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.
During a recent lunch with my daughter, a senior at the University of Maryland, she shared her frustration with a question she often receives: “So, what are your plans for next year?” She commented that while her life experiences through present day have been memorable, each stage has been predictable. Now, for the first time, she has more questions than answers. This ambivalence — this fear of what’s ahead — …
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The palliative care discussion starts in the emergency department
The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food.
He lived alone, hated his job, saw few people, had no friends — so he told me at every visit. His visits …
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How an email list changed a man’s life forever
The horse that came into my life has made me think about many things from a different perspective. I have learned about the horse’s subtle ways of communicating, her extrasensory (compared to our own) perception, and her instincts of flight. I have also become more aware of the energy I bring to my relationship with her. With no learned tricks or horse management skills, I have established a way of …
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Doing a lot more than the doctoring than bargained for
Traditional psychodynamic therapy is often caricatured as endless, with a complacent therapist silently growing cobwebs, listening to a patient who never plans to leave. This isn’t completely unfounded: There are therapeutic advantages to losing track of time, “swimming in the material,” and letting one’s therapeutic focus be broad. The patient’s chief complaint, i.e., the ostensible reason for coming, often gives way to more troubling underlying conflicts and concerns that might never appear in …
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Good psychotherapy eventually ends
The discharge process has now been recognized as one of the most crucial points at which the actions of doctors and hospitals can have a huge impact on immediate health outcomes for our patients. At a time when 30-day readmission rates are still touching almost 20% for Medicare patients, there is an increasingly urgent need to focus on this transition of care point. Discharging a patient is, by its very …
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We must place a higher value on discharge paperwork
One of the hardest things about being a surgeon is the inevitability of complications. It’s true for any doctor; but with surgery, it’s as if they are lit in neon and given a soundtrack. At least to me. Aiming for perfection (as do we all) and beating myself up (more than healthier people) when I miss the mark, I found bad outcomes of nearly any magnitude deeply disturbing. The big …
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What goes through a surgeon’s mind after a complication
As characterized by Dr. Rita Charon in her JAMA article almost 15 years ago, narrative medicine is “the ability to acknowledge, absorb, interpret, and act on the stories and plights of others.” It is the recognition that scientific knowledge alone is not enough — not enough for our patients, for ourselves, and for society. It stresses the importance of not only hearing what our …
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Can narrative medicine inform quality of care?
Our privacy is eroding. Some of this erosion is our own fault — we post to Facebook, Twitter, and other social media with reckless abandon. Some is the nature of modern communication — electronic trails are just as easy to find as paper trails (if not easier). Some of the privacy erosion really doesn’t bother me so much — if Target knows that I buy a lot of Cheerios, I’m …
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An erosion of privacy in health care settings
On March 10, I found myself at the front gate of the Florida State Prison, stethoscope and blood pressure cuff in hand, to examine Robert Henry at the request of his public defender.
Henry is scheduled to be executed Thursday evening by lethal injection. His crime was the murder of two people during a robbery more than 30 years ago.
He’s a 55-year-old African-American man with hypertension, elevated cholesterol, and a history …
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For all those executed, the cause of death is homicide
My third year of medical school cemented the passion for primary care I developed as a volunteer in a clinic for undocumented immigrants in San Francisco. Relationship building, continuity of care, and seeing the impact a primary care physician can have on a patient’s health all ignited my passion more than any angioplasty or neurosurgery ever could. But one question continued to nag me as I filled in the bubbles …
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The choice between family medicine and internal medicine
She looked at me, eyes pleading, telling me without needing to say a word: I am not lying to you. I am not crazy. I am not making this up.
I sighed. “We’ve done the work-up and know this is not your heart. I don’t think there are a lot more tests that can be run.” I studied her expression, trying to discern what she wanted to hear from me.
I’ve come …
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Doctor and patient: Insecurity meets insecurity
Next in a series.
Primary care physicians (PCPs) have multiple frustrations today. The greatest frustration is “time, time, time.” From in-depth interviews with over 20 PCPs, everyone said that time or more correctly lack of time was the greatest frustration of their practice (or was previously if they now were in a practice that limited the patient number to a manageable level). Each knew that they could not give the …
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Frustrations of the primary care physician should be a wakeup call
“I feel bad …” Amy whispered, then paused.
I’m a family medicine resident, and I was doing my gynecology rotation, which involved spending a few days at a Planned Parenthood facility. This was my first day. I’d been assigned a patient to shadow: a young woman named Amy, who was here to have a first-trimester abortion.
I’m a fan of Planned Parenthood’s work providing high quality, affordable contraceptive and gynecological care. In …
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Sharing secrets with my grandmother
Hospitals are environments where emotions can run high. These emotions cross all boundaries and can affect physicians, hospital staff, patients and their families. Dealing with an “angry” patient is a common challenge that physicians face.
The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. In my experience, “angry” patients can be viewed as falling into several …
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4 reasons why patients may become angry
One of the most exciting things about working in patient safety and health care quality is that it’s not solely about advancing science or applying performance improvement methods. It is also about the excitement of being part of a social movement that is changing the culture of medicine — putting patients at the center of everything, sharing errors in the hopes of preventing future ones, and confronting hierarchies that stifle …
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Introducing yourself to patients is a patient safety issue
Do we really have a looming physician shortage? We may, but even more acutely I believe we have a physician utilization problem, most particularly in primary care. After shadowing approximately 50 primary care physicians across the country and engaging physicians in conversation during 150 or so presentations on improving the delivery model of care, my observation is that 70-80% of the PCPs work output is direct waste: computer order entry, prescription processing, composing the billing …
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We have a physician utilization problem
A large number of pediatric practices these days use after-hours call centers for parents who have questions about a sick child. I’ve been looking around to find some data about how common this is, but my sense is that the majority of pediatricians use them. There is no question these call centers make live easier for the doctor; having somebody screen the calls, answer easy questions, and only call you …
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Do call centers send too many children to the emergency department?
If you are among the thousands of doctors who make their living as intensive care physicians, there is no normal work day with predefined hours or routine. Interruptions are the norm. Your day starts early in the morning, meeting with the ICU nursing staff and respiratory therapists long before morning rounds. Difficult clinical issues are reviewed as you and your team apply critical thinking on the challenging problems of the …
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An ICU physician’s work is never done
Over the years I have strived to develop my bedside manner. On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection. This commentary may convince some readers that I have the answers, but I do not. Sometimes I do very well, but sometimes my skills fall short. I do try to connect with patients and families, and give them confidence, …
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Developing bedside manner comes from understanding who the patient is
I was recently sent a link to this article entitled “Smile! You’ve Got Cancer” written by Barbara Ehrenreich. I encourage everyone to read it. The article lives up to its striking title and more. And I couldn’t help but respond with my perspective. So that you know where I’m coming from, my most personal encounter with cancer is that my grandmother died from cancer. I also treat people with acute …
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The dreadful cost of denying how you really feel
