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 part of a family medicine rotation, we recently discussed the importance of bringing spirituality into the hospital. The conversation was led by Stanford Hospital’s chaplain, Dr. Bruce Feldstein, an ER doctor in a former life. We began with definitions of spirituality, discussed personal experiences surrounding a spiritual moment, and concluded with how to take a “spiritual history,” a series of questions that explore patients’ spiritual or religious beliefs.
We even …
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Is there a place for religion in the exam room?
It was probably the most awkward question I had been asked before, and I did not have an answer.
He was a middle-aged gentleman, neatly dressed — very simple and unassuming. He blended like a lifeless statue in the waiting area. What sparked my notice of him was his accompanying robust file, crammed with familiar pink discharge slips from the ED. He was clearly what we call a “frequent flyer,” but …
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How much will it cost to die?
I have been a way from blogging for a bit and tried to clear my head a bit with a vacation skiing. I left the computer at home, disconnected (as best I could), and had the luxury of feeling the knees working less fluidly than they had before, but still had some fun for a brief 3 day stint. It was nice to notice that there’s a whole world out …
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Physician time means nothing to programmers and policy makers
One of my goals is to help doctors be happier in their day jobs. This does not mean you put on a fake smile, and grin and bear it through your day. What it does mean is you consciously set your boundaries for what you need. Stick with them and let others know. Because the truth is, you teach people how to treat you.
This is not only reserved for your …
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Stop being a doormat for your patients
An innovative study in JAMA Internal Medicine on surrogate decision making has profound implications for how we take care of older hospitalized patients. The study, by Lexy Torke and colleagues at Indiana University, systematically described the involvement of surrogates in decision making for hospitalized patients.
Surrogate decision making refers to the phenomenon in which someone other than the patient is making or helping to make the key medical decisions. In older …
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Surrogate decision making: Families are much more than visitors
There was a brief scare in our neighborhood this past weekend. Our phone rang. Our friend, who lives nearby, asked if her 12-year-old son was at our house. He wasn’t.
The child had been gone for about 15 minutes. Their family had just returned from a shopping trip with a family friend, and that family friend had forgotten one of his items at our neighbors’ house. The child said, “I’ll run …
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A physician approach to a missing child
I wrote a column recently about the role computers play in the doctor patient relationship, and my concern that screens shift physicians’ focus away from their patients. This column is part of a large conversation going on nationally and beyond about what I’d call “distracted doctoring.”
A Wall Street Journal opinion piece by my colleague Dr. Victoria McEvoy addresses the issue of whether all the digital box checking now required of doctors as part …
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Patients should silence their phones in the exam room
It has been freezing cold in much of the country for the last two months, but things have been heating up in the controversy over the implementation of ICD-10. First, a quick primer for those of you who have not been following this.
The “ICD” in ICD-10 stands for International Classification of Diseases. The “10” refers to the version of the taxonomy, which is maintained and revised periodically by the World Health …
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The real reason doctors hate ICD-10
I’ve been working with the latest electronic medical record (EMR) for almost a year now. You know the one. There are many positive changes, to be sure. It has helped me more than a few times with calculating doses for kids’ medications. I can now easily check in on my patients’ progress when they are admitted to the hospital. And, of course, the notes are far more legible.
But what do …
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We are in the age of copy and paste medicine
As a medical scribe working with a large, well-known scribe company, unnamed to protect my job, it makes me proud reading all the articles published about how much having a scribe benefits a physician, especially in the emergency department. I enjoy my job immensely and I am grateful for the opportunity to learn and engage in patient care. However, as a …
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The disturbing confessions of a medical scribe
How does a working mom and physician keep practicing medicine when her husband’s career brings her halfway around the globe? For me, it was an adventure. While it can be challenging, I encourage other physicians to experience the world with their families while still practicing medicine.
As a 14 year family practitioner from Ohio, I suddenly found myself in Qatar with two young children because of my husband’s job. Qatar is …
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Tips for expats working in health care
A few years ago when I went skydiving for the first time, I learned about the backup parachute. This is a second chute, just in case the first one failed. While no one wants to think about the primary parachute failing, it was comforting to know we were prepared … just in case. That’s kind of how I see end of life care planning, while we don’t want to think …
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4 things everyone should know about end of life planning
The tests came fast and furious. The diagnosis didn’t.
One doctor was certain it was psychosomatic. My twin younger brothers had been born a few months earlier, and I, seeking attention, was refusing to walk. My mother kept looking.
Another doctor couldn’t figure it out but gave a piece of advice. “You have other children, right? Be grateful. Take this one home, keep him comfortable, and when he is gone take comfort …
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A doctor’s powerful personal story about vaccines
I still remember when my phone rang with an eerie sound, early in December 2013. The oncologist I had seen a couple of days earlier was on the other end asking me to return to the hospital ASAP because my bone marrow biopsy results was consistent with acute leukemia and I was at risk of bleeding.
That was the first time I knew about my diagnosis while he merely broke the …
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Sympathy is the missing art in medicine
His nurse paged me at 9pm: Mr. L wants to leave against medical advice (AMA). As the covering doctor, I dreaded the impending standoff even more than usual.
I emerged from the elevator minutes later to find that the gaunt octogenarian had advanced from his isolation room, passed the nurse’s station and the unit doors, and arrived at the elevator bay to greet me. Security guards hovered at a cautious distance …
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The request to leave AMA is a signal for an honest conversation
On our recent road trip I was amazed by the number of billboards (from several health care systems and hospitals) advertising texting for emergency room (ER) wait times. My first thought was, “if you can text, how emergent is it?” This was quickly followed by the concern that the option/advertising of texting about wait times might make the ER seem, well, less for acute care and more for convenient care.
Should I be concerned?
There …
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Does texting ER wait times affect patient care?
It happens, now and then; not as often as one would wish, but occasionally. In other professions, a perfect day is when you make that super sale, finish a protracted project, win an important race or craft a special, remarkable piece of art. An oncology perfect day can be without bells, whistles, pats on the back, nor cash register’s whirr. Some of the best days lack pizzazz, vibrant emotion or …
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A perfect day in the cancer clinic
