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.

Cell phones and brain cancer: Is cellular technology innocuous?

David L. Katz, MD

Physician

February 4, 2014

Increasingly, the stuff we buy is electronic. In fact, not only that, but increasingly the stuff we buy with is electronic, too. We are using gizmos to shop for gadgets, or possibly gadgets to shop for gizmos.

In any event, we are ever more frequently in the company of the energy fields our electronic devices, and in particular our smart phones, generate. This deserves more attention than most of us accord …

The Goliath of board certification: Does David stand a chance?

Wes Fisher, MD

Physician

February 4, 2014

How should patients determine the quality of their doctor?

This is an interesting question that has now reached mainstream media status as evidenced by a Wall Street Journal article by Laura Landro, a very accomplished veteran health care reporter.

With the best and brightest going in to medicine, the requirement for more rigorous training than anywhere else in the world by (some might say) “exceptional, world class” medical educators and longstanding ongoing mandated continuing medical education …

They’ll soon be talking about my generation, but I’m not there yet

Greg Smith, MD

Physician

February 4, 2014

I had had a long day yesterday, starting with a trip up the interstate to Columbia to meet with other medical chiefs from around the state of South Carolina to discuss the issues that affect the practice of psychiatry in the mental health system today.

We had struggled with the electronic medical record, Medicare paybacks, e-prescribing, CPT coding, content of notes, billing time, and motivating our medical staffs to accept the …

Are white coats obsolete? Not yet, if you look at the evidence

Skeptical Scalpel, MD

Physician

February 4, 2014

The Society for Healthcare Epidemiology of America (SHEA) guidelines for health care workers attire were recently published.

Science Daily led with the headline “New Infection Control Recommendations Could Make White Coats Obsolete,” which is rather misleading since the guidelines say no such thing.

I won’t reproduce the entire 15-page document here since the full text is available online. But here are some highlights along with my comments.

The guidelines say that facilities may consider adopting a …

4 reasons why hospitals can be very dangerous places to be

Robert Pearl, MD

Physician

February 3, 2014

Hospitals are commonly thought of as the safest place to be for sick people.

Patients have around-the-clock access to skilled care teams. Their vital signs are continuously monitored. A physician stops by every morning to check on them.

While it all sounds safe, a hospital can be a very dangerous place to be. Here are four frightening risks hospitals pose, along with their causes and some easy-to-implement solutions that could save hundreds …

Are you a victim of patient profiling?

Pamela Wible, MD

Physician

February 3, 2014

patient profiling

Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the …

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Are you a victim of patient profiling?

What is a high risk patient?

Fred N. Pelzman, MD

Physician

February 2, 2014

“What’s a high-risk patient?” asked our newly hired care coordinator.

Interesting question, and, as you would expect, one without an easy answer.

One of our patient-centered medical home certifying agencies was performing an audit for recertification, and requested information on our high-risk patient registry, including how patients were identified and assigned to the registry.

When you ask doctors or any other providers, we all know one when we see …

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What is a high risk patient?

Using palliative care to save health care dollars

James Simmons, MD

Physician

February 2, 2014

“No Margin No Mission” was a common saying when I studied about non-profits in business school. No matter how good your intentions are, whether it be creating new systems to get people access to care or opening a new animal rescue, if it couldn’t pay for itself it wasn’t going to happen.

So it should come as little surprise that an up and coming darling of CEOs of health systems is …

Death of the physician progress note

David Mokotoff, MD

Physician

February 2, 2014

I am not sure of the date or time of death. However, I am reasonably certain of the cause. Death was by electronic data and formatting. The victim was the time-honored physician’s progress note. To be sure, these notes, even the now “ancient” written ones, were far from perfect. And they were often illegible. Shortcuts such as “as above” or AVSS (all vital signs stable) littered the pages of the …

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Death of the physician progress note

Cloning: Great for Dolly the sheep, not so good for EHRs

Betsy Nicoletti, MS

Physician

February 2, 2014

Certain medical stories are irresistible to the popular press: ICD-10 external cause codes that are ridiculous (W61.43XD, pecked by a turkey, subsequent encounter) or medical practices using their electronic health records in a way that increases their revenue.

A recent headline was eye-catching, as headlines are meant to be, “Report finds more flaws in digitizing patient files.” The New York Times reported that the Office of Inspector …

When patients write to doctors, and what it means

Miranda Fielding, MD

Physician

January 31, 2014

Where I come from, when most people refer to the Good Book, they are referring to the Bible. This is not true for my father, because to him, the Good Books are something else entirely.

He describes a scene early in his career as a plastic surgeon, when he had taken his doting mother to see his new office. Coincidentally, a lovely thank you note had just arrived from one of …

Deciding what to do with my son’s body

Jennifer Gunter, MD

Physician

January 31, 2014

My eldest son, the first-born of a set of extremely premature triplets, died a few minutes after he was born. Defying the odds I remained pregnant with my other two boys for 24 days.

After holding him for some time in the delivery room, the same room where I myself had delivered hundred of babies and passed them on to families beaming with tears of joy, I was asked about his …

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Deciding what to do with my son’s body

Compassion is what connects us all

James C. Salwitz, MD

Physician

January 30, 2014

A large woman, she has soiled herself. With practiced motion, Bob rolls his wife onto her side. Yellow diarrhea has leaked out of the diaper, soaking the nightgown and sheets, finding its way into each fold, crease, and flaw. The room fills with odor, but the winter house remains dark; outside wind blows down the empty street. It is 2:00am and Bob is cleaning shit. Only 90 minutes asleep, he …

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Compassion is what connects us all

When patients are late: Should doctors charge extra?

Michael Kirsch, MD

Physician

January 29, 2014

While patients and physicians operate under oral agreements, business agreements are generally established in writing. In these documents, terms are outlined including contingencies in the event that foreseeable obstacles or disputes develop. Oftentimes, the two parties do not agree that a contractual term has been violated. This is when the fun begins. With a little luck, the legal profession enters the arena and can speedily resolve the disagreement in a …

The callousness of the two surgeons is what remains

Jordan Grumet, MD

Physician

January 29, 2014

When I was seventeen, I developed a medical problem due to no fault of my own. It was painful, it was embarrassing, and when it became uncomfortable enough to disrupt my life, I went to see a well known surgeon downtown.

The specialist, tucked away in the hallow halls of academia, stared down at me past a pair of spectacles perched at the end of his ever-protruding nose. When he examined …

Empathy: How an idea forever changed my approach to patients

Rob Lamberts, MD

Physician

January 29, 2014

As an incurable compulsive introspect, I tend to brood, ponder, contemplate, and (of course) muse on “big ideas,” such as:

What makes people choose things which cause themselves harm?
Are some people better people than others, or are they just more skilled at hiding their problems?
Is pain really a bad thing, or is our aversion to it a sign of human weakness?
Does God ever wear a hat?
Do dogs watch Oprah?
Why did I …
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Empathy: How an idea forever changed my approach to patients

The toxicity of Medicaid

Edwin Leap, MD

Physician

January 28, 2014

I have noticed over the years that physicians who write about medicine, particularly for the general public, are limited to very specific discussions. For instance, it is perfectly acceptable to write about the plight of the poor and uninsured. It is always reasonable to advocate for a single payer system. It is perfectly acceptable to discuss how one downsized in order to make less and “give back” more. And it …

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The toxicity of Medicaid

People with overt disabilities: Are we more forgiving of their behavior?

Maria Yang, MD

Physician

January 27, 2014

Everyone noticed him before we boarded the plane. He asked the airline representative at least three times to confirm that he had a seat. He looked like an adult, but the tone of his voice was that of a child.

“Yes, you have a seat, Michael. It’s 7B.”

Grey cargo pants covered his short legs. The sleeves of his striped polo shirt collected below his elbows, making his arms look even shorter …

Money is only a microcosm of physician burnout

Sid Schwab, MD

Physician

January 27, 2014

The medical director of my clinic once gave me a book on burnout. I never read it. Didn’t have the time or energy.

Because a young reader considering a career in surgery referred to stories he’s heard of depressed and disappointed surgeons and asked for my thoughts, I’ll try to address it. Parenthetically, I’ve heard from more than a few readers that my blog and/or book has inspired them to consider …