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.
A Catholic nun, who was the administrator of a small hospital once summed up for me the role business plays in patient care: “No money, no mission.”
In order for a practice to be successful, it must be run with healthy business principles in place. But the truth is that few physicians have any training in or knowledge about the business aspects of running a practice. A satisfying and successful career …
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Take the time to understand the business of medicine
Should joint replacement manufactures provide a warranty for their products? It seems pretty logical since most consumer products come with some sort of warranty these days. Basic warranties are almost universally provided and the market for extended warranties is increasingly popular.
Take for instance my recent upgrade to the new iPhone 5s. At the time of purchase, the AT&T store suggested their extended …
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Does your joint replacement have a warranty?
In 2007, I wrote a post called “Why Shrinks Don’t Take Insurance.” The post is a bit dated, the CPT codes have changed since then, and the reasons to not take insurance have increased. Many other doctors don’t take insurance now, though psychiatry remains the number one specialty where doctors don’t participate in health insurance plans. This is an updated version of that same post.
Many psychiatrists in private practice don’t …
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Why psychiatrists don’t take insurance
This is a speech I gave recently at our local hospital when I was given a “physician of the year” award for my work managing medical detox in our community for 20 years.
At first, when I was told about this honor, I was really unsure why my clinical work in medical detox would warrant “physician of the year.”
I am not as skilled a diagnostician as many of you. I’m not …
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Managing medical detox: A speech about compost
Once in a while someone asks me if it is hard to be a mother and a surgeon. Certainly, any surgeon-parent can appreciate that juggling a household full of schedules, classes, meals, bedtimes, and activities with a practice full of office visits, pre-operative clearances, post-operative check-ups, and surgeries has its challenges. And to be sure, before I became a mother I had no idea how this would impact my work.
What …
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Being a mother has made me a better physician
Case 1: You have a 94-year-old woman with multiple medical problems in hospice who develops a fever (subjectively hot to the touch), shortness of breath, and a cough producing yellow sputum. Her daughter asks if she can be treated with antibiotics “to make her feel better.” The patient is not well enough to make decisions, but in earlier conversations had stated a goal of remaining comfortable at home, while also …
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When should you use antibiotics in hospice care?
Elton John had it right: “It’s sad, so sad. Why can’t we talk it over. Oh, it seems to me that sorry seems to be the hardest word.” Mistakes are all to common in medicine, but can we say the “hardest word” when we’re involved?
Example 1: There’s a diagnosis of recurrent lymphoma in the ICU. The oncologist gives a phone order for cytoxan, prednisone, and vincristine. The recorder, working a double …
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After a medical mistake: Honesty is the best policy
For many of my out-of-school hours as a child, no adult had any idea what I was doing.
This has everything to do with who I am today, in some remarkably good ways.
As a parent, I can’t help but wince at the lack of supervision I received, especially given what my friends and I did. We spent hours in really tall fir trees, pretending they were houses. I lived on Long …
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Sometimes being a good parent means doing less, not more
I trained in internal medicine and cardiology at the tail end of the era of lifetime board certification by the American Board of Internal Medicine. In fact, my timing was perfect — I was “boarded” in medicine in 1987, and in cardiovascular disease in 1989, which (I am pretty sure) were, respectively, the last years that the ABIM offered certificates without an expiration date in those disciplines.
Late last year, I …
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Board certification: Valid indefinitely is no longer rings true
Before any patient can go to the operating room, they need medical clearance from their primary physician. I look at this as a good thing.
Occasionally, a routine chest x-ray reveals lung cancer. Or, blood work shows abnormal values that point toward leukemia.
The bottom line for me is that I never argue when a primary care physician or specialist, such as a cardiologist, says the patient is too sick to have …
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How to proceed if patients push back
Brain death is death. This is one of the definitions of death. Even in Texas.
Because brain death is death, a do not resuscitate (DNR) order or invalidating a DNR are both meaningless, because you don’t do procedures on dead bodies. This is why taking someone off a ventilator who is brain dead is not homicide, assisted suicide, or even following a DNR, it is simply the cessation of forcing air into a …
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Who is keeping Marlise Munoz on life support against her wishes?
One year ago, my book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, was published. My goal in this last year has been to travel around the country and talk about the book and its message of advocating to improve your health. I planned a 48-city itinerary where I’d crisscross the U.S. from Massachusetts to California and back. I’d speak at bookstores, libraries, nursing homes, universities, and community …
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Learning from patients on a speaking tour
As a scientist with a brain naturally inclined to skepticism and analysis, I suppose my spiritualism may be best captured by: Keep the faith, but get the data. While some of my fellow skeptalytics, if I may coin such a term to catalog us, may be inclined to renounce that first clause altogether, thinking there is no need for faith, I am obliged to disagree.
We are all a mass of electrons …
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Keep the faith, but get the data
Numerous strategies by antiabortion groups to curb women’s constitutional right to abortion are frequently reported in the news, and come as no surprise. However, a recent development illustrates novel circumstances in which people are using legal maneuvers to conspire to restrict medical decisions by patients and their families even when the right to abortion is not at issue.
On January 8, 2014, a front-page story in the New York Times Read more…
The wishes of the patient and family versus fetal rights
It was the first time I had every flunked a test. My fragile ego was shattered. It was my first year at University of California, San Diego School of Medicine, one of the most difficult to enter. I failed my pharmacology test, not because I was stupid, not because it was difficult, but because I was clinically depressed.
A dark cloud covered my head and I could not see. Much of my …
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We should not succumb to spiritual darkness
Pilots never expect to hit a flock of birds on take off, or flame out an engine in mid-flight. No one plans to get disoriented in the air or have an equipment malfunction miles from the nearest airfield. And, it certainly isn’t routine to fly into hostile airspace with a heightened awareness of the known ground threats, the position of each member of your formation, and the safety of the …
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Time for surgeons to earn their wings
As a physician, not a day goes by without a new acronym I need to look up, a new policy I need to follow, another box I need to click or another criteria I need to meet — and this is just to keep up. While the health care picture and its various unknowns loom ever larger in the news, and health information emails overstuff my inbox, it is worth …
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Finding the right EMR vendor can help navigate mandates
I recently struggled with an interesting patient care issue related to my illness. I had to cancel several weeks of clinical sessions, which I realize is a hardship for my patients.
A few weeks ago, when seeing a long-time patient of mine — a warm woman with several chronic conditions — I …
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Physician self-disclosure about illness
Not long ago a woman in my community, who was a patient of an esteemed local oncologist, died. Let us call her “Beverly” and let us say she died of “breast cancer.” I am familiar with the details of the case because one of my partners saw her in consult, but HIPAA and common courtesy forbid me to be any more transparent. Beverly was very popular in our town and …
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Doctors often don’t have the time to address social slander
“Welcome back. How was your trip? Or exile … you were away for a long time.”
“Almost a year,” my nine o’clock patient answered. A woman just over forty, she looked tan and physically strong. Her short hair was peppered with gray, different from the last time I saw her. She had gone abroad on assignment for a magazine and a film production company, and before she left, she had joked …
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The greatest miracle a physician is privileged to be part of
