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.

Scribes put humanity back into the practice of medicine

Jim Pagano, MD

Physician

August 2, 2014

In a recent posting Dr. Kaylan Baban mused about the ubiquity of scribes and some of the reasons behind this growing phenomenon. Among them were the usual suspects: increasing patient loads leading to decreased visit times with the provider, increasing non-clinical demands monopolizing time that would be better spent actually practicing medicine, and improved legibility of notes, which are now the patient’s property and are used for …

Law and medicine are more intertwined than they should be

Michael Kirsch, MD

Physician

August 1, 2014

I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform.

I’m not suggesting that an unwelcome …

I’m not worried about ICD-10. Here’s why.

P. J. Parmar, MD

Physician

August 1, 2014

It is possible to categorize every human ailment, and assign every disease a code. This is called the International Classification of Diseases (ICD), which was first formalized as a short list of malaises at a meeting in Paris in 1900. Since then, this list has been revised ten times, getting longer each time, in an effort to aid epidemiological and policy matters around the world. The ninth edition (ICD-9) has …

Measuring the value of emergency department care

Robbin Dick, MD

Physician

August 1, 2014

Emergency department directors measure value in their departments with a number of metrics that are tracked religiously: door-to-provider times, ambulance drop-off times, left without being seen rates, length of stay for discharged patients, diversion hours, and 72-hour returns all come to mind.

These metrics clearly measure the performance of the emergency department, what to they do, if anything, to measure the value of care being provided? These metrics are often …

A short term focus on costs is expensive in the long run

Adam Philip Stern, MD

Physician

August 1, 2014

Mr. D was my patient in the partial hospital program for the chronically and persistently mentally ill, and he was barely maintaining the level of functioning necessary to remain outside of the inpatient unit. A middle aged man with long-term psychotic and depressive symptoms, Mr. D’s care was made even more complicated by an extensive history of alcohol dependence and intravenous drug use that had left him with a severely …

The problematic impact of To Err is Human

Thomas D. Guastavino, MD

Physician

August 1, 2014

November, 1999 was a watershed for physicians. It is then that the infamous “To Err is Human” report was issued by the Institute of Medicine claiming that close to 100,000 patients were needlessly dying due to preventable medical errors. The report was a bombshell, having a significant impact on how medicine was practiced. 15 years later we are still evaluating that impact.

To anyone who took the time to read the …

A physician responds to OpenNotes critics

Peter Elias, MD

Physician

July 31, 2014

There is a growing group of articulate and engaged patients committed to getting access to all their medical information in order to be better positioned to work collaboratively with their clinical teams. Published studies like the OpenNotes project have consistently shown significant benefits and a lack of serious problems. Health care systems are slow to change and just beginning to understand both the need and value to this …

Patient satisfaction has come full circle. Why you need to care.

Trina E. Dorrah, MD

Physician

July 31, 2014

I get it. It is a little strange. In fact, some people even think I’m crazy. Why? I’m a physician, but in my free time, I love helping my colleagues improve their patient satisfaction. Lately, I’ve spent a lot of time discussing a patient satisfaction survey known as CG-CAHPS (Clinician and Group Consumer Assessment of Healthcare Providers and Systems). I’m sure it doesn’t surprise you to learn that CG-CAHPS is …

After retirement, a visit to a dermatology office

Miranda Fielding, MD

Physician

July 31, 2014

I’ve always been good at pattern recognition and my visual-spatial orientation is excellent. Photography is my hobby, so it was only natural that as a medical student and internal medicine resident, I loved my dermatology electives. Each day yielded up a new parade of interesting skin lesions and rashes, and by the end of my rotations I was confident in my diagnoses and recommendations. Contact dermatitis? Steroids! Eczema? Steroids! Psoriasis? …

Getting personal with patients really matters

Imamu Tomlinson, MD, MBA

Physician

July 31, 2014

Ask almost any physician why they chose medicine, and they’ll answer, “I wanted to make a difference in the lives of patients.”

But in today’s high-pressure healthcare environment, it’s easy to get caught up in performance metrics and obsessed with efficiency. We tell ourselves, “It’s OK, as long as we’re delivering great clinical care, we’re delivering great care. After all, the massive heart attack was averted. The wound was stitched. What …

It’s time to bring back morbidity and mortality conferences

Denitza Blagev, MD

Physician

July 30, 2014

When things go wrong in medicine, as they invariably do, we try to figure out what went wrong, and why. We try to learn if there’s anything we could have done better and what we should do next time.

It used to be, in the days of the giants, that the physician responsible for the patient with the bad outcome presented the case during a morbidity and mortality (M&M) conference. It was …

After serious self-reflection, is there redemption for Dr. Oz?

Harry Oken, MD

Physician

July 30, 2014

Recently, Dr. Oz has come under scrutiny for his information on a number supplements that he alleges help with weight loss. Over the past 2 years, he has presented information about 3 diet supplements: green coffee extract, raspberry ketones and garcinia cambogia. After reviewing the available information, I can not agree that there is compelling scientific information to …

Welcome to the world of metamedicine

Hans Duvefelt, MD

Physician

July 30, 2014

Knowing what to do when faced with a sick patient is relatively straightforward. We learned a lot of it in medical school, picked more up by experience, and usually have the opportunity to look things up quickly on the Internet. Even when faced with a brand new situation, we can usually fall back on our general knowledge of science and medicine.

But in today’s practice of medicine, that’s not enough. Physicians, …

Read more…

Welcome to the world of metamedicine

Raw Medicare data singles out radiation oncology. That’s misleading.

Sea Chen, MD, PhD

Physician

July 30, 2014

This past April, just after the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated 2012 Medicare provider charge data, the New York Times published an article,”Sliver of Medicare Doctors Get Big Share of Payout.”

Almost everyone agrees that transparency in the Medicare payment system will likely lead to more efficient health care delivery with less waste and less fraud. However, thoughtful analysis must be performed so that undue stigmatization …

Seniors pay the price for Medicare’s two-midnight rule

Tanya Feke, MD

Physician

July 29, 2014

The old adage “time is money” holds true, especially in health care. Apparently the medicine time crunch spans two midnights.

In October 2013, Medicare enacted a provision that changed coverage for hospitalized patients. The “two-midnight rule” states that a patient will not be covered as an inpatient unless their hospital stay is expected to cross two midnights. The end result is that many seniors are placed under observation, even if they stay …

We should all be anonymous Samaritans

Farokh Jamalyaria, MD

Physician

July 29, 2014

I almost died today. I was driving from one clinic to another, on a busy highway in the rain, when my car hit a standing body of water and hydroplaned. I lost control of the car, spun counterclockwise across three or more lanes, and slammed into the dividing median. I remember screaming “NO!” internally right before impact. I couldn’t believe what was happening as it happened.Read more…

We should all be anonymous Samaritans

Can doctors really learn from having an illness themselves?

James C. Salwitz, MD

Physician

July 29, 2014

Once upon a time, I was a lifeguard. This was the natural result of swimming fairly well, Red Cross training, and team competition. I saw myself as a handsome, tanned guardian at the ready. OK, I was prone to self-delusion. When I became a doctor I carried over that image of high-perched protector on stilt chair, whistle in hand, rescue float close, ready to dive to the assistance of a …

Rethinking the fix-it model in medicine

Gretchen Schwarze, MD

Physician

July 28, 2014

She seemed awfully angry and at the very least dubious that I couldn’t do more for her father. After 7 hours of surgery trying to salvage her father’s leg, I tried patiently to explain that this new (third) bypass we had just successfully completed was unlikely to provide her dad with a long-term solution. Ultimately, he would lose the leg, if we were lucky he’d have it for another year …

Read more…

Rethinking the fix-it model in medicine

Doctors are helpers, not healers

Rob Lamberts, MD

Physician

July 28, 2014

It’s a seductive idea. We doctors possess knowledge and experience which can not only help people, but can save their lives. We get opportunities to be the right person at the right time to offer the right help that makes all of the difference. It’s one of the greatest things about our profession. It’s also one of its greatest traps.

I’ve heard many doctors refer to themselves as “healers,” as if …

Read more…

Doctors are helpers, not healers

Doctors today: Young, broke and human

Aunna Pourang, MD

Physician

July 28, 2014

“Oh, you’re my doctor? A woman?”

Who do you picture walking through the exam room door at your new doctor’s office? Is it the Norman Rockwell depiction of an older, jolly looking male? After residency, I was alarmed at how many patients commented on my age and gender:

“How old are you, 12?” or, “Oh, you’re my doctor? A woman?”

This got me thinking about …

Read more…

Doctors today: Young, broke and human