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.

Mainstream media highlights the MOC debate: What did they get wrong?

Wes Fisher, MD

Physician

July 28, 2014

Recently, the American Board of Medical Specialties’ (ABMS) Maintenance of Certification (MOC) program debate reached a larger mainstream media audience when the Wall Street Journal published their article by Melissa Beck entitled “Skill Reviews Upset Doctors.”

While it is certainly nice to see an article reaching the main stream media concerning doctors’ concerns with the MOC program, the issue with the MOC debate is not that doctors are upset. The real issue is …

Blue collar concierge medicine is for everyone

Stephen C. Schimpff, MD

Physician

July 28, 2014

Part of a series.

Is concierge medicine for everyone or is it just for the rich, the 1%? Most people assume it is for the elite and cannot be afforded by the common man, the masses. That is unfortunate because in many cases it can be quite affordable. Here are three examples.

AtlasMD in Kansas City and others like it think of themselves as “blue collar” concierge practices. According to …

Hospice patients can use functional improvement too

Alex Smith, MD

Physician

July 27, 2014

One of the skilled nursing facilities I work with has a hospice unit. We occasionally have patients on the hospice unit who might benefit from physical therapy. The physical therapists that see patients in the skilled nursing facility say they will talk with the patient about their goals, and if their goals are to maintain their current level of functioning, they will work with the patient. If the goals are …

Replacing doctors with technology: Don’t knock on my door yet.

Jordan Grumet, MD

Physician

July 27, 2014

The house was getting cold. My wife and kids snuggled in their blankets as I crept out of bed and checked the thermostat. The subzero winter air howled as a blustery morning took shape outside our windows. I looked at the digital display with disbelief and manually tapped the screen with my finger, hoping that the jarring motion would loosen the exact faulty screw leading to our frigid state. …

Why this is an exciting time to work in psychiatry

Helen M. Farrell, MD

Physician

July 27, 2014

Today, I celebrated mental health care. And this was after a morning of battling with insurance companies, patching together community care plans, trying to create an inpatient bed for a suicidal patient where none exist, and arguing with agencies for better patient support.

I work on a busy inpatient psychiatric unit that provides a daily reminder of the beauty, heartache, and pain that define living with mental illness. The diverse stories of …

Better care is mindfully listening to patients

Davis Liu, MD

Physician

July 27, 2014

“Dr. Liu, I don’t think he has diverticulitis.”

So said the second-year medical student. She had just completed her first year of anatomy, biochemistry, pathology, and introduction to doctoring at the local medical school. One of the sharpest medical students I’ve proctored.

Like many summers, I’ve been fortunate to spend time with the next generation of doctors. These future doctors were brimmed with enthusiasm and energy. Instead of taking time off to …

Doctors still work while on vacation

Afshine Ash Emrani, MD

Physician

July 26, 2014

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Last week, I took a 6-day vacation. Two days before and two days after, I put in a total of 32 unpaid hours of work which was cut short by a call from my daughter asking me why I am working during my time off. While away with my family, I ran into people of different walks of life and noted …

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Doctors still work while on vacation

The secret lives of doctors

Starla Fitch, MD

Physician

July 25, 2014

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Recently, when my parents came for a visit, our conversations led me to realize something important: I have been a doctor for more than 20 years, and yet my parents have no idea what my daily life is like. It then occurred to me that if they have no idea, then surely my patients have no idea either.

So, if you’re a …

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The secret lives of doctors

Dear patient: Your 5-minute appointment is awaiting you.

Susan Hecker, MD

Physician

July 25, 2014

Dear patient:

I am writing to inform you of some recent changes to my practice. These changes have been implemented to improve the quality of your care.

I will no longer be able to see you for a 20-minute or 40-minute appointment. These will instead be shortened to a 10-minute or 20 minute-appointment based on your stated needs. For example, if you just …

Sometimes there is no substitute for a face to face visit with a doctor

Michael Kirsch, MD

Physician

July 24, 2014

A 32-year-old woman recently came to see me for an opinion on stomach pain. Why would I refuse to see her again? Abdominal pain is an everyday occurrence for a gastroenterologist. She was accompanied by her mother. I had never met this woman previously.

She had suffered abdominal pains for as long as she could remember. She recalled frequent visits with the school nurse when she was a young girl.

She has abdominal distress …

3 ways to master the art of teaming in medicine

Della M. Lin, MD

Physician

July 24, 2014

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

As a physician anesthesiologist in a community hospital setting for more than 25 years, the quest for mastery keeps my practice from getting stale or boring. I relish the technological innovations in the past decade: the video laryngoscopes and ultrasound-guided nerve blocks that allow my …

Moving annual visits into the 21st century

Yul Ejnes, MD

Physician

July 24, 2014

A guest column by the American College of Physicians, exclusive to KevinMD.com.

The recent uproar over the American College of Physicians’ recommendation against routine pelvic examinations made me think about the status of the annual visit (a.k.a. yearly physical, annual exam) on average risk, asymptomatic adults that most internal medicine specialists perform. Some would say that …

Balancing activity and restfulness in retirement

John Schumann, MD

Physician

July 23, 2014

As a doctor, I’m trained to do many things: I listen. I ask. I examine, order, and test. And then I assess. I certainly try to treat. All too often, this includes prescribing.

What frequently gets obscured in this paradigm is that, on many occasions, the listening part is enough.

Take Gene, for instance. He’s a retired biochemist. When I met him for the first time as a patient, I took a …

Excessive turnover in inpatient care can wreak havoc

Val Jones, MD

Physician

July 23, 2014

If you (or a loved one) have been admitted to a hospital recently, you were probably surprised by the number of times you were asked the same questions. At first you might assume that the staff are being diligent in double-checking your information, but after the fifth healthcare provider asks you to explain why you’re there, you start to feel as if interacting with “the system” is like talking to …

Practicing convenience medicine in the ER

Michael Perraut, MD

Physician

July 23, 2014

It’s easy to get frustrated in the ER. First, you’re at work. Second, most of your patients don’t want to be there. Third, many (if not most) of your patients don’t need to be there. Finally, by the time you see them, most of your patients are tired of being there.

It’s easy to become jaded when you trudge through this never-ending mire of patient after patient, and indeed ER docs …

The VA scandal exposes the folly of metrics

Jennifer Gunter, MD

Physician

July 23, 2014

The Veteran’s Administration is under fire for covering up deaths. Men and women who were eligible for care languished on impossibly long waiting lists and even worse when some died waiting for care their deaths were covered up. This is horrific and everyone wants to know how this tragedy could have happened?

Veteran’s hospitals have long waits in my experience because they are underfunded, many (if not all) patients with complex …

Patient education: Simple solutions are the best solutions

Shirie Leng, MD

Physician

July 22, 2014

In another entry for the communication category, here’s a little play I wrote:

Scene: Pre-op area. Patient arrives for surgery exactly at the scheduled start time, that is, 90-minutes late.

Anesthesiologist (me): Good morning Mrs. Jones. I’m Dr. so-and-so. How are you this morning?

Patient: Oh, doctor, I have the most terrible headache. They told me my surgery was at 11 so here I am at 11, and now they tell me I’m late.

Me: …

8 ways to better support someone dealing with cancer

Elana Miller, MD

Physician

July 22, 2014

As many of you picked up from the tone of my last article, I am feeling much, much better. As more time has passed from the disasters of six weeks ago when I lost my relationship and home (making me feel more physically ill than I had felt this entire time), my body has finally had a chance to recover. I also have benefitted from a …

Do surgical checklists work? A closer look at the data.

Skeptical Scalpel, MD

Physician

July 22, 2014

The other day Atul Gawande tweeted the following:

Some still oppose WHO Safe Surgery Checklist because no RCT was done. Well, new RCT finds it cut complications 42% http://t.co/qWacE54NIW

— Atul Gawande (@Atul_Gawande) June 18, 2014

I am not against checklists. When I was a surgical chairman, I implemented and used one in both the operating room and the ICU. They do not add costs and …

Doctors are not the only ones who can keep a painful secret

James C. Salwitz, MD

Physician

July 22, 2014

I have written many columns urging doctors to be honest with their patients, especially about difficult news. Too often patients are lead on false hope therapy rides, rather than empowered with honest information so that they can cope with their disease and future. Doctors are not the only ones who can keep a painful secret.

I admitted Sarah to the hospital late on Saturday night. For over two years, she had …