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.
As the number of people undergoing plastic surgery rises, the number of people who get bad results also increases. Numerous cases of botched plastic surgeries persist to linger the news which continue to put plastic surgery in a bad light. As a doctor specializing in cosmetic and reconstructive surgery myself, I am saddened by the fact that such cases carry on.
With more and more people choosing to undergo plastic surgery, …
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4 questions to ask your plastic surgeon before surgery
“So like a concierge doctor?”
That was the most common response upon explaining my future direct primary care practice while in residency. That perception and label really perturbed me. My vision was to care for a diverse group of people. I spent the majority of my residency clinic hours in an urban safety net clinic, but certainly didn’t want to swing the pendulum to the opposite 1%.
To avoid that stigma, I …
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Building a concierge safety net practice
When my sister and I were little, we had an almost daily ritual with my father: drawing stories.
He would sit us on his lap and get out his clipboard, a piece of paper and his black click pen. He’d divide the paper into four parts, and draw as he told a story. Sometimes he drew old favorites and we knew what …
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I so wish I could say: Daddy, thank you so much for the stories.
Her wary eyes, magnified from her thick-lensed spectacles, watched my every move as I pulled room 21’s curtain to the side and entered her room. In her early eighties, it was apparent to me that my entrance into her life was more important than the abdominal pain that brought her to our emergency department. In the corner sat a slight man with wispy gray hair poking out from the border …
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How bingo kept a patient going
One typically thinks of advances in medical science and technology as having unalloyed benefits. The ability to cure illness, the mitigation of pain and the possibility of making diagnoses that are more accurate are some of the uncontroversial results of medical progress. Yet as a new study of vegetative states demonstrates, such advances can raise ethical quandaries for physicians and the families of patients diagnosed as vegetative.
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The advance directive impact of PET scans in vegetative states
I chose to leave clinical medicine in 1996 after just three years as a general internist. At the time, I was certain that it was the right decision and necessary for my overall health, but could not have articulated all the reasons why I needed to leave. I loved both the intellectual challenge and the art of medicine. I thoroughly enjoyed my connections with patients. I regarded my professional life …
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Physician well-being is essential to optimal patient care
Prestige in medicine often follows research. Physician-scientists who do basic science research have often been considered among the giants of medicine. As the field of medicine advanced, the gap between what we knew from basic science and how we practiced grew. This created a need for more translational researchers: physicians who could bring what they knew from the laboratory bench to the bedside through large clinical trials.
Now, the next great gap …
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New skill sets are raising the prestige of primary care
As I travel the country providing coverage for inpatient rehab units, I have been struck by the generally high quality of nursing care. Excellent nurses are the glue that holds a hospital unit together. They sound the first alarm when a patient’s health is at risk, they double-check orders and keep an eye out for medical errors. Nurses spend more time with patients than any other hospital staff, and they are therefore …
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Optimize nurse partnerships to improve patient care
When you tell people that your dad died of lung cancer, often the follow up question is, “Did he smoke?”
In my case, the answer is, sort of.
I have fuzzy memories of my dad in our basement, smoking his pipe in his black leather chair and watching the original Doctor Who (I’m still processing the cultural implications of that last detail). Rumor has it he smoked cigars in the ’60s, but …
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You can never make sense of cancer
I’ve worked at a few VA medical centers, including four years at the Phoenix VA. I’d like to report something missed in the media storm. Before spilling secrets, though, I’ll dispense with the non-secrets. Everyone who has entered a VA hospital knows:
1. The system is overwhelmed. While we might have planned for the increasing needs of aging Vietnam-era vets, I doubt anyone predicted two long wars or the number of …
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Secrets of the VA that aren’t being reported
Agnes was out shopping at her local corner store. At age 82 her body was beginning to show typical signs of aging. She had survived breast cancer surgery, a hip replacement, and cataract surgery. Her doctors told her she had osteoporosis and low vitamin D. She took medications for her hypertension, cholesterol, and osteoporosis. Her spine had begun to curve and her gait was a few steps slower.
Yet, with her …
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CPR without informed consent in the elderly
Next in a series.
The art of healing is very important in medicine. There is a difference between being a modern day physician and being a healer. All societies have healers — wise men and women, shamans, medicine men and people of other names. The “old time practitioner” was almost always a healer but many physicians today are not. It is an issue of interest, training, time and prioritization. Most …
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Primary care and the art of healing
The very basic definition of a hospital is a place of healing and recovery. Health care is in a tumultuous state of flux at the moment, with the universal drive for quality improvement and the need to reign in costs. These issues, along with the desire to enhance our patients’ satisfaction and overall health care experience, were barely even talked about a decade ago. Now, they are all the buzz …
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5 ways to improve the healing environment of hospitals
It was 1:35 p.m. when we realized that Tom was not just late for his chemotherapy treatment; he probably would not show up at all. A call from one of our staff confirmed, he had “troubles getting a ride” and wanted to move the vital therapy to another day. This was the third time in a month he had missed an appointment, thus wasting a treatment slot, nursing time and …
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Giving challenging patients the best care
In his book The Art of Loving, Eric Fromm wrote that “the deepest need of man is to overcome his separateness, to leave the prison of his aloneness.” In the Bible, after forming Adam from the dust of the ground and breathing into his nostrils the breath of life, God declares that something is missing: “It is not good for the man to be alone.”
A number of scientific studies verify that a …
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Health and well-being are holistic concepts
“Here you go, doctor.”
My patient with incredibly well-controlled type 2 diabetes hands me his fingerstick log at his regularly scheduled office visit. Despite his multiple medical problems (congestive heart failure, coronary artery disease, chronic renal insufficiency, and gout, among others) his sugars have been incredibly well-controlled over the past several years.
Page after page of scrawled numbers, tiny smears of his blood on the pages, his fingersticks range from 90 to …
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When is too much data a bad thing?
