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.
Do you have a medical, pharmacy or nursing license in several different states? Do you have a license in more than one health profession? Have you been notified that an investigation has been opened against you? Are you thinking about resigning your professional license or voluntarily relinquishing such a license? Then you must be aware of the following.
First, you should never voluntarily relinquish or resign your license after you know …
Read more…
Don’t resign your professional license in the midst of an investigation
Just as elite athletes are born with amazing skill, elite surgeons and doctors in other procedure-based specialties are also equipped with innate abilities that others do not possess. Surgical skill is often difficult to quantify. Certainly, outcomes data can be obtained and reputations are formed over time. Years of training allow the truly gifted surgeons to develop their skills and perfect their craft.
However, all surgeons are not created equal. During …
Read more…
Will video replays lead to safer surgeons?
I recently participated in a small conference devoted to “physician alignment in the academic medical center.” The meeting was sponsored by a health care consulting firm, and drew about a dozen participants from around the country. The title refers to ways in which academic centers figure out how to work with their traditionally autonomous if not completely independent physicians to advance the institutional mission. An informal format allowed us to …
Read more…
Academic medical centers: Should we continue to feed the beast?
Recently, a family in my practice decided to move out of state, back to where they had lived before. When we said goodbye, the mother said that she was sad to change pediatricians. The pediatrician they would be returning to, she said, “only takes care of strictly medical things.”
Clearly, she meant that I take care of more than the strictly medical things. I was flattered, especially since this was something …
Read more…
Going the extra mile for patients: How friendly is too friendly?
“You are the worst doctor I have ever met.”
This was the second patient in a row to explode at me when I explained that further back surgery for his back pain had a low chance of success. I spent a couple of minutes explaining the many successes of our hospital’s pain program. Then he exploded again: “You mean I drove five hours just to hear you tell me that you …
Read more…
Tips for treating patients suffering from chronic pain
Recently, I received a phone call in the late afternoon from someone very close to me. Please note that this someone is also a doctor. “Uh, I need you for a minute. I’m kind of freaking out. Can I talk to you?”
She had just gone to her local optometrist to get a new prescription for glasses. The optometrist looked in her eyes, told her that both of her optic nerves …
Read more…
Communicating urgently without scaring patients
I have been visiting different sites and having staff meetings with different groups of clinicians since I came back to my psychiatric services chief job recently. I have noticed something that is very important to the smooth operation of a mental health center, and most likely any health care facility you might look at.
In order to do the best job possible and help the most people who need us, we …
Read more…
Medicine then and now: The importance of team
I have written a good amount about automation, the good, the bad and the ugly. I have written about doctors and ancillary providers and physician extenders, also good, bad and ugly. A recent comment on Karen Sibert’s excellent blog A Penned Point caught my eye as an amalgamation of these subjects.
This person wrote, and I hope he doesn’t mind my quoting him:
American anesthesiologists should focus much more on becoming true …
Read more…
It’s time for anesthesiologists to be real doctors
All patients should be treated with professionalism and respect. We all want our patients leaving our care happy, healthy and satisfied, if at all possible. However, sometimes patients don’t leave an emergency department very happy or satisfied. Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the …
Read more…
The focus on patient satisfaction is enough to make you sick
I think we are overly limited by our descriptive terms. We throw around concepts like hospice and palliative care, but in reality the medicine I practice is much more a hybrid. Many of my patients are elderly, demented, and plagued by metastatic disease. Often when one of them becomes ill, it is unclear if they are merely treading water, or about to drown. The problem with our modern definitions is that they leave little …
Read more…
Introducing the palliative care ICU
Things are going well with the practice, but I am being wrung a bit dry. That’s the reason for my dip in writing. I am putting a lot of energy and emotion into the practice, and I don’t have a whole lot left at the end of the day. I have always been one to write out of passion and convictions — I write because I believe what I am …
Read more…
Embrace failure to succeed
Recently, an ancient sculptural masterpiece has been on temporary display in the Metropolitan Museum of Art’s Greek and Roman halls. On loan from Rome’s Museo Nazionale Romano, “Boxer at Rest” depicts a battered pugilist immediately after a fight. His face bears evidence of broken nasal bones, swelling and hematoma under his right eye, and multiple lacerations and abrasions to his nose, cheeks, and forehead. One secret …
Read more…
Boxer at Rest: A physician’s interpretation
I was saddened earlier this week to read, first on Facebook as posted by his son Daniel, that Michael Palmer had passed away after suffering a heart attack and then a stroke, while going through customs in New York on the way back from a trip to Africa. Many of you know Dr. Palmer as the bestselling author who wrote medical mystery thrillers like “The Sisterhood” in …
Read more…
Michael Palmer: A doctor first, in the truest sense of the word
Ever since the days of William Osler, annual physical examinations with one’s doctor have been an accepted and expected part of health care. But recently the practice has come under some criticism. Given the dearth of studies showing that physicals lower the risk of death and hospitalization, some experts and organizations state that the annual physical should be abandoned.
I appreciate the effort here to question tradition and to consider if …
Read more…
Why the annual physical still has value
Last month, a superb study by the Michigan Bariatric Surgery Collaborative showed that the more skilled surgeons were, the better were their outcomes.
Surgeons submitted a video of their choice depicting their performance of a laparoscopic gastric bypass. Since it was self-selected, it was presumably their best work. At least 10 of their peers, blinded as to the name of the surgeon, rated skills on the video which had been edited …
Read more…
Video review of surgeons: Can the logistical issues be overcome?
At the International Conference on Communication in Healthcare, which I just returned from, there was a discussion continuously coursing beneath the surface and bubbling up every once in a while. If we, acolytes of shared decision making, whether patients or providers, want to encourage decision making that has the person involved at the center, recognizing their preferences and values, does the kind of decision in question have anything to do …
Read more…
Are all decisions sensitive to preferences?
To what end?
Those three words have become something of a mantra, a mission, a philosophy of care.
- To what end do I prescribe a medication?
- To what end do I make a diagnosis?
- To what end do I order tests?
- To what end am I documenting?
- To what end is there a patient record?
- To what end do I send a person to a specialist?
- To what end do patients need to come to see me in …
Read more…
3 words that define a philosophy of care
Here’s a familiar story in America’s hospitals. An “old fashioned” surgeon decides that the protocols and procedures put in place by the medical executive committee or other governing body don’t apply to him. “I’ve done it this way for 30 years, and it works fine. I’m the busiest surgeon here, and no one is going to tell me how to do my job.”
People in the risk management field will advise …
Read more…
Use awareness intervention to improve physician behavior
