and AIDS takes months to years to develop …

Patient appreciation: Why I still love being a doctor

Val Jones, MD

Physician

September 22, 2014

HappySurgeon

Judging from recent articles, surveys, and blog posts, the medical profession is remarkably demoralized. Typical complaints range from “feeling like a beaten dog” to “living in humiliating servitude,” to being forced to practice “treadmill medicine.” Interestingly, the public response to these complaints is largely indifferent. The prevailing attitude (if the comments sections of online articles and blog posts are representative) seems …

A question you can never prepare for

Bruce Campbell, MD

Physician

September 22, 2014

She was nearing the end of a long and interesting life. Her birth was announced on the party line in her rural community’s first telephone system. Her death, which would come soon, would be shared on Facebook and via cell phone. She had graduated with a degree in home economics from the University of Minnesota in 1938 and had worked for a meat packing company during and after World War …

Read more…

A question you can never prepare for

A physician’s last patient before retirement

Thomas D. Guastavino, MD

Physician

September 21, 2014

Mrs. D was my last patient. I retired several months ago, and for some time prior I informed my patients so as to give them time to decide where they would like their follow-up care.

Mrs. D was an elderly lady who I first met in the ER several years prior after a fall resulting in a displaced ankle fracture. She was pleasant and alert, understanding everything I was explaining after …

The quixotic quest for precision in medicine

Dr. Saurabh Jha

Physician

September 21, 2014

88.2% of all statistics are made up on the spot.
– Victor Reeves

There’s a growing movement in medicine in general and imaging in particular which wishes to attach a number to everything. It no longer suffices to say, “You’re at moderate risk for pulmonary embolism (PE).”

We must quantify our qualification.

Either by an interval: “Your chances of PE are between 15 and 45%.”

Or, preferably, a point estimate: “You have a 15% chance …

The pressure to admit patients from the ER will only grow

Steven Reznick, MD

Physician

September 21, 2014

Once again government regulators have put in place well-meaning rules without anticipating the consequences. We all hate sitting around in the emergency department waiting to be seen and to be treated. On October 15, 2014 as part of the new Affordable Health Care Act and the patient satisfaction portion, hospital ERs will have about 180 minutes from the time you arrive and sign in to evaluate you, treat you and …

Who are the best judges of physician quality?

Margalit Gur-Arie

Physician

September 21, 2014

shutterstock_164368670

In a new Forbes article, David Shaywitz ponders whether patients are the best judges of physician quality. This is a very interesting question, not because the answer is elusive, but because the question itself is rather unusual, and may prove to be the harbinger of a new way of thinking about health care. The question raised by Dr. Shaywitz is not whether …

The dreaded post-visit calls: Are they worth it?

Fred N. Pelzman, MD

Physician

September 21, 2014

Just the other day I received a somewhat anxious-sounding phone message from a patient of mine, approximately 72 hours after her office visit with me, and about 24 hours after I had already gone over all of her lab results from the visit with her.

She sounded quite distressed, and said she’d received a message from someone, but could not really understand what they were saying. She said she was finally …

Sometimes doctoring reveals my failings as a human being

Jordan Grumet, MD

Physician

September 20, 2014

We were intimate.

As intimate as a doctor and patient can become. He had long outlived his wife and there were no children, no family, just friends. When he first came to me he was lively and active, but the years took their toll. Our visits became more regular. Every six months. Then every three.

His memory started to slip. Occasionally he would look at me suspiciously when something went wrong. His …

Not knowing what we don’t know: How can we help doctors?

Davis Liu, MD

Physician

September 20, 2014

Dr. Daniela Drake writes an provocative and bold piece on the plight of doctors in America and the impact it has on patient care: “Why Your Doctor Feels Like a ‘Beaten Dog’.” Though health care is very bureaucratic with administrative paperwork, huddles, and hassles, her linkage of how patients were neglected as a consequence of the system doctors work in is weak.

She talks about Victoria, a teenager, who …

Doctors are hammers. Don’t automatically be their nails.

Michael Kirsch, MD

Physician

September 20, 2014

Is your doctor a hammer and you’re a nail? Here’s some insider advice coaxing patients to be more wary and skeptical of medical advice. Should you trust your doctor? Absolutely. But you need to serve as a spirited advocate for your own health or bring one with you. Ask your physician for the evidence. Sometimes, his medical advice may result more from judgement and experience as there may not be …

Cost-benefit analysis: A case where conservative management wins

Noura M. Dabbouseh, MD

Physician

September 20, 2014

We speak of everyday decisions in terms of cost-benefit analyses. Many of our patients can’t afford a healthy meal, let alone a hefty hospital bill, thus making cost awareness increasingly relevant. But on the day that I met Mr. R., it wasn’t the financial aspects of his care that concerned me. I was thinking about the patient, his family, and two roads diverged in a hospital ward. I was thinking …

Two women, two cancers, two different pathways

Don S. Dizon, MD

Physician

September 19, 2014

I sometimes wonder what I would do if I was told I had cancer. How much would I subject myself to in order to survive, or to achieve remission? As a parent, I can answer only that I would likely go through hell and back if it meant being there for my kids — to watch them grow up, graduate …

Doctors need more quiet time

Wes Fisher, MD

Physician

September 19, 2014

After you’ve written on a blog for a long time, you begin to ask yourself why. Oh sure, there are the great opportunities for a single person to make a point, to act as a tiny tugboat trying to push a corporate mothership in a slightly different direction, but you begin to realize that there are very few times that actually …

Read more…

Doctors need more quiet time

6 major myths about health care at home debunked

Michael Fleming, MD

Physician

September 19, 2014

As every physician already knows full well, health care services delivered to the home rather than in an institutional setting are increasing, a trend destined to expand even faster in the decades ahead.

This shift is inevitable, thanks to our rapidly growing elderly population and the corresponding prevalence of chronic illness, along with the nationwide push for higher quality care at lower cost and dramatic advances in medical technology such as …

Curbing prescription pain medication abuse by working together

Asokumar Buvanendran, MD

Physician

September 18, 2014

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

I recently heard a story on the news about a grandmother of eight who had gotten addicted to heroin after being prescribed an opioid painkiller, Oxycontin, for hip pain. It sounds extreme, but unfortunately to those of us in the pain medicine field, it’s all …

The best doctor I can be is one that is patient

Sarah Houssayni, MD

Physician

September 18, 2014

Many healers, teachers and parents have them.

At one point, I did, too. I had delusions. I thought I was a hero, a rescuer clad in a shiny white coat and wielding the sword of clinical wisdom.

I look back on those days with nostalgia and regret. I wish they’d lasted a little longer — my belief in my own medical grandeur and invincibility.

My most memorable patient changed that for me.

I remember how …

The death certificate didn’t say enough

James C. Salwitz, MD

Physician

September 17, 2014

August 17, 2010. Maris is a 57-year-old woman in excellent health. She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law. A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge.

It is 10:11 a.m. when Maris presents to the emergency room. Three hours earlier, her legs became wobbly while …

Read more…

The death certificate didn’t say enough